OpenUCT :: Browsing by Faculty "Faculty of Health Sciences"

Browsing by Faculty "Faculty of Health Sciences"

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Open Access
A 12 week pre-season fitnes training programme for senior male high school rugby players : the effect of supervision on anthropometric, physiological and physical performance variables
(1998) Clark, David Rodney; Lambert, Michael I
The study comprises of two sections; i) a survey to determine the attitude towards fitness training for rugby and the current fitness training habits of elite high school rugby players in their penultimate year at school, ii) a training study on a sample of the same population group, to measure the effect of a 12 week fitness training programme, based on scientific principles, on anthropometric, physiological and performance variables. The training study also measured the efficacy of training supervision compared no supervision on these variables.
Open Access
The 341C/T polymorphism in the GSTP1 gene is associated with increased risk of oesophageal cancer
(BioMed Central Ltd, 2010) Li, Dongping; Dandara, Collet; Parker, M Iqbal
BACKGROUND: The Glutathione S-transferases (GSTs) comprise a group of enzymes that are critical in the detoxification of carcinogens. In this study the effects of polymorphisms in these genes on the risk of developing oesophageal squamous cell carcinoma (OSCC) were evaluated in a hospital-based case-control study in two South African population groups. Genetic polymorphisms in GSTs were investigated in 245 patients and 288 controls samples by PCR-RFLP analysis. RESULTS: The GSTP1 341T variant was associated with significantly increased risk of developing OSCC as observed from the odds ratios for the GSTP1 341C/T and GSTP1 341T/T genotypes (OR = 4.98; 95%CI 3.05-8.11 and OR = 10.9; 95%CI 2.43-49.1, respectively) when compared to the homozygous GSTP1 341C/C genotype. The risk for OSCC in the combined GSTP1 341C/T and T/T genotypes was higher in tobacco smokers (OR = 7.51, 95% CI 3.82-14.7), alcohol consumers (OR = 15.3, 95% CI 1.81-12.9) and those using wood or charcoal for cooking and heating (OR = 12.1, 95% CI 3.26-49) when compared to those who did not smoke tobacco, or did not consume alcohol or user other forms of fuel for cooking and heating. Despite the close proximity of the two GSTP1 SNPs (313A>G and 341C>T), they were not in linkage disequilibrium in these two population groups (D':1.0, LOD: 0.52, r2: 0.225). The GSTP1 313A/G polymorphism on the other hand, did not display any association with OSSC. The homozygous GSTT1*0 genotype was associated with increased risk of OSCC (OR = 1.71, 95%CI 1.18-2.46) while the homozygous GSTM1*0 genotype was associated with significantly decreased risk of OSCC in the Mixed Ancestry subjects (OR= 0.39, 95%CI 0.25-0.62). CONCLUSIONS: This study shows that the risk of developing OSCC in the South African population can be partly explained by genetic polymorphisms in GST coding genes and their interaction with environmental factors such as tobacco smoke and alcohol consumption.
Open Access
3D approximation of scapula bone shape from 2D X-ray images using landmark-constrained statistical shape model fitting
(2016) Wasswa, William; Mutsvangwa, Tinashe E M; Douglas, Tania S
Two-dimensional X-ray imaging is the dominant imaging modality in low-resource countries despite the existence of three-dimensional (3D) imaging modalities. This is because fewer hospitals in low-resource countries can afford the 3D imaging systems as their acquisition and operation costs are higher. However, 3D images are desirable in a range of clinical applications, for example surgical planning. The aim of this research was to develop a tool for 3D approximation of scapula bone from 2D X-ray images using landmark-constrained statistical shape model fitting. First, X-ray stereophotogrammetry was used to reconstruct the 3D coordinates of points located on 2D X-ray images of the scapula, acquired from two perspectives. A suitable calibration frame was used to map the image coordinates to their corresponding 3D realworld coordinates. The 3D point localization yielded average errors of (0.14, 0.07, 0.04) mm in the X, Y and Z coordinates respectively, and an absolute reconstruction error of 0.19 mm. The second phase assessed the reproducibility of the scapula landmarks reported by Ohl et al. (2010) and Borotikar et al. (2015). Only three (the inferior angle, acromion and the coracoid process) of the eight reproducible landmarks considered were selected as these were identifiable from the two different perspectives required for X-ray stereophotogrammetry in this project. For the last phase, an approximation of a scapula was produced with the aid of a statistical shape model (SSM) built from a training dataset of 84 CT scapulae. This involved constraining an SSM to the 3D reconstructed coordinates of the selected reproducible landmarks from 2D X-ray images. Comparison of the approximate model with a CT-derived ground truth 3D segmented volume resulted in surface-to-surface average distances of 4.28 mm and 3.20 mm, using three and sixteen landmarks respectively. Hence, increasing the number of landmarks produces a posterior model that makes better predictions of patientspecific reconstructions. An average Euclidean distance of 1.35 mm was obtained between the three selected landmarks on the approximation and the corresponding landmarks on the CT image. Conversely, a Euclidean distance of 5.99 mm was obtained between the three selected landmarks on the original SSM and corresponding landmarks on the CT image. The Euclidean distances confirm that a posterior model moves closer to the CT image, hence it reduces the search space for a more exact patient-specific 3D reconstruction by other fitting algorithms.
