Infant health: a community-based assessment and educational intervention in two rural communities in the Eastern Cape.
- Authors: Kuzeeko, Faith
- Date: 2021
- Subjects: Angus Gillis Foundation (South Africa) , Infants -- Mortality -- South Africa , Infants -- Health and hygiene -- South Africa , Breastfeeding -- South Africa -- Eastern Cape , Infants -- Care -- Equipment and supplies , Infants -- Care -- South Africa -- Eastern Cape -- Case studies , Children -- Mortality -- South Africa , High throughput screening (Drug development)
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/170837 , vital:41964
- Description: South Africa is on track to attaining the 2030 Agenda on reducing under-five deaths to 25 deaths per 1000 live births at its current momentum, however an unacceptable amount of infants are still at risk from preventable illnesses. Malnutrition is the major underlined cause of infant mortality rates in South Africa. Exclusive breastfeeding rates are low nationwide due to low exposure to breastfeeding information, some mothers having other commitments and others having breastfeeding difficulties. Implementation and expansion of simple, cost-effective interventions, such as exclusive breastfeeding for six months to reduce and/or prevent infant mortality rates, remains low in South Africa. The aim of the study was to determine one infant health issue of major concern to participants in two rural villages in the Eastern Cape, namely Glenmore and Ndwayana. The identified infant health issue was used to design an educational intervention in the villages. This was the second phase of this study. A community-based participatory approach was utilized in which the Angus Gillis Foundation, a non-profit organization that works in these communities, was one of the stakeholders. Stock status of WHO priority medicines for infants, semi-structured interviews and focus group discussions were carried out during the baseline study. The intervention phase contained pre-2 intervention semi-structured interviews with ten pregnant women followed by an educational intervention with nine out of the ten; and finally, a post-intervention with seven out of the ten women. A questionnaire was completed by members of the Angus Gillis Foundation to provide feedback on the sustainability of the intervention. Semi-structured interviews revealed that medicines stocked at the clinic parallel those indicated in the WHO priority medicines list for infants. The results from the focus group discussions indicated that mothers do not exclusively breastfeed their infants during the first six months. Pre- and post-intervention results on exclusive breastfeeding illustrated a positive change in participants’ knowledge and intent to breastfeed exclusively for six months. They showed a better understanding of the importance of exclusive breastfeeding and indicated a more focussed intention and confidence to carry out optimal breastfeeding practices. In the questionnaire the members of the Angus Gillis Foundation stated that the intervention is sustainable as it was linked with the existing networks. These include educational programs carried out in the villages by the foundation together with positive health champions, community health workers and women self-help groups; which will be able to build on the present knowledge base. Finally, the study also included the design of a booklet on the identified infant health issue. In conclusion, participants highlighted lack of understanding regarding breastfeeding as an issue of concern during the baseline phase of the study. This community-based educational intervention improved the understanding of breastfeeding among the participants, resulting in a positive change in perception with regards to exclusive breastfeeding practices.
