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Item Open Access Characteristics of patients with recurrent involuntary admissions for seventy-two hour assessment at Kimberley Hospital Complex, Northern Cape Province, Republic of South Africa(University of the Free State, 2019-04) Marufu, Godwin; Steinberg, W. J.; Van Rooyen, F. C.Introduction: Mental illness is common throughout the world, yet the true prevalence is underestimated. Forty-three percent (43%) of all psychiatric admissions in South Africa are involuntary, with a cyclical rise in re-admission rates, referred to as the revolving door syndrome. There was a need to unravel this syndrome, and help identify early, those patients at high risk of it, so that appropriate interventions are implemented to optimise psychiatric care and stem this system failure. Aim: The study aimed to quantify the frequency of re-admissions and recurrent re-admissions and describe the demographic characteristics, social support systems, and clinical characteristics of patients admitted for involuntary seventy-two-hour observation at the Kimberley Hospital Complex, Department of Family Medicine in the Northern Cape Province of South Africa. Method: This was a retrospective, hospital records- based cohort study, of all qualifying 1142 consecutive, involuntary admission episodes, from 614 patients at Kimberley Hospital from 01 January 2016 to 31 December 2017. There was a purposeful, non-random participant selection. Results: Fifty-four percent of the participants were admitted only once during the study period (n=614; 54%). The recurrent re-admission rate was two percent (n=28; 2%), with an average 6 admissions per each participant in the recurrent readmissions group, and the admissions ranging from five to sixteen (range 5 - 16). In between, the re-admissions decreased from a low risk rate of 32% (n=365) to high risk rate of 12% (n=135). Conclusion: This study showed that recurrent re-admissions, also known as the revolving door syndrome, is as much a problem in the Northern Cape Province of South Africa as it is across the rest of the world. The participant at a high risk of re-admission was more likely to be male, Black, young, unemployed, single, abusing substances, coming from a low-income area, with a previous history of involuntary admission, with a diagnosis of Schizophrenia and/or substance-use psychiatric disorder, be on antipsychotic medication, and with a long in hospital stay. Being of Coloured ethnicity, was a particular risk factor for recurrent re-admissions.Item Open Access A clinical audit of Red Blood Cell transfusion at National District Hospital(University of the Free State, 2021) Madito, Nonofo Snowy; Hagemeister, D. T.; van Rooyen, F. C.𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Red blood cell transfusion is one of the most critical and expensive live-saving treatment modalities. Literature has shown that restrictive transfusion is safe and yields good patient outcomes. Evidence shows that a clinical audit is one of the most valuable instruments to determine if transfusion practices align with the guidelines and identify knowledge deficiencies. The National District Hospital was audited against the South African guidelines, including trigger conditions, administrative standards and monitoring requirements. 𝗔𝗶𝗺: To evaluate the red blood transfusion practice and patients’ outcomes at National District Hospital and determine adherence to transfusion guidelines. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: A retrospective descriptive study was conducted. Blood transfusion registers in the hospital were used to compile all transfusion episodes from 01 June 2019 to 31 December 2019. Files were retrieved from the admissions office using that list. A datasheet was used. The department of Biostatistics at the University of the Free State processed the data. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: One hundred eighteen (118) transfusion episodes occurred in the study period, 78 files could be retrieved, but only 76 met the inclusion criteria. The median age was 47. HIV (44.7%) was the most common comorbid condition. A large percentage of patients (81.6%) received oral iron as an additional treatment. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL. All ordered units were transfused. The audit revealed that 68% of the cases adhered to the guidelines. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Most of the transfusion episodes adhered to the guidelines. Training on transfusion medicine recommended.Item Open Access Developing an improved seizure diary as a monitoring tool for epileptic patients in South Africa(University of the Free State, 2023) Egenasi, Chika Kennedy; Moodley, A. A.; Steinberg, W. J.𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Epilepsy is a debilitating disease with a high risk of morbidity and mortality globally. A seizure diary is one of the methods described in the literature that can be used to manage patients living with epilepsy. These diaries are available in two formats, paper-based and electronic diaries. This study aimed to develop an improved seizure diary and determine patients’ perception of its use in the management of patients with epilepsy in South Africa. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀 In the first phase of this study, a scoping review of literature was performed. An extensive search of appropriate literature was conducted using online databases, such as MEDLINE, Scopus, CINAHL, Cochrane and EBSCOhost. Key phrases, such as seizure diary, paper diary, and seizure tracker, were used to identify and retrieve relevant themes, categories, and subcategories of literature for examination. In the second phase of the study (a cross-sectional study), cohorts of patients with epilepsy were identified at the casualty and local clinics of a hospital in Kimberley, and the neurology specialist epilepsy clinic in Bloemfontein. Questionnaires were distributed to patients, to gather data on their perceptions of and attitudes to the epilepsy diary, and their opinions on what must be included in a seizure diary. The third phase of the study involved a modified Delphi survey with a panel of 10 local and two international experts, who deliberated on what they believed were the required contents of a seizure diary. In the fourth phase, a longitudinal study, a new seizure diary was developed, based on the suggestions of the expert Delphi panel and the recommendations of patients living with epilepsy. The new seizure diary was distributed to patients who had completed the initial questionnaire, and they were requested to use it for six months. In phase 5a (cross-sectional study), patients, relatives, and caregivers (participants) were requested to complete a questionnaire about their experiences of the new seizure diary. Finally, in phase 5b, a final version of the new seizure diary was designed. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 In phase 1, 1 125 articles were identified from the database search, of which 23 were selected for review by the study. In phase 2, 182 patients with epilepsy were recruited for the study, 65 were patients who had previous exposure to a seizure diary, and 117 were unexposed. Of the patients who had previous exposure to the seizure diary, 64 (98.5%) found the diary useful, but 15 (23.1%) reported facing various challenges with using the seizure diary. In phase 3, the modified Delphi survey had three rounds, with 12 expert panellists completing each round. Consensus for any item was set at 70%. Eighteen items were suggested as the required contents of a seizure diary. The seizure diary, designed in phase 4, was distributed to 139 patients (81 previously diary-unexposed and 58 who had previous exposure to a seizure diary) to use for six months. In phase 5a, of the 139 patients who received the new seizure diary,100 (67 previously diary-unexposed participants and 33 participants who had previous exposure to a seizure diary) completed questionnaire 2. Participants who had previous exposure to a seizure diary were predominantly very positive about the new diary because it had more information. However, 21.2% preferred the old one, because it was easier to complete. In phase 5b of the study, the final draft of the new seizure diary was designed for use by patients with epilepsy. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 An expert panel of specialists, patients, caregivers, and relatives participated in developing a new seizure diary. Despite a few patients reporting that they preferred the old seizure diary, most participants preferred the new seizure diary and were willing to use it.Item Open Access Knowledge, attitude and practices of health care providers on smoking cessation intervention – a case of Sol Plaajtie Subdistrict, Northern Cape(University of the Free State, 2020-01) Muza, Lizwe Calvin; Steinberg, W. J.Background: Clinicians are crucial in influencing smokers to quit through provision of behavioural (counselling) or pharmacological smoking cessation interventions. Numerous studies conducted across different parts of the world indicate an increase in smokers who quit with assistance compared to those without. However in-order for healthcare providers to efficiently offer this advice; they need to be equipped with the right knowledge on smoke intervention and possess the right attitude and willingness to counsel their patients on smoking cessation. Objective: To determine the knowledge, attitude and practises of healthcare providers on smoking cessation intervention strategies in Sol Plaatjies Sub-district in the Northern Cape. Methodology: The researcher made use of a descriptive cross-sectional design with a selfadministered questionnaire aimed at determining the knowledge, attitude and practises of health care providers on smoking cessation intervention. One hundred and sixty five participants were selected to participate in the study from four groups namely; medical officers, professional nurses, enrolled nurses and assistant enrolled nurses. Results: Responses were received from 156 participants constituting 95% of the targeted population. The results revealed that 52% had no knowledge of South African tobacco smoking cessation guidelines highlighting a lack of training on smoking cessation intervention whilst 87% knew the importance of counselling patients on smoking and its impact on quitting. Majority of them did not know the medicines recommended for tobacco treatment in South Africa. Three-quarters (75%) expressed that smoking cessation counselling is an important part of their jobs, but only half of them indicated that they made follow-up arrangements on those attempting to quit. They also cited a number of barriers to smoking cessation interventions mainly due to lack of community-based tobacco cessation treatment centres for referrals as well as unavailability of educational materials among others. Conclusions: The study revealed that most of healthcare workers in the Sol Plaatje District are not aware of the existence of smoking cessation guideline. It was also observed that respondents agree that smoking cessation