Browsing by Author "Nyasulu, Peter"

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    Clinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa : a research protocol
    (BMJ Publishing Group, 2020-08-06) Allwood, Brian W.; Koegelenberg, Coenraad F. N.; Irusen, Elvis; Lalla, Usha; Davids, Razeen; Chothia, Yazied; Davids, Ryan; Prozesky, Hans; Taljaard, Jantjie; Parker, Arifa; Decloedt, Eric; Jordan, Portia; Lahri, Sa'ad; Moosa, Rafique; Schrueder, Neshaad; Du Toit, Riette; Viljoen, Abraham; English, Rene; Ayele, Birhanu; Nyasulu, Peter; COVID-19 Research Response Team
    Introduction The outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital. Methods and analysis The study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB. Ethics and dissemination The research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.
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    Determinants of poor adherence to antiretroviral treatment using a combined effect of age and education among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa
    (Pan African Medical Journal, 2019-01-18) Mabunda, Kuhlula; Ngamasana, Emery Ladi; Babalola, Joseph Omoniyi; Zunza, Moleen; Nyasulu, Peter
    Introduction: sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic. Methods: a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value < 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire. Results: a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence. Conclusion: the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.
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    Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi
    (Dove Medical Press, 2019) Nyasulu, Peter; Sikwese, Simon; Chirwa, Tobias; Makanjee, Chandra; Mmanga, Madalitso; Babalola, Joseph Omoniyi; Mpunga, James; Banda, Hastings T.; Muula, Adamson S.; Munthali, Alister C.
    Introduction: The global burden of tuberculosis (TB) remains significantly high, with overreliance on biomedical interventions and inadequate exploration of the socioeconomic and cultural context of the infected population. A desired reduction in disease burden can be enhanced through a broader theoretical understanding of people’s health beliefs and concerns about TB. In this qualitative study, we explore the knowledge, beliefs, and perceptions of community members and people diagnosed with TB toward TB in Ntcheu district, Malawi. Methods: Using a qualitative phenomenological study design, data were obtained from eight focus-group discussions and 16 individual in-depth interviews. The community’s experiences and perceptions of TB were captured without using any preconceived framework. Adult participants who had had or never had a diagnosis of TB were purposively selected by sex and age and enrolled for the study. Discussions and individual interviews lasting about 60 minutes each were audiotaped, transcribed, and translated into English and analyzed using MaxQDA 10 software for qualitative analysis. Results: Most participants believed that TB was curable and would go for diagnosis if they had symptoms suggestive of the disease. However, based on their beliefs, individuals expressed some apprehension about the spread of TB and the social implications of being diagnosed with the disease. This perception affected participants’ responses about seeking diagnosis and treatment. Conclusion: A supportive and collective approach consisting of a combination of mass media, interactive communication campaigns, emphasizing TB symptoms, transmission, and stigma could be useful in addressing barriers to early diagnosis and care-seeking behavior.
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    A Retrospective study of the pre-hospital trauma burden managed by the Western Cape Government Emergency Medical Services
    (Emergency Care Society of South Africa, 2021) Abdullah, Naseef; Saunders, Colleen; McCaul, Michael; Nyasulu, Peter
    Background: Trauma is one of the leading causes of premature death and disability in South Africa. There is a lack of data describing the pre-hospital trauma burden in sub-Saharan Africa. This study aimed to describe the epidemiology of common trauma emergencies managed by the Western Cape Government (WCG) emergency medical services (EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this Is the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these, 168 980 (34.3%), or 25.5 per 1000 population, were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were men between the socio-economically active ages of 21–40 years (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS caseload. The patient acuity was categorised as urgent in 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report on the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the World Health Organization (WHO) or any other low- and middle-income countries (LMICs). It also provides the foundation for further research on emergency care needs in South Africa and support for Afrocentric health care solutions to address this public health crisis.
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    A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings : a focus on front-line health workers and health-system organizations
    (Taylor & Francis Open, 2017) Wallis, Lee; Hasselberg, Marie; Barkman, Catharina; Bogoch, Isaac; Broomhead, Sean; Dumont, Guy; Groenewald, Johann; Lundin, Johan; Bergendahl, Johan Norell; Nyasulu, Peter; Olofsson, Maud; Weinehall, Lars; Laflamme, Lucie
    Background: Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. Objectives: This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. Methods: A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. Results: There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. Conclusions: Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.