- Full Text:
- Date Issued: 2021
- Authors: Kuzeeko, Faith
- Date: 2021
- Subjects: Angus Gillis Foundation (South Africa) , Infants -- Mortality -- South Africa , Infants -- Health and hygiene -- South Africa , Breastfeeding -- South Africa -- Eastern Cape , Infants -- Care -- Equipment and supplies , Infants -- Care -- South Africa -- Eastern Cape -- Case studies , Children -- Mortality -- South Africa , High throughput screening (Drug development)
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/170837 , vital:41964
- Description: South Africa is on track to attaining the 2030 Agenda on reducing under-five deaths to 25 deaths per 1000 live births at its current momentum, however an unacceptable amount of infants are still at risk from preventable illnesses. Malnutrition is the major underlined cause of infant mortality rates in South Africa. Exclusive breastfeeding rates are low nationwide due to low exposure to breastfeeding information, some mothers having other commitments and others having breastfeeding difficulties. Implementation and expansion of simple, cost-effective interventions, such as exclusive breastfeeding for six months to reduce and/or prevent infant mortality rates, remains low in South Africa. The aim of the study was to determine one infant health issue of major concern to participants in two rural villages in the Eastern Cape, namely Glenmore and Ndwayana. The identified infant health issue was used to design an educational intervention in the villages. This was the second phase of this study. A community-based participatory approach was utilized in which the Angus Gillis Foundation, a non-profit organization that works in these communities, was one of the stakeholders. Stock status of WHO priority medicines for infants, semi-structured interviews and focus group discussions were carried out during the baseline study. The intervention phase contained pre-2 intervention semi-structured interviews with ten pregnant women followed by an educational intervention with nine out of the ten; and finally, a post-intervention with seven out of the ten women. A questionnaire was completed by members of the Angus Gillis Foundation to provide feedback on the sustainability of the intervention. Semi-structured interviews revealed that medicines stocked at the clinic parallel those indicated in the WHO priority medicines list for infants. The results from the focus group discussions indicated that mothers do not exclusively breastfeed their infants during the first six months. Pre- and post-intervention results on exclusive breastfeeding illustrated a positive change in participants’ knowledge and intent to breastfeed exclusively for six months. They showed a better understanding of the importance of exclusive breastfeeding and indicated a more focussed intention and confidence to carry out optimal breastfeeding practices. In the questionnaire the members of the Angus Gillis Foundation stated that the intervention is sustainable as it was linked with the existing networks. These include educational programs carried out in the villages by the foundation together with positive health champions, community health workers and women self-help groups; which will be able to build on the present knowledge base. Finally, the study also included the design of a booklet on the identified infant health issue. In conclusion, participants highlighted lack of understanding regarding breastfeeding as an issue of concern during the baseline phase of the study. This community-based educational intervention improved the understanding of breastfeeding among the participants, resulting in a positive change in perception with regards to exclusive breastfeeding practices.
- Full Text:
- Date Issued: 2021
Collaborative health literacy development: a World Health Organization workplace health promotion approach to address tobacco use
- Authors: Duxbury, Theodore Orlando
- Date: 2019
- Subjects: Tobacco use -- Health aspects , Smoking -- Health aspects , Employee health promotion , Employee health promotion -- Computer programs , Rhodes University -- Employees -- Tobacco use
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/104116 , vital:29930
- Description: Background: Non-Communicable Diseases (NCDs) are a major global public health threat and tobacco use in particular is the leading cause of preventable illness and mortality globally. Furthermore, vulnerable and socially disadvantaged people get sicker and die sooner, especially because they are at higher risk of being exposed to harmful products such as tobacco and have limited access to health services. Tobacco use also has a major impact on the workplace, adversely affecting work productivity and increasing absenteeism. Both the living and work environments, therefore, play an important role in contributing towards the NCD epidemic. Demographics, culture, behaviour change reluctance and health literacy are all factors which exacerbate tobacco prevalence in South Africa. Workplace health promotion, however, is not well established in many workplaces. This study aimed to develop, implement and evaluate the effectiveness of a culturallysensitive and contextually-appropriate collaborative workplace health promotion literacy programme on tobacco use, utilizing tailored health information leaflets and the Rhodes University peer educators support staff, guided by the World Health Organization Workplace Health Promotion Framework. Method: The research was conducted