Browsing by Author "Namane, Mosedi"

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    Open Access
    Assessing the palliative care needs of end stage kidney disease patients in a tertiary hospital in Nigeria
    (2022) Adebayo, Adetayo Jolade; Namane, Mosedi; Samuel Ajayi
    Background: Worldwide, end-stage kidney disease (ESKD) is associated with high morbidity and mortality. Currently, the incidence of ESKD in Nigeria is about 1.6% -12.4% and is higher amongst 25-45 year-olds, implying that ESKD indirectly affects the economic productivity of the nation negatively. ESKD is a condition that may progresses rapidly from a chronic to a terminal phase and is responsible for about 2-3% of all hospital admission worldwide while in Nigeria the proportion of admissions is as high as 10%. This high symptom and disease burden of ESKD warrants implementation of a palliative care program that is able to assess and manage the needs of patients with this condition and to support their families. Methods: A descriptive study was undertaken to assess the palliative care needs of patients. A random sample of 110 ESKD patients attending University College Hospital (UCH) Ibadan were interviewed using published standardized and validated questionnaire over a period of 3-months. The questionnaire was a combination of the Integrated Palliative Outcome Scale-Renal Patient Version (IPOS-R) and Hope Spiritual Assessment Tool (HOPE). The socio-demographic characteristics comprising of gender, age, place of residence and knowledge of palliative care were determined. IPOS-R was used to explore the patients' symptom-burden, psychological and social palliative care needs and quality of life while the HOPE was used to explore patients' spiritual needs. Ethical approval was obtained from the relevant organizations. Data was analyzed using the IBM SPSS version 23.0. Results: More than half of the participants (57%) were female, 92% had co-morbidities, 86% had formal education, 60% were self-employed and their median age was 43.5years. Half (51%) reported experiencing severe symptoms and poor quality of life. More than half (50%) of the patients complained of shortness of breath, pain, general body malaise, sore mouth, restless with more than 80% reporting nausea, poor appetite, difficulty in sleeping and weakness. Fifty-three percent reported experiencing anxiety most of the time and reported that their families and friends were worrying about them. The majority (98%) said their source of hope was God. Most patients (93%) said they were not aware of palliative care medicine. Conclusion: There is a huge need for palliative care for patients with ESKD in Nigeria. This study has developed a framework that can be used by a palliative care team, in collaboration with nephrologists, to provide a person-centered care for these patients and their families.
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    Development, implementation and impact of Phlebotomy training on blood sample rejection and Phlebotomy knowledge of primary health care workers at selected primary health care facilities in Cape Town: a quasi-experimental study design
    (2016) Abbas, Mumtaz; Namane, Mosedi; Mukinda, Fidele Kanyimbu
    Background: There is an increasing amount of blood sample rejection at primary health care facilities (PHCFs) impacting negatively on the staff, facility, patient and laboratory costs. Aim: The primary objective was to determine the rejection rate and reasons for blood sample rejection at four PHCFs pre and post phlebotomy training. The secondary objective was to determine whether phlebotomy training improved knowledge amongst primary health care providers (HCPs) and to develop a tool for blood sample acceptability. Study Setting: Two Community Health Centres (CHCs) and two Community Day Centres (CDCs) in Cape Town. Methods: A quasi-experimental study design. Results: The sample rejection rate was 0.79% (n= 60) at CHC A, 1.13% (n= 45) at CHC B, 1.64% (n= 38) at CDC C and 1.36% (n= 8) at CDC D pre training. The rejection rates remained approximately the same post training (p>0.05). The same phlebotomy questionnaire was administered pre and post training to HCPs. The average score increased from 6 3% (95% CI 6.97 - 17.03) to 96% (95% CI 16.91 - 20.09) at CHC A (p 0.039), 58% (95% CI 9.09 – 14.91) to 93% (95% CI 17.64 – 18.76) at CHC B (p 0.006), 60% (95% CI 8.84 – 13.13) to 97% (95% CI 16.14 – 19.29) at CDC C (p 0.001) and 63% (95% CI 9.81 – 13.33) to 97% (95% CI 18.08 – 19.07) at CDC D (p 0.001). Conclusion: There is no statistically significant improvement in the rejection rate of blood samples (p>0.05) post training despite knowledge improving in all HCPs (p <0.05).
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    Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial
    (2014-01-11) Bobrow, Kirsty; Brennan, Thomas; Springer, David; Levitt, Naomi S; Rayner, Brian; Namane, Mosedi; Yu, Ly-Mee; Tarassenko, Lionel; Farmer, Andrew
    Abstract Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care. Methods/design The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1:1:1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants. Discussion The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting. Trial registration NCT02019823
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    Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
    (2020) Huang, David; Namane, Mosedi; Orrell, Catherine
    Introduction: Tenofovir-Emtricitabine-Efavirenz (TEE) fixed-dose-combination (FDC) has been recommended since 2013 as the first-line antiretroviral therapy (ART) for treating HIV for people living with the virus (PLWH) in South Africa. More evidence has emerged to show long term adverse effects of Efavirenz(EFV). This study assesses the adverse effect profile of TEE by determining the event rate of switching from co-formulation and the reason for such switch. Method: This retrospective cohort study involved the review of the records of HIV infected adults receiving the TEE fixed dose combination ART over a 5-year period. All adult patients 18 years age or above, non-pregnant, previous ART treatment naïve that started TEE during 1 September 2014 and 31 August 2019 were included. Follow-up was censored at first drug change, transfer-out, loss-of-follow-upon deaths. Results: Two-thousand-and-ninety subjects were newly initiated on ART and 1961 met the inclusion criteria. Ninety-four patients (4.8%) had drug-changes prior censor date whereas 1867 remained on TEE. Forty-seven (50%) were single drug changes due to adverse effects and the other 50% were regimen changes as result of virological failure. The median time to change for TDF and EFV were 0,24 and 1,26 person years respectively. The median time to change for virological failure was 1,02 years. Patients with baseline CD4 count less than 200 cells/uL has higher risk of switch event. The proportion of poor outcome (death or loss to follow up) in patients with no drug switches (8,78%) was similar to those of patients with drug changes(8,5%). Conclusion: Tenofovir-Emtricitabine-Efavirenz combination treatment remains an excellent first-line ART option for people living with HIV, with a low rate of substitutions due to toxicity and high virological suppression. With the advent of Tenofovir-Lamivudine-Dolutegravir combination regimen as the preferred first-line, clinicians should remain cognisant of Tenofovir adverse drug effects.
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    Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control
    (BioMed Central, 2018-01-23) Bobrow, Kirsten; Farmer, Andrew; Cishe, Nomazizi; Nwagi, Ntobeko; Namane, Mosedi; Brennan, Thomas P; Springer, David; Tarassenko, Lionel; Levitt, Naomi
    Background: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods: We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results: We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions: Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Trial registration: The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials. gov (NCT02019823; 24/12/2013).
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    Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control
    (2018) Bobrow, Kirsten; Farmer, Andrew; Cishe, Nomazizi; Nwagi, Ntobeko; Namane, Mosedi; Brennan, Thomas P; Springer, David; Tarassenko, Lionel; Levitt, Naomi
    Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description.