Open Access
3D cine DENSE MRI: ventricular segmentation and myocardial stratin analysis
(2013) Auger, Daniel A; Spottiswoode, Bruce S
Includes abstract. Includes bibliographical references.
Open Access
4D flow and displacement sensitive MR imaging of upper arm arterio-venous connections for haemodialysis
(2016) Jermy, Stephen; Meintjes, Ernesta M; Franz, Thomas; Auger, Daniel A
Chronic Kidney Disease (CKD) is a disease that causes kidney damage, often leading to the patient requiring haemodialysis treatment. Haemodialysis treatment requires a vascular access method, commonly Arteriovenous (AV) fistulae and grafts. These access methods must be regularly assessed to ensure the access remains unblocked and the flow rate is normal. Phase Contrast MRA (PC-MRA) is a versatile Magnetic Resonance Imaging (MRI) modality which is capable of imaging and quantifying blood flow in vivo. It is for this reason that this imaging technique was used to image blood flow in the vasculature of the upper arm of volunteers and haemodialysis patients with either an AV fistula or graft. This imaging technique is capable of producing temporally resolved Three-dimensional (3D) datasets (known as "Four-dimensional (4D)" flow) of blood flow in major vessels. Velocities are phase encoded between -π and π based on the chosen Velocity Encoding Constant (venc). To successfully characterise all velocities in the volume it is necessary to set the venc to be approximately equal to the highest velocity found in the vessel. Any lower venc value will cause phase wrapping, an imaging artefact causing all higher velocities to be wrapped by a multiple of 2 π. However, the increase in sensitivity to high velocities reduces the overall specificity of the velocities, especially for low velocities. Due to the pulsatile nature of blood flow in arterial vessels, a large range of velocities are encountered, while venous flow is more constant but lower than the peak arterial flow value. For this reason and due to the length of the 4D flow scans, 20-30 minutes, it would be preferable to perform one scan at a relatively low venc and correct any phase wrapping during post-processing. In this study, we performed both Two-dimensional (2D) PC-MRA scans at various locations in the upper arm and 4D PC-MRA scaans with similar venc settings. The purpose of the study was to implement and test several methods of phase unwrapping to remove phase wrapping artefacts from affected areas within the PC-MRA datasets.
Open Access
50 years of Emmonsia disease in humans: the dramatic emergence of a cluster of novel fungal pathogens
(Public Library of Science, 2015) Schwartz, Ilan S; Kenyon, Chris; Feng, Peiying; Govender, Nelesh P; Dukik, Karolina; Sigler, Lynne; Jiang, Yanping; Stielow, J Benjamin; Muñoz, José F; Cuomo, Christina A; Botha, Alfred; Stchigel, Alberto M; De Hoog, G Sybren
New species of Emmonsia-like fungi, with phylogenetic and clinical similarities to Blastomyces and Histoplasma, have emerged as causes of systemic human mycoses worldwide. They differ from classical Emmonsia species by producing a thermally-dependent, yeast-like phase rather than adiaspores, and by causing disseminated infections, predominantly in immunocompromised patients and often with high case-fatality rates. Such differences will be important for clinicians to consider in diagnosis and patient management, and for microbiologists who may encounter these fungi with increasing frequency.