using a participatory action research approach, which involved four phases: Firstly, the Exploratory phase assessed tobacco-related health promotion policies and practices at Rhodes University; and established facilitating and constraining factors related to tobacco use. Secondly, the Educational health promotion phase involved designing and testing a health promotion educational intervention to address tobacco use related challenges, which took the form of culturally sensitive and appropriate health information leaflets to be used as an educational intervention Thirdly, in the Implementation phase health promotion training workshops were conducted with volunteering Rhodes University Peer Educators. Finally, an Evaluation phase involved evaluating the tobacco health promotion programme presented to the Rhodes University Peer Educators through a focus group discussion; and evaluating Peer Educator recall on the tobacco related health information discussed during the training workshops through a post-post intervention questionnaire. Eight semi-structured interviews (SSIs) and seven focus group discussions (FGDs) were conducted with support staff, peer educators and key stakeholders to establish the need for a comprehensive workplace health promotion initiative, and to identify the facilitating and constraining factors to conducting such an initiative on tobacco use at the University. Three health information leaflets (HILs) were developed collaboratively with the Peer Educators following a series of scientific, end-user testing approaches. The HILs were tested for readability, comprehension, actionability and suitability. A four-day health promotion training programme was conducted to improve user friendliness, memory retention and recall of the HILs by the peer educators and to improve tobacco related health literacy aspects. The participants’ memory recall was evaluated using a pre- and post-, and post-post-intervention questionnaire to evaluate knowledge transfer. The study participants were also equipped with the completed HILs to distribute to their peers and to use as reference sources of information when needed in future. Results: The peer educators and institutional management supported the need for a tobacco workplace health promotion intervention. The intervention and evaluation phase of this study proved that health information material developed was readable, actionable, suitable, userfriendly, culturally sensitive and contextually appropriate. The workshops resulted in a significant increase in the participants’ tobacco related health knowledge. Through the adoption of a collaborative approach to the research, the participants felt empowered and ready to be agents of change amongst their peers in the workplace. Recommendations: The collective use of external expert reviewers, end-user testing techniques and validated computer programmes are recommended to improve the validity of health promotion research outcomes. A longitudinal study that focus on behaviour change, specifically, with health evaluation and monitoring aspects could be conducted as the next step to this study.
- Full Text:
- Date Issued: 2019
- Authors: Duxbury, Theodore Orlando
- Date: 2019
- Subjects: Tobacco use -- Health aspects , Smoking -- Health aspects , Employee health promotion , Employee health promotion -- Computer programs , Rhodes University -- Employees -- Tobacco use
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/104116 , vital:29930
- Description: Background: Non-Communicable Diseases (NCDs) are a major global public health threat and tobacco use in particular is the leading cause of preventable illness and mortality globally. Furthermore, vulnerable and socially disadvantaged people get sicker and die sooner, especially because they are at higher risk of being exposed to harmful products such as tobacco and have limited access to health services. Tobacco use also has a major impact on the workplace, adversely affecting work productivity and increasing absenteeism. Both the living and work environments, therefore, play an important role in contributing towards the NCD epidemic. Demographics, culture, behaviour change reluctance and health literacy are all factors which exacerbate tobacco prevalence in South Africa. Workplace health promotion, however, is not well established in many workplaces. This study aimed to develop, implement and evaluate the effectiveness of a culturallysensitive and contextually-appropriate collaborative workplace health promotion literacy programme on tobacco use, utilizing tailored health information leaflets and the Rhodes University peer educators support staff, guided by the World Health Organization Workplace Health Promotion Framework. Method: The research was conducted using a participatory action research approach, which involved four phases: Firstly, the Exploratory phase assessed tobacco-related health promotion policies and practices at Rhodes University; and established facilitating and constraining factors related to tobacco use. Secondly, the Educational health promotion phase involved designing and testing a health promotion educational intervention to address tobacco use related challenges, which took the form of culturally sensitive and appropriate health information leaflets to be used as an educational intervention Thirdly, in the Implementation phase health promotion training workshops were conducted with volunteering Rhodes University Peer Educators. Finally, an