Browsing by Department "Adolescent Health Research Institute"

Now showing 1 - 16 of 16
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    A histopathological and genomics study of the mutated human FAM111B gene related POIKTMP disease
    (2023) Tambwe, Nadine; Arowolo, Afolake
    Fibrosis is a pathological feature of many chronic inflammatory diseases, eventually leading to organ failure and death. POIKTMP is a rare, multi-organ fibrosing disease which is associated with mutations of the human FAM111B gene. FAM111B gene codes for a protein whose function is not well characterized. Therefore, elucidating the mechanism of FAM111B or its mutations in POIKTMP is beneficial to understanding the complexities surrounding this multisystemic fibrosing disease. The study sought to understand the pathogenesis of fibrosis, its role in POIKTMP and its causative gene mutation: FAM111B Y621D. First, Sanger sequencing was used to confirm the presence of the FAM111B Y621D mutation using DNA isolated and amplified from post-mortem FFPE tissues of a POIKTMP patient first described with the disease in South African Following that, qRT-PCR was employed to assess gene expression changes between the patient and the familial control. The RT2 Profiler Human fibrosis PCR Array was then used to associate POIKTMP and 84 known fibrotic markers to propose a possible fibrotic pathway associated with POIKTMP disease using mRNA from the lung and skin POIKTMP patient tissues. Gene-set enrichment analysis (GSEA) using Enrichr, a computational GSEA tool, was used to predict enrichment analysis between the identified upregulated fibrosis markers and the FAM111B gene. Finally, Immunohistochemistry was used to identify cellular and sub-cellular protein distribution of FAM111B and other fibroproliferative markers of interest to annotate pathological changes. The results from this study validated the FAM111B Y621D mutation in the affected tissues. Next, FAM111B mRNA was shown to be downregulated in the lungs and skeletal muscle tissues of the POIKTMP patient. The human fibrosis PCR array experiments identified eight upregulated fibrotic markers: MMP3, MMP13, PDGFA, ITGB-1, THBS-2, COL3A1, TGFβ3, and CCN2 in the patient lungs and skin tissues, which were validated by qRT-PCR. Furthermore, these genes with FAM111B form a gene-list that was used in interrogating various gene-set libraries in the gene-set enrichment analysis. FAM111B was enriched in some gene-set libraries within the Diseases/Drugs and Cell type categories. The GSEA terms enriched within these libraries are the pathways associated with SARS-COVID-19 perturbations and cell/tissue types related to the small intestine, breast, oesophagus, thyroid, smooth muscle and stromal cells of some of these organs. Lastly, immunohistochemistry results corroborated this study's mRNA expression analysis by showing that FAM111B was more highly expressed in the skin than in the lung patient. TGF-β1 and Ki-67 markers were assessed from protein expression, which resulted in higher expression in the POIKTMP patient skin tissue than in the lungs. Altogether, our data suggest that FAM111B and mutations in this gene play a pivotal role in POIKTMP and other fibrosing organ diseases, representing a potential disease biomarker and possible therapeutic target in POIKTMP and other fibrotic disorders.
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    A study of the Haematological findings, Serum Proteins and Liver function tests in the Natal African in Health and in Amoebiasis
    (1958) Powell, S J
    A notable feature of this century has been the introduction of medical science to large, undeveloped areas throughout the world. Backward, mainly tropical, regions have become fertile fields for study, particularly of nutritional and parasitic disorders, and the application of the modern biochemical methods have show that many inhabitants of these countries lack certain of the biochemical "normal" values seen in Europeans. One of the most striking differences is that of the serum proteins. Although by no means confined to this continent, these differences are commonly found in Africans.
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    A study of the nature and origin of the minialbumins to be found in cadmium-poisoned animals
    (1967) Sutherland, Elizabeth Mary; Kench, J E
    Cadmium, one of the trace metals, has, in the last two to three decades, become increasingly important in both industrial and biological fields. The recognition of cadmium as a serious health hazard has led to a closer examination of its properties and biochemical effects. Cadmium, an element of ata:nic number 48, atomic weight 112.41 and valency 2, is a soft 'White lustrous metal belonging to the second sub-group of the Periodic Table. It has a boiling point of 768°c, melting point of 321°0, is remarkably volatile for a heavy metal, and exists naturaly as a mixture of eight isotopes, constituting 2 x 10-5% of the earth's crust. Extraction of cadmium is by distillation from zinc ores. The electron configuration of cadmium is 4d105s2, and it forms simple bipositive cations only. There are no ligand field stabilization effects in cadmium ions, and the stereochemistry is, therefore, determined solely by size and electrostatic and covalent bonding forces.s Cadmium chloride shows octahedral co-ordination.