Open Access
The 52 and 60 kD Ro/SS-A : antigens where are they? : do anti-Ro/SS-A autoantibodies cause cutaneous disease?
(1998) Yell, Jennifer Anne
Systemic lupus erythematosus, considered a multifactorial autoimmune disease, is a disease affecting many systems, with associated immunological abnormalities. It has a striking diversity of clinical patterns, pathologies and prognoses. Genetic factors determine the inherited baseline, on which environmental, hormonal and infectious triggers act to produce autoantibodies. Ro antibodies have been considered pathogenic in subacute cutaneous and neonatal lupus erythematosus. I affinity-purified antibodies to the 52 kD Ro from immunised rabbits (whole 52 kD protein) and human sera (using two immunodominant regions of the protein). I affinity-purified antibodies to the 60 kD Ro from immunised rabbits (whole 60 kD protein) and human sera (using two immunodominant regions of the protein, as well as the total "native" protein). Using these purified antibodies, with immunofluorescence on normal neonatal human keratinocytes, I showed that the 52 kD Ro is mainly cytoplasmic and the 60 kD Ro is mostly nuclear, with some fine cytoplasmic staining. I looked at the capacity of these purified antibodies to penetrate living keratinocytes under various conditions (hormones, drugs and vitamins). No antibody penetration was found, although one whole serum gave low levels of intracellular fluorescence. I studied the putative membrane translocation of 52 kD and 60 kD Ro under conditions of stress (UV A or UVB with or without hormones, drugs, vitamins and heat shock). I could not identify translocation of the 52 or 60 kD antigens with purified antibodies, although some whole sera showed fluorescence. I can find no evidence that antibodies directed against the 52 and 60 kD Ro antigens cause cutaneous disease.
Open Access
9β Polymorphism of the Glucocorticoid Receptor Gene Appears to Have Limited Impact in Patients with Addison’s Disease
(Public Library of Science, 2014) Ross, Ian Louis; Dandara, Collet; Swart, Marelize; Lacerda, Miguel; Schatz, Desmond; Blom, Dirk Jacobus
BACKGROUND: Addison’s disease (AD) has been associated with an increased risk of cardiovascular disease. Glucocorticoid receptor polymorphisms that alter glucocorticoid sensitivity may influence metabolic and cardiovascular risk factors in patients with AD. The 9β polymorphism of the glucocorticoid receptor gene is associated with relative glucocorticoid resistance and has been reported to increase the risk of myocardial infarction in the elderly. We explored the impact of this polymorphism in patients with AD. Materials and METHODS: 147 patients with AD and 147 age, gender and ethnicity matched healthy controls were recruited. Blood was taken in a non-fasted state for plasma lipid determination, measurement of cardiovascular risk factors and DNA extraction. RESULTS: Genotype data for the 9β polymorphism was available for 139 patients and 146 controls. AD patients had a more atherogenic lipid profile characterized by an increase in the prevalence of small dense LDL (p = 0.003), increased triglycerides (p = 0.002), reduced HDLC (p<0.001) an elevated highly sensitive C-reactive protein (p = 0.01), compared with controls. The 9β polymorphism (at least one G allele) was found in 28% of patients and controls respectively. After adjusting for age, gender, ethnicity, BMI and hydrocortisone dose per metre square of body surface area in patients, there were no significant metabolic associations with this polymorphism and hydrocortisone doses were not higher in patients with the polymorphism. CONCLUSIONS: This study did not identify any associations between the 9β polymorphism and cardiovascular risk factors or hydrocortisone dose and determination of this polymorphism is therefore unlikely to be of clinical benefit in the management of patients with AD.
