Browsing by Author "Fortuin, Jill"

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    A South African Epidemiological Study of Fatal Drownings: 2016–2021
    (2022-11-16) Fortuin, Jill; Karangwa, Innocent; Mahlalela, Nongcebo; Robertson, Cleeve
    Drowning is a serious public health concern. Low-and-middle-income countries are the most affected by drowning, as they carry 90% of the global drowning burden. The purpose of this retrospective epidemiological study is to provide an overview of fatal drownings in South Africa between 2016 and 2021. The data used for the study were obtained from the South African Police Service. Descriptive statistics were used to summarize the data. Statistical analyses included a t-test and chi-square test. The results indicate that the average number of fatal drownings per annum is 1477 in South Africa, with an average drowning rate of 2.54 per 100,000 population for the period 2016 to 2021. The KwaZulu-Natal province had the highest incidence of drowning. The 0–4-year-age group has the highest prevalence of drowning among all the age categories. More males drowned in South Africa compared to females.
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    Designing the concept for a mobile health solution to educate female scholars residing in a low-to-middle income socio economic setting in Cape Town about HPV and its vaccine
    (2022) Oliver, Kedebone; Fortuin, Jill; Douglas, Tania
    Introduction Cervical cancer is the second most common cancer in South African women and fourth most common in women worldwide. Human papillomavirus (HPV) infection is the causative agent of 90% of cervical cancers. It can be prevented, especially in younger, non-sexually active individuals through a 2- or 3-dose vaccination. The vaccines are given free of charge to female grade 4 learners (9-15 year-olds) in South African public schools since 2014. The vaccination programme was promoted through educational pamphlets, posters, publications on the government websites, social media, and broadcasts on national radio and television prior to the start of the campaign. However, the available vaccines do not protect against all types of HPVs, and thus consistent education would be useful to advise young girls about safe lifestyle choices. Young people use mobile devices extensively, and therefore these devices may be an effective way to reach them directly, and to engage with them consistently. The project aimed to design the concept for a mobile health (mHealth) solution to aid in educating young female scholars residing in a low-to- middle-income setting in Cape Town about HPV and its vaccine. Methodology A user-centred approach known as the Information systems research (ISR) design framework was used to design the concept for a mHealth solution. It involved three main steps that were applied in a cyclic manner: namely the cycles of relevance, design and rigour. The relevance cycle involved assessment of the needs and knowledge of the target population (grade 4-7 female scholars of the Ikamva Labantwana Bethu tutoring programme in Crossroads) through a quantitative survey with 43 participants, which was followed by two focus group discussion with 8 participants each. The focus group discussion formed part of the design cycle, where a mock mHealth tool (based on the survey results) was presented to the groups to engage them about their attitudes, preferences, and perceptions towards the proposed solution. The rigour cycle involved combining the survey and focus group discussion data with knowledge from literature, for the conceptual design of the mHealth tool. Results A total of 43 learners completed the survey, and all participants indicated that they were vaccinated for HPV at school; however, none of them were able to answer the HPV knowledge questions. There was a high level of access to mobile technologies, as all the participants reported that they had access to cell phones and laptops (own or borrowed). The learners showed a strong preference for learning about sexual health and HPV from schoolteachers and tutors, with 25 out the 41 participants selecting this option, and 52% preferring an interactive learning style. During the focus group discussions, emphasis was placed on the mHealth application having entertainment features, while still being informative. Conclusions There was sufficient access to mobile technologies and WIFI access, which made an mHealth solution feasible. The fact that the participants had all been vaccinated, but they still didn't know what HPV was, showed that an mHealth tool could be useful. The learners prefer to learn interactively, and from their teachers and tutors, which is an element that can be introduced to the mHealth platform through a chatting function and educational video.