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    An exploration of disclosure and non-disclosure patterns in HIV-infected children in Cape Town, South Africa
    (2018) Shea, Robert F; Muloiwa, Rudzani
    A cross-sectional, descriptive study combining with open-ended (qualitative) interview questions with quantitative component was conducted to explore disclosure experiences of mothers and caregivers of HIV-infected children. The study was conducted with 102 parents and caregivers at a tertiary hospital in Cape Town delivering care to 303 HIV-infected paediatric patients. The study sample included 102 participants, ranging in age from 16 years to 71 years. The sample included 73 mothers (72%), six fathers (6%), 11 foster-mothers (11%), and 12 caregivers or grandmothers (12%). The median age of participants’ children was 4 (IQR 2-8) years and ranged from five months to 16 years. Only 48 (47%) were old enough for disclosure to be possible. Disclosure or disclosure delay was associated with several factors, including the child’s age or ability to understand, anxiety and guilt about being blamed for infecting the child, fear of exposing the child to stigma, discrimination and social exclusion related to the child disclosing to others, and the hope that the child would be adherent if they understood their illness and the way in which the medication could improve their health outcomes. Only 16 (33%) of 48 participants actually disclosed the child’s HIV status. The results indicate that HIV-disclosure remains a challenging, emotionally-charged experience for mothers and caregivers. The findings of this research, and similar studies, point to the value of integrating disclosure support and planning into routine care for children and adolescents, as well as their parents and caregivers.
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    Aspects of laryngotracheobronchitis in African children
    (1972) Wesley, Anne Gardiner
    "Laryngotracheobronchitis" is a relatively recent term for infective upper airway disease (Baum, 1924). Prior to this "croup" was used by both public and profession to describe a train of laryngeal symptoms which sometimes were due to infection. The word derives from the Anglosaxon "kropan" (Neffson and Wishik, 1934a) or "hreopan" (MacKenzie, 1880) and although used earlier by Blair (MacKenzie, 1880; Eisner, 1959), was popularised in 1765 by the Scottish physician Home (Cormack, 18750). Both used the term in descriptions of what was probably diphtheria.
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    Cancer free survival in mutation positive HNPCC individuals with colorectal adenomatous polyps identified on surveillance colonoscopy
    (2013) Swart, Oostewalt; Goldberg, Paul
    The prevalence of colorectal cancer (CRC) places it in the top five cancers worldwide and is the second most common cause of cancer related death. Developed populations have a 5-6% lifetime risk of CRC(l). The South African Cancer Registry (last updated 2004) shows a 1/98 and 1/150 life time risk for developing CRC in males and females respectively (2).
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    Chloroform anaesthesia
    (1961) Whitaker, Anthony Michael
    As far back as 1796 a group of Dutch chemists produced a dense oily liquid. This was probably ethylene dichloride (CH2C1)2 and it was known as Dutch liquid or chloric ether, remaining for many years a chemical curiosity. Professor Benjamin Silliman, in his Yale College Elements of Chemistry, dated February, 1831, gave a description of the physical properties of chloric ether, and ended the paragraph by stating: Its medical powers have not been ascertained but from its constitution and properties, it is highly probable that it would be active diffusive stimulant (83a).