Open Access
A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South-African provinces
(2023) Vlok, Neville; Stassen, Willem; Wylie Craig
Introduction: Helicopter Emergency Medical Services (HEMS) forms an important role in integrated modern emergency medical services and have a suggested mortality benefit in certain patient populations, such as those affected by severe trauma or with time-sensitive pathologies in rural areas. Despite this, HEMS is an expensive resource used in South Africa and appropriate use and feasibility in low-to-middle income countries (LMIC) is highly debated. To maximise benefit, it is essential that the right patients be selected for HEMS. In order to evaluate this, the current practices first need to be described. The aim of this study was to describe a population of patients being transported by HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis and clinical characteristics and interventions. Methods: A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a private, single aeromedical operator in South Africa, over a 12-month period (July 2017 – June 2018) in Gauteng, Free State, Mpumalanga and North-West. Results: A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT)). The majority of the patients were male (n=548, 59.8%), suffered blunt trauma (n=379, 41.4%) followed by medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%). Most flights occurred in daylight hours (n=729, 79.6%). Median mission times were 1-hour 53minutes for primary missions, and 3 hours 10 minutes for IFT cases. Median on-scene times were 26 minutes for primary cases and 55 minutes for IFT cases. Although many patients were transported with an endotracheal tube (n=428, 46.7%), more than a third did not have an advanced airway and received supplemental oxygen via other means (n=348, 37.9%). Almost half of patients received no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Almost all patients received intravenous fluid therapy (n=867, 94.7%). The administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%) were also common interventions. Conclusion: By describing current HEMS transport practices in one of the largest cohorts in Africa to date, a better understanding is gained of how HEMS is utilised daily. Apart from the lack of universal call out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. Due to the lack of coordinated coronary care networks, it seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.
Open Access
A 12-month retrospective, descriptive study of Hout Bay Volunteer Emergency Medical Service, Cape Town, South Africa
(2019) Kahle, Jurgen Werner; Cunningham, Charmaine; Fleming, Julian; Hodkinson, Peter
Background There is a growing need for Emergency Medical Services (EMS) globally and in Africa, as health services develop. The establishment and continued operation of volunteer ambulance services might assist with this need. This study provides a comprehensive overview of the operational activities of a volunteer ambulance service and forms a first step for further studies of this and other volunteer ambulance services. Objectives This study describes and quantifies the operational activities of Hout Bay Volunteer Emergency Medical Service (Hout Bay EMS) a volunteer ambulance service in Cape Town, South Africa for a one year period from 1 January to 31 December 2016. Methods This retrospective study describes call-outs, shifts and service demographics of Hout Bay EMS for 2016, using Provincial EMS dispatch data and shift records from Hout Bay EMS. Performance comparisons are drawn between Hout Bay EMS and Provincial EMS. Outcomes In the study period, there were 682 call-outs involving Hout Bay EMS, a total mission time of 951 hours worked over 119 shifts by 31 active members in 2016. Assault was the leading call-out type (18.40%); 58.24% of call-outs were Priority 2 (less urgent), and 39.30% of call-outs ended in no patient transport. Response times to Priority 1 call-outs were generally shorter for Hout Bay EMS than those of Provincial EMS within the Hout Bay area. Members largely preferred night shift to day shift by a factor of 4:1; the majority of shifts were worked by Basic Life Support (28.57%) and Intermediate Life Support (57.98%) qualified members compared to the relatively few shifts (13.44%) worked by Advanced Life Support members. This study shows that a small volunteer ambulance service mostly active on weekends can successfully complement the efforts of the larger, full-time provincial ambulance service it is dispatched by. This model could be replicated elsewhere to meet the growing need for emergency medical services.
Open Access
A 15-year retrospective review of urodynamic studies in Children at Red Cross War Memorial Childrens Hospital (RCWMCH), Cape Town, South Africa
(2022) Mosalakatane, Thembisile Dintle; Coetzee, Ashton; Wright, Anne; Raad, Jeanette; Lazarus, John; Nourse, Peter; Howlett, Justin; McCulloch, Mignon
Background: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.