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    Developing a mHealth-based portable ultrasound platform for breast cancer screening
    (2021) Musasizi, Racheal; Fortuin, Jill; Douglas, Tania
    Background Breast cancer is amongst the 10 most common cancers globally. The disease burden is increasing rapidly in Sub-Saharan African countries, where women living in rural and or remote areas are particularly prone to be diagnosed with late-stage breast cancer. This is due to the limited availability of advanced screening and diagnostic options. Ultrasound is a feasible screening tool for breast cancer, due to its portability, affordability and accuracy. The integration of mHealth with portable ultrasound enables the provision of screening services in rural and remote areas, through electronic consultation by a non-specialist with a specialist for interpretation and reporting of the ultrasound results. This project developed an application for a mHealth-based portable ultrasound platform that could be used by a non-specialist to provide breast cancer screening services with remote specialist support. Methods A systematic review of the literature was conducted for the period of 2004 to 2019 to gather evidence on the use of mHealth-based portable ultrasound platforms for improved access to ultrasound services like breast cancer screening. The evidence from the literature was used to design and develop a prototype of an application for a mHealth-based portable ultrasound platform suitable for breast cancer screening. The prototype application was integrated with a mobile-based portable ultrasound from Philips Lumify. Images generated by scanning a phantom breast using the portable ultrasound were uploaded onto the application and downloaded from the application to demonstrate the concept. Results The systematic review showed only two clinical conditions (obstetrics and cardiovascular disease) which used a mHealth-based portable ultrasound platform. The outcomes from the studies showed improved access to the respective ultrasound services in terms of patient management, early detection, improved quality of care and increased patient attendance, which resulted in access to other services. The integration of the prototype application with a mobile-based portable ultrasound resulted into a mHealthbased portable ultrasound platform prototype intended for breast cancer screening. The ability to upload images onto the platform and download images from the platform satisfied the design requirements for the platform. Conclusion A mHealth-based portable ultrasound prototype was developed, which has potential for improving access to breast cancer screening services. Further research including testing of the application with health professionals and patients is recommended to strengthen the feasibility of the concept.
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    The impact of mHealth interventions on health systems: a systematic review protocol
    (BioMed Central, 2016-11-25) Fortuin, Jill; Salie, Faatiema; Abdullahi, Leila H; Douglas, Tania S
    Background: Mobile health (mHealth) has been described as a health enabling tool that impacts positively on the health system in terms of improved access, quality and cost of health care. The proposed systematic review will examine the impact of mHealth on health systems by assessing access, quality and cost of health care as indicators. Methods: The systematic review will include literature from various sources including published and unpublished/grey literature. The databases to be searched include: PubMed, Cochrane Library, Google Scholar, NHS Health Technology Assessment Database and Web of Science. The reference lists of studies will be screened and conference proceedings searched for additional eligible reports. Literature to be included will have mHealth as the primary intervention. Two authors will independently screen the search output, select studies and extract data; discrepancies will be resolved by consensus and discussion with the assistance of the third author. Discussion: The systematic review will inform policy makers, investors, health professionals, technologists and engineers about the impact of mHealth in strengthening the health system. In particular, it will focus on three metrics to determine whether mHealth strengthens the health system, namely quality of, access to and cost of health care services. Systematic review registration: PROSPERO CRD42015026070.
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    Impact of the Functional Resonance Analysis Method (FRAM) in safety management at healthcare organisations
    (2021) Wessels, Maatje; Fortuin, Jill; Douglas, Tania
    Patient safety events are likely to be one of the ten leading causes of death and disability in the world (World Health Organization, 2020). To manage safety, healthcare organisations have traditionally focused on identifying failures, performing analysis of events, and developing strategies to reduce the failures. Several thought leaders have argued that the traditional method is not adequate to manage safety in a complex environment. Their argument is that safety management should not solely focus on what went wrong, it should also include efforts which enable things to go right more often. If healthcare organisations want to broaden their approach towards managing safety, suitable methods must be investigated. The Functional Resonance Analysis Method (FRAM) was developed by Hollnagel in 2004 and has been applied in high-risk industries such as railway, aviation, maritime and healthcare. FRAM investigates the interaction of the different functions within a complex, underspecified system, and improves the understanding of normal work and its variability (Hollnagel, 2012). This systematic review will assess the application of FRAM in healthcare settings to develop a rich understanding of the application of FRAM in healthcare as a complementary method to safety management. Firstly, understanding how FRAM was implemented within healthcare organisations and secondly understanding how healthcare organisations have perceived the value-add of FRAM in terms of safety management. The results are expected to provide healthcare organisations with guidance on applying the FRAM and demonstrate the value it potentially adds to safety management. In the studies reviewed, FRAM was applied in a wide variety of settings and in different contexts. Thematic value-added aspects were identified and discussed. Shortcomings and prerequisites for the application of FRAM was also highlighted. This dissertation wishes to motivate healthcare organisations to investigate and apply alternative methods such as FRAM to enhance their ability to manage safety in a complex environment.