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    Client knowledge, attitudes and practices to cervical screening in Mitchell's Plain, Cape Town, South Africa
    (2007) Daries, Vanessa Cheryl; Moodley, Jennifer
    Background: Cervical cancer is a common cause of death among women in developing countries, including South Africa. In 2000, the South African National Department of Health introduced the national cervical cancer screening policy, which states that every woman is entitled to three free Papanicolaou (Pap) smears in her lifetime, at 1 0-year intervals starting at the age of 30 years. A number of studies have indicated that the uptake of cervical cancer screening is dependent on the targeted population's knowledge, attitudes and practices (KAP) related to health-seeking behaviours. The aim of the study is to determine the baseline KAP to Pap smears and cervical cancer of women aged 25 years and older in Mitchell's Plain, Western Cape Province. Methods: A cross-sectional survey was undertaken among clients attending primary health care facilities in the Mitchell's Plain district, Cape Town, Western Cape Province. The study population consisted of women aged 25 years and older who presented at the public health care facilities in Mitchell's Plain between 1 April and 31 July 2002 and who consented to participate in the study. The data were analysed using the STAT A version 8 statistical package. Results: A total of 445 women were interviewed, most of whom were above the age of 30 years (72%), married (68%) and unemployed (68%). Ninety-five per cent said they had heard of a Pap smear; however, when asked what part of the body was examined during a Pap smear, only 4% correctly answered. Only 13% of the women knew that a Pap smear was a test for cancer of the cervix, although 52% recognised it as a test for cancer. Of the women interviewed, 73% had heard of cancer of the cervix. A total of 78% of women had had a Pap smear. The results indicated no significant association between ever hearing of a pap smear and the following predictors: age, educational level, marital status, pregnancy and the use of contraception. Women who were significantly more likely to have had a Pap smear included: older women, those who were in a relationship, owned a radio, were employed, had ever been pregnant or had heard of a Pap smear before. Main sources of information regarding Pap smears were reported to be posters (17%) and the radio (16%). Conclusions: The data suggest that although a very high proportion of the women (95%) had heard of Pap smears, a smaller proportion (78%) had actually had a Pap smear. This study showed that there were missed opportunities that the health workers could possibly have utilised to encourage women in the targeted age group to have a Pap smear while at the health facilities for reasons other than reproductive health. Women who had not been afforded the opportunity to have a Pap smear by the health provider reported a great interest in having a Pap smear, showing willingness to improve their health if afforded the opportunity. In order to reduce the high morbidity and mortality from cervical cancer in South Africa, very large numbers of women in the target age group need to be recruited to the screening programme. To be able to achieve an increase in the cervical cancer screening uptake, huge efforts have to be made to actively recruit women who are within reach of the health services, particularly any women who present at the health facilities.
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    Generation of Glioblastoma specific SNAP based antibody fusion proteins for future radiolabelling application
    (2023) Mayuni, Grace; Barth, Stefan
    Each year, Central Nervous System (CNS) cancers affect about 300,000 individuals globally, accounting for 1-2% of all adult cancer cases. Despite being rare, CNS cancers reportedly have disproportionately high morbidity and mortality rates compared to their incidence. Globally, Glioblastoma Multiforme (GBM) is the most aggressive CNS malignancy, accounting for 45% of brain tumours, with less than 5% of patients surviving for more than 5 years. To date, complete surgical resection followed by adjuvant chemotherapy and/or radiotherapy has been the standard of care treatment. This has been shown to not be curative, as it can only slightly improve prognosis and increase patient survival from 3–4 months to 14–16 months after diagnosis. However, it has been noted that early diagnosis increases the chance of patients going into complete remission following early treatment. Unfortunately, current methods of diagnosing GBM are very invasive and imprecise, necessitating more targeted, and more reliable diagnostic techniques. The use of antibody-based targeted agents in GBM treatment is being advanced due to their ability to specifically differentiate tumour masses from healthy tissue. The success of antibody-based targeted approaches lies in the selection of biomarkers that are selectively found in tumour cell populations. One type of biomarker is known as tumour-associated antigens (TAAs), which are antigenic substances