Open Access
A 40-50kDa Glycoprotein Associated with Mucus is Identified as α-1-Acid Glycoprotein in Carcinoma of the Stomach
(2012) Chirwa, Nthato; Govender, Dhirendra; Ndimba, Bongani; Lotz, Zoe; Tyler, Marilyn; Panieri, Eugenio; KAHN, DELAWIR; Mall, Anwar S
Background and Aim: Secreted gastric mucins are large O-glycosylated proteins of crude mucus gels which are aberrantly expressed in malignancy. An albumin associated 55-65kDa glycoprotein was previously shown in mucus gels in gastric cancer. The aim of this study was to investigate its expression and identification in human gastric tissue. Methods: Mucins were purified from crude mucus scrapings of 16 partial and 11 total resections and a rabbit polyclonal antibody was raised to the 55-65kDa glycoprotein. The location and expression of the glycoprotein was examined in normal gastric mucosa (n=20), intestinal metaplasia (n=18) and gastric cancer (n=27) tissue by immunohistochemistry. Mucins were analyzed by isoelectric focusing (IEF) on 2-D polyacrylamide gels. Identification of the 40-50kDa glycoprotein was by MALDI-TOF MS technique. Plasma levels were examined by Western blotting. Results: Extensive SDS-PAGE analysis gave a PAS positive glycoprotein in the 40-50kDa range, in patients with gastric cancer but not normals. It was expressed in parietal and columnar cells of normal gastric tissue and intestinal metaplasia respectively, and in 22 of 27 gastric cancer specimens. In 2-D PAGE stained with Coomassie Blue there were 3 spots positively identified as alpha-1-acid glycoprotein (AGP) by MALDI-TOF MS technique. PAS staining revealed a single bright spot in the same position but could not be identified. Preliminary measurements showed slightly higher levels of AGP in plasma of patients with gastric carcinoma. Conclusion: AGP levels are increased in gastric tissue and in the plasma of those with carcinoma of the stomach.
Open Access
A 52-Week Placebo-Controlled Trial of Evolocumab in Hyperlipidemia
(2014) Blom, Dirk J; Hala, Tomas; Bolognese, Michael; Lillestol, Michael J; Toth, Phillip D; Burgess, Lesley; Ceska, Richard; Roth, Eli; Koren, Michael J; Ballantyne, Christie M; Monsalvo, Maria Laura; Tsirtsonis, Kate; Kim, Jae B; Scott, Rob; Wasserman, Scott M; Stein, Evan A
BACKGROUND Evolocumab, a monoclonal antibody that inhibits proprotein convertase subtilisin/ kexin type 9 (PCSK9), significantly reduced low-density lipoprotein (LDL) cholesterol levels in phase 2 studies. We conducted a phase 3 trial to evaluate the safety and efficacy of 52 weeks of treatment with evolocumab. METHODS We stratified patients with hyperlipidemia according to the risk categories outlined by the Adult Treatment Panel III of the National Cholesterol Education Program. On the basis of this classification, patients were started on background lipid-lowering therapy with diet alone or diet plus atorvastatin at a dose of 10 mg daily, atorvastatin at a dose of 80 mg daily, or atorvastatin at a dose of 80 mg daily plus ezetimibe at a dose of 10 mg daily, for a run-in period of 4 to 12 weeks. Patients with an LDL cholesterol level of 75 mg per deciliter (1.9 mmol per liter) or higher were then randomly assigned in a 2:1 ratio to receive either evolocumab (420 mg) or placebo every 4 weeks. The primary end point was the percent change from baseline in LDL cholesterol, as measured by means of ultracentrifugation, at week 52. RESULTS Among the 901 patients included in the primary analysis, the overall least-squares mean (±SE) reduction in LDL cholesterol from baseline in the evolocumab group, taking into account the change in the placebo group, was 57.0±2.1% (P<0.001). The mean reduction was 55.7±4.2% among patients who underwent background therapy with diet alone, 61.6±2.6% among those who received 10 mg of atorvastatin, 56.8±5.3% among those who received 80 mg of atorvastatin, and 48.5±5.2% among those who received a combination of 80 mg of atorvastatin and 10 mg of ezetimibe (P<0.001 for all comparisons). Evolocumab treatment also significantly reduced levels of apolipoprotein B, non-high-density lipoprotein cholesterol, lipoprotein(a), and triglycerides. The most common adverse events were nasopharyngitis, upper respiratory tract infection, influenza, and back pain. CONCLUSIONS At 52 weeks, evolocumab added to diet alone, to low-dose atorvastatin, or to high-dose atorvastatin with or without ezetimibe significantly reduced LDL cholesterol levels in patients with a range of cardiovascular risks.