Evaluation phase involved evaluating the tobacco health promotion programme presented to the Rhodes University Peer Educators through a focus group discussion; and evaluating Peer Educator recall on the tobacco related health information discussed during the training workshops through a post-post intervention questionnaire. Eight semi-structured interviews (SSIs) and seven focus group discussions (FGDs) were conducted with support staff, peer educators and key stakeholders to establish the need for a comprehensive workplace health promotion initiative, and to identify the facilitating and constraining factors to conducting such an initiative on tobacco use at the University. Three health information leaflets (HILs) were developed collaboratively with the Peer Educators following a series of scientific, end-user testing approaches. The HILs were tested for readability, comprehension, actionability and suitability. A four-day health promotion training programme was conducted to improve user friendliness, memory retention and recall of the HILs by the peer educators and to improve tobacco related health literacy aspects. The participants’ memory recall was evaluated using a pre- and post-, and post-post-intervention questionnaire to evaluate knowledge transfer. The study participants were also equipped with the completed HILs to distribute to their peers and to use as reference sources of information when needed in future. Results: The peer educators and institutional management supported the need for a tobacco workplace health promotion intervention. The intervention and evaluation phase of this study proved that health information material developed was readable, actionable, suitable, userfriendly, culturally sensitive and contextually appropriate. The workshops resulted in a significant increase in the participants’ tobacco related health knowledge. Through the adoption of a collaborative approach to the research, the participants felt empowered and ready to be agents of change amongst their peers in the workplace. Recommendations: The collective use of external expert reviewers, end-user testing techniques and validated computer programmes are recommended to improve the validity of health promotion research outcomes. A longitudinal study that focus on behaviour change, specifically, with health evaluation and monitoring aspects could be conducted as the next step to this study.
- Full Text:
- Date Issued: 2019
Workplace health promotion at Rhodes University: harmful use of alcohol
- Authors: Marara, Praise
- Date: 2019
- Subjects: Chronic diseases -- South Africa , Health education -- South Africa , Drinking of alcoholic beverages -- Health aspects -- South Africa , Employees -- Alcohol use -- South Africa , Employee health promotion -- South Africa , Rhodes University -- Employees -- Health and hygiene
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/67444 , vital:29088
- Description: Background: Non-communicable diseases (NCDs) are responsible for 38 million deaths annually, which translates to 68% of global deaths every year. Incidence and prevalence of NCDs are increasing rapidly and the poor bear a disproportionate burden. The increase in NCDs has been primarily due to a proliferation of modifiable risk factors, such as unhealthy diet, physical inactivity, tobacco use, and excessive alcohol consumption. Substance abuse, mainly of alcohol, is a common cause of health problems in almost all countries across the globe. Alcohol abuse is a major contributor to the global burden of diseases and accounts for 3.3 million deaths, approximately 5.9% of all global deaths, annually. Alcohol misuse is the fifth leading risk factor for premature death and disability and is the top risk factor among people between 15 and 49 years of age. The rise of harmful use of alcohol in South Africa contributes to the disease burden faced by the country, with alcohol-related disorders making up 44.6% of all alcohol-attributable disabilities. Strategies to reduce harmful use of alcohol include national policies and educational interventions including health promotion. Health promotion is a common practice in the prevention of NCDs, but workplace health promotion has not yet been well established in many workplaces. Identification of past workplace initiatives and exploring their facilitating and limiting factors is thus important to consider when planning future initiatives. Raising awareness on harmful use of alcohol through workplace health promotion projects can help to prevent and reduce alcohol-related problems. For these health promotion activities to succeed, they need to be developed with consideration of factors such as the environment, culture, and socio-economic standing of the intended target population. Method: This study, conducted at Rhodes University, followed a mixed methods research approach and consisted of two phases. The first phase of the current study was a needs assessment and involved working with the key stakeholders. Using the Community Based Participatory Research approach and the Centres for Disease Control and prevention workplace health model to guide the research, five semi-structured interviews were conducted with key stakeholders to identify factors affecting workplace health promotion, and their opinions on how to improve these initiatives were sought. The participants were asked to identify areas on which the intended intervention should focus, as well as to identify their preferred means of