present at a much relatively lower incidence on normal cells but highly correlated with certain tumour cells. The focus of this study was on two TAAs that have been established as being overexpressed in GBM: (i) the transmembrane protein epidermal growth factor receptor (EGFR), which is associated with tumour cell proliferation, and (ii) Fibroblast Activation Protein alpha (FAPα), an active protease in the stromal tissue of the GBM tumour microenvironment. SNAP-tag® fusion antibodies against the abovementioned TAAs were employed in this study. The fusion antibody is a recombinant antibody-based fusion protein created by fusing the SNAPtag®, a modified version of the DNA repair enzyme O6 -alkylguanine DNA alkyltransferase (hAGT), to a single chain variable fragment (scFv) region of an antibody, thereby providing a tool that can detect and label TAAs. The SNAP-tag® element is engineered to irreversibly react with any benzylguanine (BG) substrates, including labelling dyes or toxins, with a controlled 1:1 Masters Thesis 14 Grace Mayuni stoichiometry. According to previous studies, SNAP-tag fusion proteins have exhibited strong cytotoxic profiles as an immunotherapeutic tool as well as good imaging profiles as an immunodiagnostic tool. In this study, the recombinant SNAP fusion proteins, anti-FAPα (scFv)-SNAP and anti-EGFR (scFv)-SNAP were transiently expressed in mammalian cell culture. The recombinant protein was purified from harvested cell culture supernatant using immobilized metal ion affinity chromatography (IMAC). The enzymatic activity of the SNAP-tag element was tested using BGmodified fluorophores. To characterize highly specific in vitro labelling, the SNAP-tag-based fusion proteins were conjugated to BG-Alexa Fluor 647 to generate an immunofluorescent protein that can label TAAs in live tumour cells. To characterize the immunotherapeutic activity, the SNAP-tag fusion proteins were conjugated to the small molecule toxin, BG-Auristatin F, to generate an ADC that can kill TAA-expressing cells in vitro. Anti-FAPα (scFv)-SNAP and anti-EGFR (scFv)-SNAP fusion proteins were successfully expressed in this study with sufficient yields for small-scale purification. Through a series of selflabelling experiments with the BG-modified fluorophores, BG-Alexa Fluor 488 and BG-Alexa Fluor 647, the enzymatic activity of the SNAP-tag element of each construct was confirmed. The optimal binding ratio of fusion protein: BG-substrate conjugate for downstream experiments was determined to be 1:1. Using live cell imaging, the biological functionality of the fusion protein construct through site-specific labelling on antigen-expressing cell lines was demonstrated. Finally, this study investigated the cytotoxicity of SNAP-fusion proteins conjugated to toxic payloads. Using a cell proliferation assay, the next-generation ADC, anti-EGFR (scFv) SNAPAURIF, was tested and validated for its cell-killing activity. This ADC was able to elicit high rates of killing, exhibiting IC50 values in nanomolar ranges in three different antigen-positive tumour cell lines, with no cytotoxicity observed in the antigen-negative tumour cell lines. The targeted activity of this recombinant SNAP fusion protein format validates its biological function, making it suitable for further preclinical investigation. This study aimed to characterize SNAP fusion proteins that can target GBM-specific TAAs. It successfully demonstrated the optimal conjugation efficiencies and validated the site-specific targeted activity of the scFv SNAP fusion antibody format. This work serves as a proof-of-concept Masters Thesis 15 Grace Mayuni towards investigating the use of radio-labelled SNAP-tag-based antibody fusion proteins in GBM tumour detection and patient stratification to offer personalized therapeutics.
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    Investigations of the Genetic aspects of the mixed Lymphocyte culture reaction in Southern Africa
    (1978) du Toit, Ernette D
    The genetic relationship between the serologically detectable antigens of the HLA-A and B loci and the mixed lymphocyte culture (MLC) reaction is of utmost importance in the understanding of histocompatibility. From the literature it appeared that neither the HLA-A, B genotype nor the MLC reaction is the complete answer to donorrecipient selection in organ transplantation. This study was therefore initiated in June 1971 in an attempt to clarify the problem. It is inherent in a project of this nature that much time is spent in collecting samples from donors in diverse areas. Most experiments had to be repeated two or three times, therefore some of the problems we set out to resolve were clarified by other workers before we were able to complete our investigations.
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    Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals
    (2017) Erasmus, Ermin; Gilson, Lucy; Govender, Veloshnee; Nkosi, Moremi
    BACKGROUND: This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. RESULTS: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. CONCLUSIONS: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected.