Open Access
A biochemical study of some of the hydrolases to be found in the latex of the pawpaw, Carica papaya L
(1968) Skelton, Gerald S; Kench, J E
Using fresh papaya latex as the starting material, this thesis describes methods for the isolation and purification of three major proteinases by column adsorption chromatography; a comparative study of certain salient chemical and physical properties of these enzymes is presented. Reference is made to some conflicting results in the literature concerning papain studies, and an effort has been made in this work, by further experimentation, to account for some of the discrepancies. A supplementary study of biochemical interest has been the collecting of latex from the same growing fruit at fixed time intervals : analysis of the samples shows the changes in the yields of latex and enzyme content during the six months that the fruit takes to ripen.
Open Access
A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa
(2011)
BackgroundTo better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.MethodsSurveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe.ResultsSurvey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis.Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region.ConclusionsIn order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to.
Open Access
A biscuit fortified with iron, iodine and B-carotene as a strategy to address micronutrient deficiencies in primary school children
(2001) Van Stuijvenberg, Martha Elizabeth; Hussey, G. D.; Benade, A. J. S
Deficiencies of vitamin A, iron, and iodine continue to be prevalent in developing countries worldwide and can, in addition to the classic consequences such as nutritional anaemia, goitre, cretinism, xerophthalmia and blindness caused by severe deficiencies, also affect the growth, development and immunity of young children. The various internationally acknowledged strategies for combating micronutrient deficiencies include high-dose supplementation, food fortification, dietary diversification and nutrition education. The aim of this research was to evaluate a micronutrient-fortified biscuit as a strategy to address micronutrient deficiencies in primary school children from a poor rural community. The research comprised three phases. During the first phase the effect of a biscuit fortified with iron, iodine, and B-carotene on the vitamin A, iron and iodine status of 115 children was evaluated and compared with 113 controls, in a randomised placebo-controlled trial. To enhance the absorption of iron a vitamin C-fortified cold drink was given together with the biscuit. Anthropometric status, cognitive function and morbidity were assessed as secondary outcomes. The 12-month intervention resulted in a significant improvement in serum retinol, serum ferritin, transferrin saturation, haemoglobin and urinary iodine excretion. Morbidity and cognitive function, particularly the cognitive function in the children presenting with low iron status and with goitre! at baseline, were also favourably affected. Linear growth was positively affected only in the children with marginal iron stores at baseline. During the second phase of this study the long-term effectiveness of the biscuit programme, in terms of elimination of micronutrient deficiencies, compliance, acceptability and sustainability, was evaluated in a longitudinal study over a period of 30 months. In addition, cross-sectional data on vitamin A and iron status from subsequent studies conducted in the same school at 33, 42 and 45 months after the start of the original biscuit intervention, during which time the fortified biscuit continued to be distributed at the school, are reported. Although micronutrient status improved significantly during the 12 months of the first study, all variables (except urinary iodine) returned to pre-intervention levels when the schools reopened after the summer holiday. Serum retinol increased again during the next nine months, but was significantly lower in a subsequent survey, carried out directly after the summer holiday; this pattern was repeated in two further cross-sectional surveys. Iron status showed no recovery during a subsequent intervention period when the vitamin C-fortified cold drink was supplied on a less frequent basis, or during the period that ferrous bisglycinate was used as iron fortificant. Because of the compulsory iodisation of salt, that came into effect halfway through the first phase of the study, improved iodine status, as measured by urinary iodine excretion, was maintained. In the third phase of the research, red palm oil, a rich natural source of B-carotene, was examined as an alternative vitamin A fortificant in the biscuit. This study contained elements of both a randomised placebo-controlled trial and an equivalence trial. The biscuit with a red palm oil-based shortening was shown to be as effective as the biscuit with fl-carotene from a synthetic source in improving the vitamin A status of these children. In conclusion, the results of the studies described in this thesis showed that a micronutient-fortified biscuit is a feasible, practical and effective way of improving the micronutrient status of primary school children from a poor rural community. Long-term evaluation of this programme, however, showed that improved micronutrient status is not sustained during the long summer school holidays, and it is suggested that the biscuit programme is supplemented with other strategies, such as local food production programmes and nutrition education. Red palm oil, with all of its additional qualities (i.e. no trans fatty acids; rich source of antioxidants), appears to be an attractive alternative for use as a vitamin A fortificant. The choice of the iron compound to be used in the biscuit, however, needs further investigation.