communicating health messages. During this phase, a group of peer educators who volunteered their involvement in the health promotion project focusing on harmful use of alcohol was also identified. The second phase of this project aimed to address concerns raised in the first phase through a health promotion initiative for support staff that focuses on the prevention of NCDs diseases through reducing alcohol related harm. During the educational health promotion phase of the study, three health information leaflets based on harmful use of alcohol were designed. These leaflets went through a series of evaluations by the researchers’ peers, support staff during a pilot study, peer educators and other health professionals to assess content validity, context specificity, and cultural appropriateness for the target group. The health information leaflets were then used as written materials in the educational intervention of the project and were also used to design a poster. Through participatory involvement, a facilitator’s manual on harmful use of alcohol was developed, which was used during the workshops in the implementation phase of the research. The facilitator’s manual was modified based on provided feedback on improving the content of the facilitator’s manual. The readability of the manual was also performed to make it suitable for the end users. The peer educators were also trained through workshops to enable them to promote and raise awareness on harmful use of alcohol to others in the workplace. Workshops were participatory in nature and were also equipped with the completed health information leaflets to distribute to their peers and to use as reference sources of information when needed. Results: Participants in the semi-structured interviews reported that some health promotion initiatives have previously been attempted and advertised to support staff, but there was poor participant participation. Peer educators reported that these initiatives were not communicated to them and venues and work commitments sometimes were barriers to participation in these projects. The peer educators suggested incentivising initiatives for better participation. Another key suggestion was to inform and to include their managers and supervisors in these initiatives so they are permitted to take time off work. Health education material like posters or leaflets were also proposed as modes of delivering health information. During the design of the material to be used for this project’s intended intervention, the health information leaflets were deemed readable, suitable, actionable, context-specific, and culturally appropriate. Workshops conducted during Phase 2 of the study proved to be valuable in training peer educators. Peer educators also deemed the workshops useful, and reported their readiness to be agents of change in the workplace. Conclusions: Based on the input of key stakeholders and peer educators, there is currently no health promotion policy at Rhodes University, especially with respect to NCDs health promotion policies and protocols for NCDs. Health promotion initiatives, especially for support staff, that address NCDs have previously been attempted at the university but were not successful. Factors affecting workplace health promotion were identified. Knowledge of these factors was useful when implementing the health promotion project on harmful use of alcohol. The health leaflets were deemed suitable for use by the target population. Peer educators who went through the workshops and were provided with the facilitators’ manuals concluded that the sessions were useful in their continued participation in the health promotion project. Continued involvement of the Wellness Office and peer educators can assist in ensuring the sustainability of this workplace health initiative.
- Full Text:
- Date Issued: 2019
- Authors: Marara, Praise
- Date: 2019
- Subjects: Chronic diseases -- South Africa , Health education -- South Africa , Drinking of alcoholic beverages -- Health aspects -- South Africa , Employees -- Alcohol use -- South Africa , Employee health promotion -- South Africa , Rhodes University -- Employees -- Health and hygiene
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/67444 , vital:29088
- Description: Background: Non-communicable diseases (NCDs) are responsible for 38 million deaths annually, which translates to 68% of global deaths every year. Incidence and prevalence of NCDs are increasing rapidly and the poor bear a disproportionate burden. The increase in NCDs has been primarily due to a proliferation of modifiable risk factors, such as unhealthy diet, physical inactivity, tobacco use, and excessive alcohol consumption. Substance abuse, mainly of alcohol, is a common cause of health problems in almost all countries across the globe. Alcohol abuse is a major contributor to the global burden of diseases and accounts for 3.3 million deaths, approximately 5.9% of all global deaths, annually. Alcohol misuse is the fifth leading risk factor for premature death and disability and is the top risk factor among people between 15 and 49 years of age. The rise of harmful use of alcohol in South Africa contributes to the disease burden faced by the country, with alcohol-related disorders making up 44.6% of all alcohol-attributable disabilities. Strategies to reduce harmful use of alcohol include national policies and educational interventions including health promotion. Health promotion is a common practice