Masters Degrees (Epidemiology and Biostatistics)

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Browsing Masters Degrees (Epidemiology and Biostatistics) by Author "Maartens, Desiree Duane"

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    A study of comorbidities, lifestyle risk factors and fatigue of patients with multiple sclerosis in South Africa
    (Stellenbosch : Stellenbosch University, 2019-12) Maartens, Desiree Duane; Heine, Martin; Derman, Wayne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY : Background: Multiple Sclerosis (MS) affects approximately 2.3 million people globally. A geographical gradient in the prevalence of MS has been reported, with the lowest prevalence reported for sub- Saharan Africa. The vast contextual differences between sub-Saharan Africa and developing countries may argue for a better understanding of MS in an African setting specifically. Aims and Objectives: The main aims of this thesis were to better understand MS in an African context by reviewing research conducted in Sub-Saharan Africa in the past, and build upon that knowledge by evaluating demographics and characteristics of pwMS in an African country (South Africa [SA]). The objectives were to; (i) scope the existing literature on MS, originating from sub-Saharan Africa (Chapter 2) (ii) evaluate the characteristics and key symptoms of pwMS in SA (Chapter 3), and (iii) investigate the agreement between the reported cut-off values for categorising severe fatigue, one of the key symptoms reported by patients with MS globally, by using three different questionnaires (Chapter 4). Methods: (i) A scoping review of the literature on MS from sub-Saharan Africa was undertaken. (ii) A cross-sectional online survey was developed and distributed to all pwMS in SA affiliated with the Multiple Sclerosis Society of SA (n=1048). Measures were included across all domains of the International Classification of Functioning model. (iii) The fatigue questionnaires (Fatigue Severity Scale (FSS), Fatigue Scale for Motor and Cognitive Functions (FSMC) and PROMIS Fatigue Short Form (SF)) included in the crosssectional study were subsequently used to determine their agreement in identifying patients with severe fatigue using previous reported cut-off values, and Receiver Operating Curves were developed to determine new robust cut-off values which acknowledge the unidimensional character of each questionnaire. Results: Thirty-three studies from sub-Saharan Africa were included for the scoping review. Four themes could be derived to group the included studies; aetiology (n=6), epidemiology (n=9), haematology (n=13) and other (n = 5). Majority of the studies (88%) were conducted in South Africa, and only few reports were from the last decade (9%). No comprehensive report on the characteristics and symptom experience of pwMS in sub-Saharan Africa was identified. Subsequently, 122 pwMS (11.6%) completed the anonymous survey (Age=4710yrs, Male (%) =14). PwMS were generally moderately disabled (30.2%) according to the Patient Determined Disease Steps. Comorbidity was frequent, with 39.3% of pwMS reporting three or more comorbidities. The most common comorbidities being: depression (36.1%), high blood pressure and high cholesterol (20.5%) respectively, migraines (15.6%) and anxiety disorders (13.9%). The FSS, FSMC and PROMIS Fatigue SF categorised 73.9%, 78.9% and 30% respectively as severely fatigued. Using Cohen’s Kappa, a significantly moderate agreement was found between FSS and FSMC, (k = 0.563, p = 0.000), and not the PROMIS Fatigue SF. Cut-off values of 5.8 out of 7 for the FSS and 88.5 out of 100 for FSMC would provide 100% certainty a patient with these values (or higher) would have classified as having severe fatigue on both fatigue measures. Conclusion: Despite an increased reporting of MS in sub-Saharan Africa, there is very little recent research on the epidemiology and characteristics of patients with MS in this context. Intervention studies specifically developed for an African context were absent. A triad of poor lifestyle behaviour, low levels of physical activity, and high burden of comorbidity were reported which are concerning in the light of the global burden of disease. Often hampered by the multi-dimensional character of fatigue, the developed robust cut-off values for fatigue could be used in future research where the presence of fatigue is important in for instance evaluating the benefits of interventions to tackle this key symptom. The results of this thesis can be used to set the stage for developing an African specific research agenda for MS.