knowledge is an important element of their jobs and it’s necessary to provide smoking cessation counselling. However, these healthcare providers do not consistently record patient smoke history and quit attempt. They also faced other challenges such as lack of time and unwillingness of patients to quit smoking. Recommendations: It is to improve training and development among healthcare providers in-order to adequately equip them with the right knowledge on smoking cessation as well making available material on smoking cessation; there is also need to open more communitybased tobacco cessation treatment and referral centres for patients to avoid relapse.Item Open Access Knowledge, attitude, and practices on diabetic foot care among nursing staff at primary health care facilities in Sol Plaatje sub-district, Kimberley(University of the Free State, 2020-08) Mafusi, Labala Guy Juste; Steinberg, W. J.; Harmse, M. C.As essential team members of the healthcare system, nurses have more contact with the patients and are indispensable in patients' education. They can ameliorate diabetic patients' quality of life by aiding in preparing and implementing educational programs that assist patients in growing self-care behaviours associated with diabetic foot care. Furthermore, they can stop or prevent diabetic foot problems by pointing out risk groups in the community. To reduce Diabetic Foot Disease's load sensibly, improve patient education and preventive and screening programmes on Diabetic Foot Care, healthcare providers need to be knowledgeably possessing the right attitude, which is crucial in offering any meaningful advice to their clients. Positive attitudes, combined with sound knowledge, prevent compromising health care standards. However, for nurses to efficiently offer education, they need organised training programs combining theory and practice. Nurses involved in the management of diabetes-related foot problems must be encouraged to take part in these programs. Objectives: To assess the knowledge, attitude, and practice of nursing staff regarding diabetic foot care in Sol Plaatje primary healthcare centres in the Northern Cape. Methodology: The researcher used a descriptive cross-sectional study with a self-administered questionnaire to assess the knowledge, practice, and nursing staff attitude on diabetic foot care. A total number of one hundred and twenty-eight nurses providing primary care to patients within the Sol-Plaatje sub-district were targeted to participate in the study from three groups: professional nurses, enrolled nurses, and auxiliary nurses. Results: Responses were received from 105 participants constituting 82% of the targeted population. Of the participants, 88% were professional nurses, and the majority, 95%, were female; the median age was 48 years and the median year of practice was 15 years. The results showed that 58% of this sample had a good knowledge of South African Diabetic foot guidelines even though compliance level was low, highlighting a lack of training on diabetic foot care with 86% needing diabetic foot care training whilst 94% knew the importance of foot assessment on diabetic patients. The majority, 59%, did not know the importance of diabetic foot prevention and 57% did not know of the 60-Second Screening Tool for high-risk diabetic foot, and 70% did not know about the 10g monofilament tool used for foot neurology check. 98% expressed that diabetic foot education is an essential part of their job, yet only 46% indicated that they record foot examination, whilst 82% do not do a 60-Second comprehensive assessment. The majority, 91% of Nurses displayed a positive attitude towards caring for diabetic foot patients despite 59% of poor screening attitude. Also, the knowledge of specialist referrals was insufficient among nurses. Conclusions: This study revealed that most frontline healthcare providers (nurses) in Sol Plaatje Sub-District are aware of the diabetic foot guideline for primary care in contrast to the majority not being aware of the 60-Second Screening Tool for high-risk diabetic foot and the 10g monofilament tool. It was also noted that respondents agree that diabetic foot education is an essential part of their jobs. Nurses do not regularly record patient diabetic foot examination findings. They also requested training in diabetic foot care. Poor screening attitude may be attributed to inadequate training and suboptimal update of knowledge. Recommendations: My recommendation is to promote the 60-Second Screening Tool for high-risk diabetic care and avail tool for foot neurology check whilst also improving training and development among healthcare providers (nurses) to equip them with the right knowledge on diabetic foot care and improve their attitude on diabetic foot prevention, which will increase their compliance to guidelines. There is also a need to make available material on diabetic foot care whilst also improving referral systems to avoid delay in specialist care and amputation complication.Item Open Access Reasons cited for the interruption of anti-retroviral treatment in the Bloemfontein/Mangaung area(University of the Free State, 2020-11) Thomas Ross, Du Plessis; Van Lill, M.; Nel, R.Background: HIV infection is a chronic condition that affects millions of people worldwide and causes significant morbidity and mortality. It is however treatable with anti-retroviral treatment. This does require regular, uninterrupted dosages to prevent the development of treatment resistance. There are many reasons why patients may be unable to remain compliant on their treatment including medication, healthcare and psycho-social reasons. Objectives: To investigate the reasons cited for treatment interruption of anti-retroviral treatment in patients admitted to National District Hospital from the Mangaung district. Methods: This was a prospective descriptive study. Data was obtained by voluntary structured interviews from patients admitted to National district hospital between February and April of 2020. A total of 17 patients were included. Results: Unemployment among participants was at 68%, with 54% reporting no consistent income. There was a fairly even spread of reasons cited for treatment interruption between the healthcare, medication and psychosocial factors. Stock issues, however, remained a prominent problem reported. Almost half of participants reported omissions in their counselling prior to treatment initiation. Medication side effects remains a problem with 52% of participants reporting side effects and 44% of those attributed non-compliance to it. The majority of patients reported good family support and fear of disclosure or stigma was not reported. All participants screened positive for symptoms of depression, with 52% falling into the moderate and severe depression categories. Conclusions: The challenges for people living with HIV to remain compliant with their treatment remains numerous and varied. The role that unemployment and poverty plays cannot be ignored. Continuing efforts need to be made to create a robust supply of medication to patients if good outcomes are to be achieved. Patients need to be well educated prior to treatment initiation and given good advice regarding the management of side effects. The prevalence of symptoms for Depressive Mood disorder in this patient population is high and needs to be actively screened for at initiation and follow-up of patients. Further research within more well-defined communities can be beneficial for the healthcare workers working in those areas.Item Open Access Strategies to enhance the approach to prostate cancer screening of African men in the Free State(University of the Free State, 2023) Benedict, Matthew Olukayode Abiodun; Claassen, Frederik M.; Steinberg, Wilhelm J.; Mofolo, Nathaniel𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Prostate cancer is a significant public health concern in South Africa, with rising incidence and mortality rates, particularly among African men. Prostate-specific antigen (PSA) screening is a practical method for early detection and improved outcomes. However, it carries the risks of overdiagnosis and overtreatment. Recent studies have shown a more significant net benefit of PSA screening for Black men than the general population. However, there are knowledge, attitude and practice gaps among primary healthcare providers and users, especially Black men, regarding prostate cancer screening. Practical strategies to address these gaps are lacking. This study focuses on vulnerable African men in the Free State Province, South Africa. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This thesis presents the results of five complementary studies aiming to identify gaps in prostate cancer screening and determine strategies to enhance prostate cancer screening among African men in the Free State Province from the perspectives of primary healthcare providers and users. The first study employed a cross-sectional descriptive design, using case record information and self-administered questionnaires to profile Black South African men with prostate cancer attending a tertiary hospital’s oncology and urology clinics in the Free State Province. The second study used a cross-sectional analytical survey design, administering self-administered questionnaires to assess the knowledge, attitude and practice of primary healthcare providers in the study setting. The third study also employed a cross-sectional analytical survey design, utilising self-administered questionnaires to investigate African men’s knowledge, cultural beliefs and screening intentions regarding prostate cancer screening. Factors associated with their intention to screen for prostate cancer were examined. Quantitative data were analysed using descriptive statistics, and associations were tested using chi-squared or Fisher’s exact tests. The fourth and fifth studies comprised a scoping review and a modified Delphi survey to identify and propose strategies to enhance prostate cancer screening among African men in the study setting, addressing the identified gaps. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The findings revealed that aggressive prostate cancer is prevalent among African men in the study setting. Poor knowledge and awareness of the disease and low screening uptake were observed. Factors such as dietary habits, lifestyle and presentation time were associated with aggressive disease at diagnosis. Cultural beliefs influenced screening uptake among men. Factors associated with a higher intention to screen included reduced fear, perceived benefits, situational barriers, and perceived risk of developing prostate cancer. Regarding primary healthcare providers, the majority demonstrated poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%) related to prostate cancer screening. Female providers, lower cadre nurses and community health workers had lower knowledge scores. Lack of prostate cancer-related continuing education was significantly associated with poor knowledge, negative attitudes and poor practice among healthcare providers. The study proposed strategies to address the identified gaps among African men and primary healthcare providers. Community-oriented approaches involving the active participation of both providers and community members were emphasised. These strategies focused on relevant prostate cancer health education topics in public spaces, employing diverse, comprehensive, user-friendly and culturally sensitive methods. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: This thesis highlights the gaps in prostate cancer screening among African men and primary healthcare providers in the Free State Province, South Africa. Targeted strategies are needed to enhance prostate cancer screening uptake and improve outcomes in this vulnerable population. Implementing the proposed strategies can improve awareness and knowledge of the disease and ultimately enhance screening practices among African men in the study setting.Item Open Access A study of the knowledge, attitudes and practice of lifestyle modifications among patients with type 2 Diabetes mellitus attending the Outpatient Department of the National District Hospital, Bloemfontein, Free State(University of the Free State, 2020-09) Peter, Paul Ifeanyi; Steinberg, W. J.; Van Rooyen, F. C.Introduction: Type 2 Diabetes Mellitus (DM), no doubt, constitutes a major public health burden globally with uncontrolled diabetes mellitus often resulting in several short and longterm complications. It may also sometimes result in loss of lives. Therefore, it is of utmost importance that individuals with diabetes mellitus are regularly made aware of the need for optimal glucose control. Apart from the pharmacological management of Type 2 DM, a healthy lifestyle plays a prominent role in the optimal control of the blood glucose level and prevention of complications but often little is known about the practice of lifestyle modifications among the Type 2 DM patients. Objectives of the study: To determine the knowledge, attitude and practice of lifestyle modifications among patients with Type 2 DM attending the outpatient department (OPD) at the National District Hospital, Bloemfontein, Free State. Methods: This project was a descriptive study with a cross-sectional component. The study was conducted among patients with Type 2 Diabetes Mellitus attending the outpatient department (OPD), National District Hospital, Bloemfontein, Free State. A self-administered structured questionnaire was used for the data collection. Information regarding the socio-demographic characteristics of the participants and their anthropometric measurements was obtained. The participants' knowledge, attitude and practice regarding physical exercise and healthy diet with regards to lifestyle modification practices among Type 2 diabetes were assessed. Results: A total of 149 correctly filled questionnaires were included in the data analysis. Majority of the participants, 104(69.8%) were females, while the mean age of the participants was 47.7 years. Majority of the participants (82.0%) had a varied level of formal education. Only 23.3% of the respondents were employed. Almost half (49.3%) of the respondents have been living with diabetes for more than ten years since diagnosis. Of the respondents, 64.4% were obese, and 23.8% were overweight. There was decent knowledge of lifestyle modification practices with regards to physical exercise and healthy dietary habits among the respondents. Respondents displayed a good attitude to physical exercise, but more than half had a poor attitude regarding the adjustment of their diet. Even though the majority of the respondents (94.0%) had a positive attitude to the need for weight control, about two-thirds of the respondents admitted they do not monitor their weight regularly. Only 63.3% of the respondents engage in physical exercise on a regular basis. The practice of controlled and planned diet was found to be poor among the respondents. The identified barriers to lifestyle modifications were respondents feeling too heavy to engage in physical exercise, bad weather and financial constraints. There was no statistically significant association between the gender of the respondents and their attitude to regular physical exercise or dietary modifications. There was also no significant association between the gender of the respondents and their practice of lifestyle modifications. There was no statistically significant association between the number of years the respondents have been living with diabetes mellitus and their attitude to lifestyle modification practices. There was also no association with their practice of regular exercise or dietary modifications. There was no significant association between the BMI of the respondents and their practice of regular physical or dietary modifications. Conclusion: In conclusion, the study revealed that despite the good knowledge of physical exercise and healthy dietary habits with regards to lifestyle modification among the Type 2 DM patient at the Outpatient Department of the National District Hospital, Bloemfontein, the uptake of these practices is still low. There is a need to address the poor attitude and poor practice of dietary modification and the sub-optimal engagement in physical exercise among the patients. It is also vital to regularly emphasise to the patient the importance of not only engaging in the lifestyle modification practices but also the need to do it correctly. Proper practices are essential for it to be efficient and bring about the desired purpose, which is the optimal control of blood glucose, by so doing, preventing potential complications associated with uncontrolled diabetes mellitus.