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    Perspectives on etonogestrel implant use in HIV-infected women in Cape Town, South Africa: a qualitative study among providers and stakeholders
    (2018) Brown, Anna; Morroni, Chelsea; Harries, Jane
    Access to a range of safe and effective modern contraceptive methods enables women to make free and informed choices about their reproductive lives and broadly improves maternal and child health outcomes. Successful avoidance of unintended pregnancy and the corresponding ability to plan for pregnancy are especially valuable in the context of Human Immunodeficiency Virus (HIV) infection. Revised South African national guidelines seeking to expand overall contraceptive access were released in 2012 and, in response to the severity of the domestic HIV epidemic, specifically detailed the sexual and reproductive health rights and needs of HIV-positive women. Six years later, evaluation of the implementation and impact of these guidelines, as well as of more recent policy responses in this area, is necessary. This need for evaluation is outlined in Part A of this mini-dissertation in the form of a research proposal. A literature review (Part B) assesses what is currently known about considerations surrounding contraceptive decision-making in the context of HIV and antiretroviral therapy (ART). The use of the subdermal Long Acting Reversible Contraceptive (LARC) implant in HIV-positive women is explored in depth, given that the 2012 guidelines introduced the method as an entirely new option for South African women, as well as in light of recent controversy surrounding the implant’s provision to women taking the first-line ART drug, efavirenz (EFV). A journal-style article structured for submission to BMC Public Health (Part C) then uses thematic qualitative methodology to explore primary family planning provider and other relevant stakeholder perspectives on the provision of implants to HIV-positive women clients attending Cape Town primary care facilities. The study adds to existing literature regarding implant provision in the context of HIV and ART, and offers new insight into the impact of a 2014 South African Department of Health decision to recommend against the then-newly introduced implant as an option for women taking EFV-based ART. This research finds that several converging factors may have lead primary providers to view the implant as broadly contraindicated in all HIV-positive clients regardless of their iii exposure to EFV, namely: insufficient provider training; provider and community unfamiliarity with and scepticism about the new method; structural pressures on providers to keep up to date with and provide wide-ranging integrated services in busy clinical environments; and inadequate stakeholder consultation surrounding the wording and overall appropriateness of the implant/EFV guidance itself. Recommendations are provided in the article, including the need for: the retraining of primary healthcare providers in rights and choice-based family planning (particularly in implant provision and counselling); simplified counselling messages and user-friendly decision-making tools to help providers facilitate informed contraceptive choice for HIV-positive women; generalized beneficiary and community sensitization/education about implants including in the context of HIV and ART; and more comprehensive stakeholder/beneficiary consultation in future contraceptive policy-related endeavors.
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    The effectiveness of graded motor imagery for reducing phantom limb pain and disability in amputees
    (2018) Limakatso, Katleho Maxwell; Parker, Romy; Manie, Shamila; Madden, Tory
    Introduction Phantom limb pain (PLP) is described as painful sensations felt in the missing portion of an amputated limb. PLP occurs in up to 85% of amputees, making it the most common painful condition secondary to amputation. PLP interferes with sleep, mobility, and work, general activities of daily living and enjoyment of life. Current pharmacological and non-pharmacological interventions have shown limited efficacy for reducing PLP, perhaps because they do not effectively target the mechanisms that have been proposed to underlie PLP in people who have undergone amputations. Graded motor imagery (GMI) is a cortical mechanisms-based intervention which aims to reduce PLP using a graded sequence of strategies including left/right judgements, imagined movements and mirror therapy. The aim of this thesis was to investigate whether the GMI programme is effective for reducing PLP and disability in people who have undergone amputations. Methods A single blinded randomised controlled trial was conducted at Somerset, Khayelitsha and Victoria hospitals in Cape Town, South Africa. The experimental group underwent a 6-week GMI programme where each phase was carried out for two weeks, during which the patient received treatment for 30 minutes on two separate days of the first week (at least one day apart) and continued with a structured home-exercise programme during the first week until the end of the second week. The control group continued with routine care. Data on the outcomes- PLP severity, pain interference with function and health-related quality of life were collected at baseline, 6 weeks and 3 months by a blinded outcome assessor. Results The study recruited 21 participants from which 11 and 10 were randomly allocated to the experimental and control groups respectively. Within group analysis showed that participants in both the experimental and control groups had improved pain severity scores immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain immediately after treatment (p=0.02). However, there was no difference between groups at 3-months follow-up (p=0.14). To explore clinically meaningful improvements in pain, the Number Needed to Treat (NNT) were calculated using a cut-off of 3 points on a 0-10 scale. The NNT were 2 [95% CI: 1.1 – 6.5] and 3 [95% CI: 1.9 – 7.1] immediately after treatment and at 3-months follow-up respectively. For pain interference with function, within group analysis showed that participants in the experimental group had significant improvements immediately after treatment and at 3-month follow-up. The between-group analysis showed that the experimental group had significantly greater improvements in pain interference with function immediately after treatment (p=0.007) and at 3- month follow-up (p=0.02). The NNT were 1.4 [95% CI: 1 – 1.8] and 1.9 [95% CI: 1.1 – 6.5] immediately after treatment and at 3-months follow-up respectively. For disability, the experimental group had significantly fewer problems with mobility than the control group at 3 months (χ2 = 9.8; p= 0.04). Conclusion The results of the current study provide support for the use of GMI to treat PLP based on the proposition that PLP is driven by cortical mechanisms and that GMI effectively targets these mechanisms. On the basis of the significant pain reduction within the GMI group, the lack of serious adverse effects, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone amputations. While more studies using rigorous methodology, including sham treatment, larger sample sizes and a more generalisable sample, are required, the efficacy of GMI coupled with its affordability and low risk, suggest that it is applicable in a resource-constrained primary health setting in South Africa.
