Masters Degrees (Epidemiology and Biostatistics)

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Browsing Masters Degrees (Epidemiology and Biostatistics) by browse.metadata.advisor "Esterhuizen, Tonya"

Now showing 1 - 5 of 5
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    Association of home hygienic practice and diarrhoeal presence in low-cost housing in Cape Town, South Africa
    (Stellenbosch : Stellenbosch University, 2017-12) Brand, Amanda; Esterhuizen, Tonya; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY: Background: Good home hygiene in key high-risk areas shows potential to be a simple and cost-effective intervention for preventing infectious disease transmission in low income homes. Knowledge of good home hygiene does not, however, always translate to practice due to complex factors which hinder translation. The objective of the study was to investigate whether an association between cleanliness and diarrhoeal disease exists, and to understand the factors which impede knowledge translation. Method: This cross-sectional study in low-income areas in Cape Town, South Africa took the format of an administered questionnaire focusing on health, and hygienic behaviour. Interviewer-assessed cleanliness was also recorded for each home. Results: Gastrointestinal symptoms were significantly associated with unclean kitchens and toilets (odds ratio (OR)=5.93 (1.98 – 19.78) and OR=17.67 (5.20 – 63.90), respectively). The presence of diarrhoea was significantly associated with dirty toilet areas (OR=8.94 (2.34 – 40.96)), despite its relatively low prevalence (17% (11 – 25%)). While knowledge of home hygiene and health was high, a lack of association between knowledge and observed cleanliness indicated a gap in the translation of knowledge to practice. Proposed emotional drivers of this process could not be substantiated, but evidence suggested that lack of understanding of underlying reasons plays an important role, but it may be effectively overcome by education. Conclusions: Good home hygiene shows potential for preventing infectious disease risk in low-income areas, but knowledge does not translate to effective practice. This is likely attributable to a lack of understanding of underlying principles, specifically among persons with low levels of formal schooling.
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    Influence of previous tuberculosis treatment on time to culture conversion for patients receiving a bedaquiline-containing regimen at Sizwe Tropical Disease Hospital, South Africa
    (Stellenbosch : Stellenbosch University, 2021-03) Saimen, Amashnee; Esterhuizen, Tonya; Padanilam, Xavier; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY : Tuberculosis remains one of the leading causes of death worldwide. There is a growing crisis concerning the number of drug resistant TB cases. New drug regimens were urgently needed to improve mortality and morbidity among drug resistant TB patients. Bedaqualine is a newly developed diarylquinoline with a unique mechanism of action. . Studies have reported varying time to culture conversion regarding RR/MDR-TB patients with history of previous TB treatment. The Rv0678 mutation found in patients with prior Rifampicin exposure has demonstrated a more than four-fold increase in the minimum inhibitory concentrations of Bedaquiline. Previously treated TB patients may be more likely to have higher bacterial load due to extensive parenchymal damage. This study will provide information on effective Bedaquiline treatment duration for those previously exposed to TB treatment. Aim: To determine whether previous exposure to TB treatment influences the time to culture conversion as compared to no previous TB treatment exposure in patients receiving a DR- TB regimen containing Bedaquiline. Primary Objective: To compare the time to culture conversion for previously treated and new DR-TB patients receiving the Bedaquiline containing regimen. Secondary Objectives: 1.To evaluate treatment regimens at time of culture conversion for previously treated andnew DR-TB patients 2.To compare the rate of relapse in previously treated and new DR-TB patients receivingthe Bedaquiline containing regimen. 3.To compare the duration of Bedaquiline therapy in previously treated and new DR-TBpatients 4.To establish the severity of disease of previously treated and new DR-TB patients. Setting and Study Population: The study will be conducted at Sizwe Tropical Disease Hospital in Gauteng Province. Sizwe Tropical Disease Hospital serves as a referral centre for complicated MDR/XDR-TB cases in Gauteng. Study Design: A retrospective cohort study will be undertaken for confirmed DR-TB patients who were initiated on DR-TB regimen containing Bedaquiline from April 2016 to March 2019. Inclusion Criteria: Bacteriologically confirmed DR-TB All patients receiving DR-TB Regimens containing Bedaquiline including new DR-TB with no previous history of TB treatment Documented culture conversion Variables: Culture Conversion; Time to culture conversion; Duration of Bedaquiline treatment Sampling Technique: The group sample sizes were determined to be 76 (Previous treatment group) and 304 (New treatment group), power of 80% with a level of significance of α 0.05. Time Frame: The study will be conducted from June 2020 to November2020.