Open Access
A case for integrating human rights in public health policy
(2006) London, Leslie
In a global environment where human rights and well-being are coming under increasing threat, both from the spectre of terrorism and from the counter-reaction to it,1 and where international governance systems continue to pay lip service to poverty reduction while encouraging unbridled private accumulation of wealth resulting in huge inequalities between and within countries,2,3 the need to make human rights considerations an integral part of how public health policies are formulated cannot be overemphasised. Contestation over entitlements to socio-economic rights has troubled health care systems worldwide, from resource-poor settings in Africa, where questions have been raised as to whether human rights approaches are best suited to addressing the problem of AIDS in Africa,4,5 through to the over-consumptive USA where universal access to health care remains a policy objective doomed to unfulfilment under market-fixated economic systems.6,7
Open Access
“A case study evaluating the effectiveness of adherence clubs in Gugulethu as a strategy for mobilizing and engaging men in HIV treatment”
(2022) Ncube, Petronella; Colvin, Christopher J; Mbokazi, Nonzuzo
The existing global literature shows that men living with HIV need efficient antiretroviral treatment (ART) delivery. Adherence clubs (ACs) have been identified as one way to improve retention of stable patients living with Human Immunodeficiency Virus (HIV). ACs are among several strategies that have been said to potentially assist in the engagement and mobilization of men in HIV services. However, very few have been evaluated to see whether they are effective in this regard. This qualitative study examines the facilitating factors that help retain and engage men in HIV services by trying to understand the perceived effectiveness of the Adherence Club in Gugulethu. The study employs a qualitative approach to explore the facilitating factors which help retain and engage men in HIV services. A total of 12 participants participated in in-depth telephonic interviews. The participants included stakeholders of the AC such as the health workers (facilitators, nurse, community health worker (CHW) and adherence counsellors), men attending the club and family members who are indirectly involved in supporting participants engagement in the AC as patients. Interviews were conducted in IsiXhosa and for data analysis, they were translated to English, and a thematic analysis was done. The findings show facilitating factors in all stages of the socio-ecological model with the patient level being the vital stage which allows for the integration of other level factors. This study shows that when men properly utilize the different resources provided for their HIV treatment, their engagement and retention in the AC improves. It is therefore key for policy makers to consider planning for male-focused health services to ensure that men view health services as spaces which are inclusive and tailored for them to improve their engagement and retain them in health services.
Open Access
A case study exploring disability inclusion within the Muslim Ummah in South Africa
(2023) Mayat, Nafisa Essop; Amosun, Seyi Ladele; Galvaan Roshan
Religion and spirituality are central to the way many people, including persons with disabilities, make sense of both the world itself, and their place in that world. However, in most scholarship focusing on disability, religion, as a way of understanding and dealing with disability, is side-lined or absent (Imhoff, 2017). Islam has a long rich history in South Africa and is currently one of the major religions here (Mahida, 2012). Followers of Islam are commonly referred to as members of the Muslim Ummah as a collective, an Ummah that includes persons with disabilities and non-disabled persons. Given the paucity of research focusing on disability in the Muslim Ummah in South Africa, this study sets out to gain insight into the way disability inclusion is enacted within the Muslim Ummah in South Africa. The research question asks: How is disability inclusion interpreted, experienced and enacted by people within the Muslim Ummah in South Africa? Adopting an interpretative qualitative research approach and applying an intrinsic case study method, the research was conducted with members of the Ummah in three major cities in South Africa, viz. Durban, Johannesburg and Cape Town. Data was generated from persons with disabilities, family members of persons with disabilities, the Ulema and a non-disabled person from the Ummah from each city. In-depth face-to-face interviews and a review of three Muslim publications were used as data gathering mechanisms. Interviews were held with seven persons with disabilities, either a physical or sensory disability, five family members of participants with disabilities, six Ulema and three non-disabled persons. All participants were aged 18 and older. Data was analysed by looking for themes that emerged from the data. Three themes, “Seen as Inferior'', “Carrying the