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    Improving diabetes management of pregnant women in under-served communities of South Africa by using a mobile phone
    (2021) Arbi, Shameela; Fortuin, Jill; Najaar, Baheya
    Background Diabetes has been reported as being the tenth leading cause of death in South Africa, and can affect a person's livelihood, productivity and physical ability. In particular, gestational diabetes mellitus (GDM) affects 7-10% of pregnancies worldwide and greatly increases the risk of developing Type II diabetes after pregnancy, particularly if the patient has a high Body Mass Index. Research suggests that accurate education and proper management regarding diabetes can have a positive impact on the quality of patient life, as well as the country's healthcare system. One such disease management platform exists as mHealth, which is the acronym for mobile health, and is best described to be the use of mobile communication for health services and information. This report intends to Method The information for this report was gathered by means of a combination of Internet research, alreadyexisting knowledge of the subject, textbooks, journal articles, and thoughtful direction from the project supervisor. The research consisted of three studies: a systematic review, prototype design, and a user survey. The systematic review collected and analysed existing literature related to the knowledge and impact of mHealth among pregnant women with or at risk of GDM in underserved communities. The use of mHealth was analysed by focusing on its impact on outcomes related to glycaemic control, pregnancy and delivery, and behaviour and knowledge. This information was then used to develop a suitable mobile health platform targeted at a specific user: a pregnant woman. Design methods were used to identify the most effective solution, and a prototype was built using the online software Proto.io. User feedback on the produced prototype was received through an interview questionnaire, which was hosted by the online survey system SurveyMonkey. Results By paying close attention to parameters limited to under-served communities, the systematic review included four articles relevant to the scope of the research. Through the outcome analysis, the review revealed that two of the more common reasons for the development of GDM is a newly-pregnant woman being unaware of the risk, as well as lack of immediate access to available information on how to self-manage her pregnancy. It was identified that patient follow-up played a major role in helping them maintain weight and glucose goals, which is one of the driving factors behind the design of the intervention. Based on the requirements and specifications of the solution, a mobile application was chosen to be developed, in order to be able to develop a solution with the capability to meet a list of functions and features identified through the collected literature and user-based design. From the 33 respondents to the survey, it was discovered that majority (81.82%) of the respondents expressed competence in the use of mobile technology and had access to the internet and a smartphone. Most respondents (60.61%) specified that they preferred receiving knowledge in a ‘hands-on' capacity. Majority of the findings lined up with the collected literature as it was determined that the respondents believed having access to key medical and health information has a positive effect on the health outcomes of both mother and baby. Conclusions The investigation concluded that providing women with access to information and self-management platforms generally results in an increase in positive health outcomes for both women and their babies, during pregnancy and later in life. From the systematic review results, mobile health has a significant and positive impact on a patient's quality of life, as well as the healthcare industry. The results indicated technology can improve patient knowledge, understanding and management of GDM, though more research and controlled trials are required to support this deduction.
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    Nanomedicine for drug delivery in South Africa: a protocol for systematic review
    (BioMed Central, 2018-10-06) Saidi, Trust; Fortuin, Jill; Douglas, Tania S
    Background: The emergence of nanomedicine in the past decade has changed the landscape of disease diagnosis and treatment. Nanomedicine makes use of nanostructures for applications in different fields of medicine, including drug delivery, biosensors, neuro-electronic interfaces, in vivo imaging, and cell-specific molecular interactions. Despite its relative infancy, nanomedicine has generated a significant body of research as evidenced by peer reviewed literature and several patents. This proposed systematic review will focus specifically on drug delivery systems in which nanoparticles are used to enhance the pharmacological and therapeutic properties of drugs. The strength of nanoparticulate drug delivery systems is their ability to alter the pharmacokinetics and bio-distribution of drugs. Globally, the discourse on nanomedicine is dominated by research being done in the developed countries of Europe and in the United States of America. Less attention has been given to the applications of nanomedicine in developing countries, particularly Africa. There is dearth of information on the applications of nanomedicine in terms of drug delivery with particular reference to which diseases are being targeted generally in Africa. The review will describe the specific diseases that are being targeted and the progress being made in South Africa, with a view to determining whether the applications of nanomedicine are being appropriated to address the context-specific challenges in this country or if they mimic what is being done globally. Methods: Keywords related to nanomedicine and drug delivery will be combined to build a search strategy for each of the following databases: PubMed, Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Cochrane Methodology Register), Google Scholar, NHS Health Technology Assessment Database and Web of Science. We will also check reference lists of included studies for other eligible reports and search unpublished data. To ensure that the search is comprehensive, grey