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    Risk factors of neurodevelopmental delay in paediatric tuberculous meningitis
    (Stellenbosch : Stellenbosch University, 2022-04) Saal, Caro-lee; Solomons, Regan; Esterhuizen, Tonya; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY: Objective: Neurodevelopmental delay in children is one of the long-term complications of tuberculous meningitis (TBM) with significant social, financial and scholastic implications. The objective of the study was to assess the risk factors in children with case-defined TBM that could predict neurodevelopmental delay at the conclusion of anti-tuberculous treatment, after 6 months in HIV non-infected and 9 months in HIV co-infected. Methods: We conducted a retrospective cohort study of all the children diagnosed with TBM at a large academic hospital in Cape Town, South Africa, over a 30-year period between 1985 and 2015. We assessed the relationship between demographic, clinical, laboratory and neuro-imaging characteristics, with cognitive impairment at conclusion of anti-tuberculous treatment. Results: A total of 327 patients were included. The median age on admission was 28 months (interquartile range(IQR) 15-47) with females accounting for 159 (48.6%) and males 168 (51.4%).Of included participants 170 (52%) were HIV negative. Younger age at diagnosis was more likely to have lower IQ levels. Patients were more likely to have lower IQ levels if they had decreased level of consciousness (LOC) (OR=3.30, 95% CI: 1.80-6.05); brainstem dysfunction (OR=2.39, 95% CI: 1.42-4.02); motor function impairment (OR=1.96, 95% CI:1.14-3.39) and infarcts (OR=2.60, 95% CI: 1.53-4.42). Those with positive CSF culture results were less likely to have lower IQ levels (OR=0.38, 95% CI: 0.20-0.75) Conclusion: This study demonstrated that demographic (age on admission) and clinical characteristics (decreased level of consciousness, impaired motor function, brainstem dysfunction, cerebral infarcts, negative cerebrospinal fluid (CSF) culture) were independent risk factors for lower IQ levels at treatment conclusion, in children with clinically-defined TBM.
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    Translation and validation of the Shona version of the exercise benefits and barriers scale in Zimbabwean adult people living with HIV/AIDS : a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2023-03) Dambi, Jermaine Matewu; Esterhuizen, Tonya; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY: Objectives: Despite the widely known benefits of physical activity (PA), only 25% of people living with HIV (PLHIV) meet the WHO-recommended minimum PA levels. With the need to promote PA, there is a need to objectively measure PA, including understanding context-specific barriers, facilitators, and general awareness of the importance of PA. This study aimed to translate and validate the Shona version of the Exercise Benefits and Barriers Scale (EBBS) in Zimbabwean PLHIV. Design: cross-sectional study. Setting: Four (4/9) randomly selected polyclinics (primary healthcare facilities) in urban Harare, Zimbabwe. Participants: We recruited adult patients (aged ≥ 18 years) with a confirmed diagnosis of HIV. Participants had to be willing to provide informed consent, not acutely unwell and requiring emergency treatment, and proficient in the Shona language. Interventions: We used a forward-backwards translation method to translate the EBBS from English to Shona, a Zimbabwean native language. The alpha EBBS-Shona version was pilot tested on 10 PLHIV to assess the face validity, understandability and cultural appropriateness using semi-structured interviews. Thereafter, the EBBS was administered to 567 consecutively selected PLHIV. Results: Most participants were female (72.5%) and self-reported having secondary/high school education (78.8%), with a mean age of 39.9 (SD 12.1) years. The EBBS-Shona version yielded a four factor solution consisting of three benefits factors and one barrier factor against the originally postulated six-factor structure. The EBBS-Shona yielded α=0.85 and intraclass correlation coefficient= 0.86, demonstrating excellent reliability. Increased perception of exercise benefits was positively correlated with increased reports of physical activity, higher health-related quality of life and lower psychiatric morbidity; evidence for construct validity. Conclusions: This study demonstrates the validity and reliability of the EBBS-Shona version in Zimbabwean PLHIV. The EBBS-Shona version can be used for research and clinical purposes to glean data to inform the development, implementation, and evaluation of bespoke PA interventions for PLHIV. Strengths and limitations of this study: • Application of a robust translation and adaption methodology • Utilisation of both exploratory and confirmatory factor analysis for structural validation • Recruitment of a large sample size • Electronic data collection negating missing responses • Non-random, facility-based recruitment of study participants
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    Traumatic brain injury in the intensive care unit : association between the Glasgow coma score and the intensive care unit mortality; the Botswana experience
    (Stellenbosch : Stellenbosch University, 2021-03) Mkubwa, Jack Joseph; Esterhuizen, Tonya; Bedada, Alemayehu; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY : Background: Traumatic brain injury prevalence in Botswana is high and this, coupled with a small population, may reduce productivity. There is no previous study on the association between mortality in traumatic brain injury and the Glasgow coma score in Botswana although global literature supports its existence. Objectives Our primary aim was to determine the association between the initial Glasgow Coma scale score and the time to mortality of adults admitted with TBI at the Princess Marina Hospital, Botswana, between 2014 and 2019. Secondary aims were to assess the risk factors associated with time to mortality and to estimate the mortality rate from TBI. Methods This was a retrospective cohort design, medical record census conducted from 1st January 2014 to 31st December 2019. Results: In total, 137 participants fulfilled the inclusion criteria and majority, 114 (83.2%) were male with mean age 34.5 years. The initial GCS score and time to mortality were associated (aHR: 0.69; 95% CI: 0.508-0.947). Other factors associated with time to mortality included constricted pupil (aHR: 0.12; 95% CI: 0.044-0.344), temperature (aHR: 0.82; 95% CI: 0.727-0.929), and subdural haematoma (aHR: 3.41; 95% CI: 1.819-6.517). Most cases of TBI, 74 (54%) were due to road crashes. Mortality was 48, 35% (95% CI: 27.1% to 43.6%) and entirely from severe TBI. Conclusion: The study confirmed significant association between Glasgow coma score and mortality. Males were mainly involved in TBI. These findings lacked external validity due to a small sample size and therefore a larger multi-centre study is required for validation.