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    The Impact of covid-19 on occupational therapy students in mental health practice learning placements
    (2023) Cassim, Feroza; Abbas, Iesrafeel; Sonday Amshuda
    Introduction: Practice learning (PL) is a core feature of occupational therapy (OT) students' curriculum and professional development during their undergraduate training. It promotes students' clinical reasoning abilities and enhances their reflective skills as emerging clinicians, enabling them to graduate as competent healthcare practitioners. However, the covid-19 pandemic interrupted curriculum delivery and forced blended teaching and learning methods. Globally this was recognized to have a significant impact on the training of undergraduate health science students who relied on face-to-face teaching and learning methods. This study aimed to explore the opportunities and barriers that influenced undergraduate OT students' learning experiences within mental health (MH) PL placements during the covid-19 pandemic. Methods: A qualitative descriptive research design was utilized to explore the barriers and opportunities occupational therapy students faced during the covid-19 pandemic in MH PL. Eight undergraduate students were purposively sampled, each participating in a 60-minute individual face-to-face interview which was transcribed verbatim and analyzed inductively using thematic analysis. Findings: Three key themes emerged from the study: 1) Acknowledging ME in the pandemic, describing the need for acknowledgement of what the participants were experiencing during the pandemic, 2) Setup for failure, describing the elements that participants identified as barriers to their ability to thrive in PL and 3) Stuck between a rock and a hard pandemic, demonstrating the opportunities and the barriers for learning which were present in PL placements, and which became more distinct because of the pandemic. Discussion: Complexities of PL in MH PL placements within higher education highlighted the opportunities and barriers which were present in participants' learning experiences, shaping their development as emerging healthcare practitioners. The complexities highlighted the need for additional emotional support structures in the PL learning experience. Social identity constructs, such as language, gender, and culture emerged as critical elements in the consideration of curriculum transformation work impacting PL in South Africa (SA). The context of the pandemic created space for considering how professional identity development is formed and impacted in undergraduate OT students who emerged from the pandemic. Barriers which were present because of the pandemic included feeling underprepared by the pandemic curriculum for PL. Whilst opportunities for learning were positively influenced by peer learning from fellow students. Recommendations included further development of the practice education curriculum in the current PL placements drawing on lessons learnt from the pandemic. Suggested future research is recommended to deepen the understanding on the long-lasting effects of the pandemic on emerging health professionals in a longitudinal study.
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    The Prevalence Of Mental Disorders And Associated Out-Ofpocket Expenditure Among Insured Patients In South Africa
    (2023) Mnangagwa, Mazvita; Sinanovic, Edina; Docrat Sumaiyah
    Mental disorders are a huge global burden, with approximately a quarter of the population developing a mental illness at some point. Despite significant advances in treatment for these disorders, massive treatment gaps still exist. In South Africa, approximately 20% of adults are believed to be struggling with poor mental health, with less than a quarter of this population ever receiving mental health care. A potential strategy for reducing such treatment gaps is private health insurance (PHI). Around 18% of the total South African population is medically insured. PHI, however, only covers a restricted set of expenses. The aim of this study is to examine the prevalence of mental disorders and the out-of-pocket costs among South African insured individuals. Discovery Health Medical Scheme (DHMS) population was used as a proxy for the private health insurance market in South Africa. DHMS is South Africa's largest medical scheme with a 56.7% market share as of 2019. STATA version 17 and Excel were used to analyse the data on five common mental disorders (depression, anxiety disorders, bipolar, development and learning disorder, and attention deficit and hyperactivity disorder) over a 36-month period. Children and adults with or without comorbidities and with no gender restrictions were included.
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    The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation
    (2018) Davids, Eugene Lee; de Vries, Petrus J; Shung-King, Maylene
    Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa.