The application of Radon-222 in constraining zones of recent groundwater recharge in the Table Mountain Group aquifer in the City of Cape Town and its surrounding areas

Agyare-Dwomoh, Yaa (2020-04)

Thesis (MSc)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT: Background: Sub-Saharan Africa has the greatest disease burden due to HIV globally. Improved access to better antiretroviral regimens has increased numbers and longevity of people living with HIV (PLWH). However, recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss at younger-than-expected ages in PLWH. The benefits of anti-retroviral drugs may be overshadowed if PLWH suffer from excess morbidity such as falls, fractures and functional impairments. Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim: This research aimed to describe the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. It further aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions about current falls prevention in the care of PLWH in selected regions of sub-Saharan Africa. Method: The research consisted of a scoping review and a primary study. The scoping review included peer-reviewed studies (excluding narrative reviews) available in English with any information referring to falls in PLWH. Any data regarding bone demineralisation in these studies were also extracted. The results were used to explain concepts arising from the qualitative study. In the primary study, an interpretative exploratory qualitative research method with a phenomenological approach was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. Results: The scoping review identified 14 studies on falls in PLWH, with all but one study published in high income countries (HIC). Prevalence of falls in PLWH approximated that of seronegative counterparts, but the studies were mostly in middle-aged to older adults in whom geriatric syndromes may already be prevalent. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention as perceived by the physiotherapists were sub-optimal and lacked a patient-centred approach. Conclusion: Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH. More awareness also needs to be created among other healthcare professionals and PLWH. Meanwhile, research on falls in younger PLWH and in sub-Saharan Africa, where HIV is most prevalent and where more robust clades exist, is needed. Relevant stakeholders including governments and PLWH themselves require concerted efforts in addressing health system challenges affecting the implementation of falls prevention services to PLWH at primary care level.

AFRIKAANSE OPSOMMING: Agtergrond Sub-Sahara-Afrika het die grootste siektelas as gevolg van MIV wêreldwyd. Verbeterde toegang tot beter antiretrovirale regimens het die aantal en lewensverwagting van mense wat leef met MIV (MLM) verhoog. Nogtans dui onlangse navorsing op ‘n skynbaar verhoogte geneigdheid tot valle asook versnelde beenverlies in jonger-as-verwagte MLM. Die voordele van antiretrovirale medikasie kan oorskadu word as MLM ly aan oormatige morbiditeit, soos valle, frakture en funksionele gestremdhede. Fisioterapeute speel ʼn belangrike rol in die optimalisering van funksie en lewenskwaliteit in MLM deur die voorkom van valle en die vermindering van die skade waartoe dit lei. Doel: Die doel van hierdie navorsing was om die omvang en aard van bestaande navorsing rakende val in MLM te beskryf, en ook om die verband tussen verminderde beendigtheid en valle in MLM te beskryf. Die navorsing het verder ten doel gehad om fisioterapeute se bewustheid van val-risiko en versnelde beendigtheidvermindering in MLM, asook hul persepsies oor huidige valvoorkoming in die sorg van MLM, in geselekteerde streke in sub-Sahara-Afrika te ondersoek. Metodes: Die navorsing het bestaan uit ʼn omvangsbepaling en ʼn primêre kwalitatiewe studie. Die omvangsbepaling het ingesluit eweknie-geëvalueerde studies (uitsluitend narratiewe oorsigte) met enige inligting rakende valle in MLM en wat in Engels beskikbaar was. Enige data aangaande verminderde beendigtheid is ook onttrek uit die studies. Die resultate is gebruik om konsepte voortspruitend uit die kwalitatiewe studie te verduidelik. In die primêre studie is ʼn interpretatiewe verkennende kwalitatiewe navorsingsmetode met ʼn fenomenologiese benadering gebruik om fisioterapeute se persepsies en ervarings rakende beengesondheid en valle in MLM te ondersoek. In-diepte semi-gestruktureerde telefoniese onderhoude is gebruik om data in te samel van fisioterapeute wat in primêre MIV-sorg werk. Hoofresultate: Die omvangsbepaling het 14 studies oor valle in MLM geïdentifiseer. Al die studies, behalwe een, was publikasies vanuit hoë-inkomste lande. Die prevalensie van valle in MLM en hul seronegatiewe eweknieë was soortgelyk, maar die studies het egter meestal middeljariges tot ouer volwassenes ingesluit, in wie geriatriese sindrome alreeds mag voorkom. Aansienlike konsensus is bevind aangaande medikasiegebruik as ‘n risikofaktor, terwyl die bewyse vir funksionele- en kognitiewe gestremdhede as risikofatore wisselvallig was. Min studies het risikofaktore vir valle in MLM vergelyk met dié in ouderdoms- en geslags-vergelykbare seronegatiewe bevolkings. Tans is daar geen bewyse vir ingrypings om die valrisiko in MLM te verminder of voorkom nie. Die primêre studie het ‘n gebrekkige bewustheid omtrent verhoogte valrisiko en verminderde beendigtheid in MLM onder fisioterapeute onthul. Fisioterapeute het as sulks nie valle of frakture aan MIV of antiretrovirale behandeling gekoppel wanneer hulle wel sulke gebeure tydens hul algemene pasiënt-ondersoeke waargeneem het nie. In retrospek kon sommige fisioterapeute egter risikofaktore wat verband hou met val by mense met MIV, herken. Huidige dienste vir val-voorkoming, soos waargeneem deur fisioterapeute, is bemerk as suboptimaal en het nie ʼn pasiënt-gesentreerde benadering nie. Gevolgtrekking: Dit mag nodig wees vir fisioterapeute om meer bewus te wees van die potensiële valrisiko en verminderde beendigtheid in MLM en om roetineweg te assesseer vir die verskynsels in ouer sowel as jonger MLM. Groter bewustheid moet ook geskep word onder ander gesondheidsorgwerkers en MLM. Intussen is meer navorsing nodig omtrent valle in jonger MLM en in sub-Sahara-Afrika, waar MIV mees algemeen, en as robuuster klades, voorkom.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108087
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