Weight for Inclusion” and “We Are Not Doing Enough”, each with two sub-themes, emerged from the analysis. “Seen as Inferior'' and its two sub- themes, ‘' Gaze of Othering and ‘'The Deep Impact of Disability'', highlight the way in which persons with disabilities are viewed as inferior within the Ummah and how this is reflected in the gaze of non-disabled persons on persons with disabilities and their families, and the impact of this gaze. ‘'Carrying the Weight For Inclusion” emphasises the responsibility that persons with disabilities have assumed in order to be accepted into and included in the Ummah and this is demonstrated through the two sub-themes, “The Unspoken Responsibility of Negotiating Persons with Disabilities” and ‘'Negotiating the Effort to be at the Masjid”. “We Are Not Doing Enough” explains that although some aspects of inclusion are evident within the Muslim Ummah, the pace of change is very slow and inclusion remains inadequate. Sub-themes ‘'Inclusion could Create Ease and Belonging” and “Still a Journey to Travel to be Included” capture the way disability inclusion is interpreted and experienced by the participants of the study, highlighting that much work is still needed to attain full inclusion and to create ease and belonging for persons with disabilities within the Ummah. The discussion explains how the dominant discourse around disability is one that reflects an ableist, normative, colonial narrative. This narrative influences how disability inclusion is enacted within the Ummah, belabouring a move to full inclusion. The phenomenon of an unconscious exclusion of persons with disabilities within the Ummah is discussed as it emerges from this dominant discourse, together with the silence that sustains the continuation of the exclusion. The ways in which this unconscious exclusion plays out in many spaces and places significant to the lives of persons with disabilities are identified. It is proposed that, in order to achieve full inclusion and belonging for persons with disabilities within the Ummah, there needs to be a re-shaping in the thinking around disability through generating new knowledge and by challenging the dominance of the normative, ableist narrative. Informed by a decolonial turn, pathways towards full inclusion and belonging of persons with disabilities within the Ummah are proposed. It is suggested that collective action by both persons with disabilities and non-disabled persons within the Ummah is needed for full inclusion and belonging to transpire. The pathway to full inclusion and belonging would enable systemic change around disability within the Ummah to ensue and it would help move the de-colonisation project forward.
Open Access
A case study exploring the application of the Occupation-based Community Development Framework: co-constructing humanising praxis
(2019) Krenzer, Meghan Lee Mackenzie; Galvaan, Roshan
The Occupation-based Community Development (ObCD) framework draws on critical occupational science concepts in working with marginalized communities to bring about transformative change (Galvaan & Peters, 2017a). However, little research has been conducted on this to date, specifically within community development practice (CDP) and in the Global South. This study asked the question: “How does the application of an occupational perspective and participatory action methods influence the processes within ObCD?” A qualitative research design employing an instrumental single case study was conducted. The case was bounded within the University of Cape Town’s final year Occupational Therapy student service-learning placements during the period of 2014 to 2016, in South Africa. Participants were purposively selected and included occupational therapy clinical educators and recent occupational therapy graduates who had applied the ObCD framework during their CDP placements. Data was generated through a focus group; individual semi-structured interviews and analysis of graduates’ written reports. A thematic analysis revealed the case to be that of co-constructing humanising praxis, describing the evolving thinking and doing of practice. Three themes, namely: 1) Processes of dialogue and doing; 2) Situating occupational perspectives in socio-political and historicised contexts; and 3) Negotiating positionalities, offer detailed descriptions of the elements to consider in engaging and developing this form of praxis. The discussion illustrates how praxis resonates with the values of critical and social occupational therapy in working towards promoting occupational justice. Thereby, proposing that occupational justice implies engaging in humanising praxis, through a co-constructed journey with stakeholders. The suggestion made is that praxis guided by the ObCD Framework promotes occupational justice. Shifts in terminology and concepts, that could depict the values in ObCD more explicitly are suggested. Finally, praxis as a potential avenue for decolonising domains of occupational therapy practice is identified. Recommendations relating to occupational therapy curricula, services and research are offered.