literature will be searched extensively. Literature to be included will have nanomedicine in drug delivery as the primary application and report on the specific diseases that are targeted in South Africa. Two authors will independently screen the search output, select studies and extract data; discrepancies will be resolved by consensus and discussion. When no consensus is reached, the third author will be consulted. Discussion: The systematic review will inform the government, policy-makers, investors, health professionals, scientists, and engineers about the applications of nanomedicine in drug delivery. In particular, it will identify the diseases targeted by the application of nanomedicine for drug delivery and the progress being made in South Africa as the disease burden of this country differs from that of developed countries where nanomedicine has been widely used for drug delivery. Systematic review registration PROSPERO CRD42017057388
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    The Effect and Potential of Digital Health in The Cycle of Care in Tuberculosis Patients from Low and Middle-income Countries
    (2021) le Roux, Jacobus Johannes; Fortuin, Jill
    Background LMICs account for approximately 87% of all new TB cases. Effective TB management is vital if the global end TB goals are to be achieved by 2035. The role of digital health (DH) interventions in achieving these goals are pertinent. TB treatment adherence is considered to be critical not only in successful eradication of the disease, but also in the containment of drug-resistant strains of the disease. This review set out to assess the effect of DH interventions on TB patient treatment adherence in LMICs. Methods A systematic review was conducted by searching various databases (Pubmed, Scopus, EBSCOhost Web of Science) as well as grey literature sources for literature incorporating randomized controlled trials (RCTs), cohort, or cross-sectional studies which assessed DH interventions aimed at improving TB patient treatment adherence within LMICs. Studies were included if they were reported primary outcomes related to patient treatment adherence and were published in English before 30 November 2020. The risk of bias was independently assessed using the Cochrane Risk of Bias Assessment Tool. Results Out of the 1030 articles identified through the databases, 41 articles were full text screened and eleven included in the synthesis of this review. Seven studies utilized text-based reminders, two employed electronic medication monitors, and two employed call reminders, and one involved video observed therapy (VOT). Grouped analysis of all included studies yielded a marginal improvement in positive patient treatment outcomes (RR 1.05, 95% CI 1.02 - 1.09). Conclusion DH interventions show promise in improving patient adherence and positive treatment outcomes. Current available literature remains scarce and of questionable quality. Studies incorporating a patient-centred approach which is executed according to standardized implementation procedures and outcome assessment is required.
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    The impact of mHealth on adolescent global health outcomes: A scoping review of mHealth initiatives
    (2018) Patientia, Ramonde Fiona; Fortuin, Jill; Douglas,Tania
    Negative health behaviour during the period of adolescence contributes to the global burden of mortality, chronic disease, and preventable disability from physical injury. It is therefore essential to encourage positive health behaviour such as on-time vaccination, safer sex practices, and early recognition of infectious conditions and mental illness, before complications arise from unprotected sexual debut or undetected illness. Our project aims to determine the favourable aspects of global mHealth interventions as applied to adolescent health outcomes for knowledge transfer to adolescent infectious disease programmes in low and middle-income countries (LMIC’s). mHealth refers to the integration of mobile or wireless technology for health delivery and promotion and may appeal to adolescents as it allows for interactive, personalized, two-way communication on various digital platforms. However, it remains unclear what specific interventions work best to target vulnerable adolescents in LMIC’s, as most of the evidence for mHealth stems from studies in high-income countries, conducted on groups other than adolescents such as caregivers, health workers and adult patients. This report is a scoping review examining the global evidence of mHealth efficacy for common adolescent conditions, in order to gain insight into the types of interventions that best target adolescents for biological and behavioural health outcomes. These insights will facilitate knowledge transfer for the implementation of adolescent mHealth infectious disease management, and identification of research gaps. We included published and unpublished studies between 31 January 1990 and 30 November 2017, with no language limitation. Primary studies included adolescents (defined as 10-19 years of age) of any gender, location, or ethnicity, with access to a mobile phone or wireless device used for a healthrelated outcome. Studies reported on health outcomes of HIV, TB, vaccine-preventable disease, depression, suicide, road traffic accidents and substances other than tobacco use. Purely qualitative study designs and voice-only calls were excluded. Despite the potential appeal of mHealth among adolescents, there is unclear overall evidence for efficacy in this population. We had hoped that the adolescent period itself would allow generalisability of interventions. However, the variable reporting quality between studies, often without rich contextual descriptions, necessitate caution with interpretation of findings. This incomplete reporting also impacted on knowledge transfer at multiple levels, despite the use of study-specific guidelines. Our recommendations for future researchers would be to undertake adequately-powered studies among clearly defined age groups, and examine biological health outcomes for longer periods of follow-up. We also encourage researchers to use mHealth-specific guidelines such as the CONSORT-EHEALTH and mERA checklists to enable effective knowledge transfer and scaling of interventions.