A research report submitted to the faculty of health sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of master of medicine in family medicine October 2017 / MT2018

Thesis (M.Pharm. (Pharmacy Practice)) -- University of Limpopo, 2022 / Developing countries face huge challenges in provision of pharmaceutical care whereas some developed countries have developed and implemented measure to improve pharmaceutical care through collaborative practices. Collaborative patient care is referred to as the cooperative work or practice by healthcare professionals assuming complementary roles and sharing responsibilities for decision making and problem solving to formulate and furnish quality patient care. Pharmaceutical care is governed by the principles and philosophy of patient centred pharmacy practice, where the main responsibilities, roles or action of a pharmacist are based on patient care. Collaborative pharmaceutical care practice for outpatient requires collaborative action of a pharmacist with other healthcare practitioners. Pharmacist-medical practitioner collaborative care practice is one of the recently emerging aspects in developing countries’ hospitals such as in South Africa which can enhance patient care. Method A qualitative study using semi-structured interviews was conducted with a purposeful sample of 8 pharmacists and 9 medical practitioners at Mankweng Hospital in Limpopo province, South Africa. In the study we used audiotaped interviews that were transcribed exactly as said and analysed using thematic content analysis. Results Three main themes emerged from the study’s interview analysis, description of the current relationship and collaborative practices; the perspective of the pharmacists and medical practitioners on collaboration; the barriers affecting pharmacist-medical practitioner collaboration; and recommendations on the ways, strategy and model to improve pharmacists-medical practitioner collaboration. This highlighted that the relationship among pharmacists and medical practitioners is moderate and there a need for improvement in the relationship. The recommendations range from established xv educational and interactional platforms, improved resource supply, clarity in terms of roles and responsibilities and enhanced managerial structures and functions. Conclusion The current relationship among pharmacists and medical practitioners is moderate. There is still a need for improvement in the relationship to achieve quality collaborative practice for pharmaceutical care in outpatient.

Background Of the 464 million patients diagnosed with diabetes mellitus globally, type 2 diabetes accounts for 90%. Type 2 diabetes contributes to other conditions such as hypertension, dyslipidaemia and cardiovascular diseases. Glycaemic haemoglobin control is essential in reducing long-term macrovascular and microvascular complications. Pharmacist interventions have been documented to have a positive role in diabetes management. In Kuwait, type 2 diabetes prevalence is increasing and found in a young population. Aims To evaluate the influence of the pharmacist-led intervention on diabetes knowledge, medication adherence and HbA1c, and hypertension. In addition, to estimate the 10-years risk of developing cardiovascular events and assess the cost of diabetes-related complications. Method The study was a randomised controlled trial with control and intervention arms conducted at the military hospital in Kuwait. Participants (n=177) were randomly allocated to the intervention group (n=88) and control group (n=89), using a 4-block randomisation procedure. The intervention group received face-to-face education and counselling from the pharmacist with a monthly follow-up for six months. The primary outcome was glycaemic control, and secondary measures were hypertension, lipid profiles, medication adherence, diabetes knowledge, 10-year estimated cardiovascular events and cost. QRISK3 and UKPDS-OM2 were used to estimate the risk of CVD events and cost comparison analysis. ii Results Compared with baseline, the mean reduction of HbA1c, blood pressure, and lipid profiles showed significant improvement in the intervention group. Additionally, improvement in medication adherence, diabetes knowledge, 10-years estimated cardiovascular events were reported with the intervention group. Also, the pharmacist-led intervention was cost-saving. Conclusion The study highlighted that adult type 2 diabetes patients who received the pharmacist-led intervention experienced a reduction in adverse clinical outcomes, improved non-clinical outcomes, and assisted in lifestyle modification.

Thesis (M.A. (Psychology)) -- University of Limpopo, 2000 / Refer to document

MA (Psychology) / Department of Psychology

PhD (Microbiology) / Department of Microbiology / Globally, one in ten child deaths before the age of 5 years is due to diarrheal disease, causing almost 800,000 mortalities worldwide, which mostly occur in Sub-Saharan Africa and South Asia. Eighty-eight percent (88%) of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. Unsanitary environments and poor hygiene practices allow diarrhea causing pathogens including viruses, bacteria and parasites to spread more easily. Norovirus (NoV) are now considered the most common cause of outbreaks of nonbacterial gastroenteritis. However, the factors which control the genetic diversity, the sources of sporadic NoV infections, the transmission and persistence of infection are poorly understood. Limited data are available for NoVs strains in South Africa, especially in rural and peri-urban areas. Despite the excessive burden of diarrhea disease in developing countries, NoVs outbreaks have been to date mostly reported in developed countries. Given that the contribution of the various pathogens to diarrhea may differ substantially between regions depending on local meteorological, geographic, and socio-economic conditions, there is a need to investigate intensively the role of viral agents associated with diarrhea in different settings in Africa continent. How would poor living conditions in rural setting impact the prevalence and genetic characteristics of Norovirus strains circulating Limpopo province is the research question of this study. ix To determine the prevalence and genetic diversity of NoVs strains circulating in the rural communities in the Limpopo Province, South Africa and investigate the genetic relationship between NoVs strains, a cross-sectional study was performed on human stools collected from rural communities. We used qualitative variables of poor living environmental conditions including type of water used at the household of child’s parent or guardian, use of toilet seat, presence of livestock at the household and parent employment status to assess possible environmental risk factors of NoV infection within the study area. Prior to this prospective study, we conducted a systematic review of the PubMed and EMBASE databases for published articles of Human NoVs in Africa between 1990 and 2013 in order to assess the contribution of Human NoVs to diarrhoeal diseases in Africa. This review provides a picture of Human NoVs studies in Africa and reveals that unreported sporadic gastroenteritis cases of Human NoVs are common in Africa. Most are community-associated infections reported from urban settings. Possible environmental transmission routes have been documented. Combined environmental and clinical studies are required for targeted actions to control transmission of Human NoVs in Africa. Between July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe district, South Africa, were enrolled for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. Nucleotide sequencing methods were performed to genotype the strains. Phylogenetic analyses x were performed to compare identified NoVs genotypes to the worldwide circulating strains. One hundred and four (41.1%) NoVs were detected. NoV detection rates in symptomatic and asymptomatic children (OR = 1.24; 95% CI 0.66 – 2.33) were not significantly different. Comparison of the median CT values for NoV in symptomatic and asymptomatic children revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in symptomatic children to our knowledge this is the first study reporting on the differences in estimated viral load of GII and GI NoV positive cases and controls. The study findings may have implications for the diagnosis of NoV disease and future vaccine development, which may only need to consider GII as the genogroup associated with diarrhea in the South African population. Sequence analyses demonstrated multiple NoV genotypes identified in rural communities of Vhembe district. The most prevalent NoV genotypes were GII.4 Sydney 2012 variants (n=7) among the capsid genotypes, GII.Pe (n=9) among the polymerase genotypes and GII.Pe/GII.4 Sydney 2012 (n=8) putative recombinants among the RdRp/Capsid genotypes. Two unassigned GII.4 variants and an unusual RdRp genotype GII.P15 were found. With note, the rare GII.P15 identified in this study, has a common ancestor with GII.P15 strain from Japan previously reported as GII / untypeable recombinant strain implicated in a gastroenteritis outbreak. To our knowledge this is the first report of this unusual genotype in the African continent. Though not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric xi pathogens possibly. However in this study no risk factor has been found between NoV positive and qualitative environmental variables of poor living conditions in rural setting. The results also suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved. The findings highlighted NoV genetic diversity and revealed continuous pandemic spread and predominance of GII.Pe/GII.4 Sydney 2012, indicative of increased NoV activity. An unusual RdRp genotype GII.P15 and two unassigned GII.4 variants were also identified from rural settings of the Vhembe district/South Africa. NoV surveillance / NRF