in the prevention of NCDs, but workplace health promotion has not yet been well established in many workplaces. Identification of past workplace initiatives and exploring their facilitating and limiting factors is thus important to consider when planning future initiatives. Raising awareness on harmful use of alcohol through workplace health promotion projects can help to prevent and reduce alcohol-related problems. For these health promotion activities to succeed, they need to be developed with consideration of factors such as the environment, culture, and socio-economic standing of the intended target population. Method: This study, conducted at Rhodes University, followed a mixed methods research approach and consisted of two phases. The first phase of the current study was a needs assessment and involved working with the key stakeholders. Using the Community Based Participatory Research approach and the Centres for Disease Control and prevention workplace health model to guide the research, five semi-structured interviews were conducted with key stakeholders to identify factors affecting workplace health promotion, and their opinions on how to improve these initiatives were sought. The participants were asked to identify areas on which the intended intervention should focus, as well as to identify their preferred means of communicating health messages. During this phase, a group of peer educators who volunteered their involvement in the health promotion project focusing on harmful use of alcohol was also identified. The second phase of this project aimed to address concerns raised in the first phase through a health promotion initiative for support staff that focuses on the prevention of NCDs diseases through reducing alcohol related harm. During the educational health promotion phase of the study, three health information leaflets based on harmful use of alcohol were designed. These leaflets went through a series of evaluations by the researchers’ peers, support staff during a pilot study, peer educators and other health professionals to assess content validity, context specificity, and cultural appropriateness for the target group. The health information leaflets were then used as written materials in the educational intervention of the project and were also used to design a poster. Through participatory involvement, a facilitator’s manual on harmful use of alcohol was developed, which was used during the workshops in the implementation phase of the research. The facilitator’s manual was modified based on provided feedback on improving the content of the facilitator’s manual. The readability of the manual was also performed to make it suitable for the end users. The peer educators were also trained through workshops to enable them to promote and raise awareness on harmful use of alcohol to others in the workplace. Workshops were participatory in nature and were also equipped with the completed health information leaflets to distribute to their peers and to use as reference sources of information when needed. Results: Participants in the semi-structured interviews reported that some health promotion initiatives have previously been attempted and advertised to support staff, but there was poor participant participation. Peer educators reported that these initiatives were not communicated to them and venues and work commitments sometimes were barriers to participation in these projects. The peer educators suggested incentivising initiatives for better participation. Another key suggestion was to inform and to include their managers and supervisors in these initiatives so they are permitted to take time off work. Health education material like posters or leaflets were also proposed as modes of delivering health information. During the design of the material to be used for this project’s intended intervention, the health information leaflets were deemed readable, suitable, actionable, context-specific, and culturally appropriate. Workshops conducted during Phase 2 of the study proved to be valuable in training peer educators. Peer educators also deemed the workshops useful, and reported their readiness to be agents of change in the workplace. Conclusions: Based on the input of key stakeholders and peer educators, there is currently no health promotion policy at Rhodes University, especially with respect to NCDs health promotion policies and protocols for NCDs. Health promotion initiatives, especially for support staff, that address NCDs have previously been attempted at the university but were not successful. Factors affecting workplace health promotion were identified. Knowledge of these factors was useful when implementing the health promotion project on harmful use of alcohol. The health leaflets were deemed suitable for use by the target population. Peer educators who went through the workshops and were provided with the facilitators’ manuals concluded that the sessions were useful in their continued participation in the health promotion project. Continued involvement of the Wellness Office and peer educators can assist in ensuring the sustainability of this workplace health initiative.
- Full Text:
- Date Issued: 2019
Medicine use in swallowing-impaired patients: Pharmacists’ knowledge, practice and information needs
- Authors: Masilamoney, Mehrusha
- Date: 2018
- Subjects: Deglutition disorders , Drugs -- Administration , Oral medication -- Administration , Pharmacists -- Practice , South African Pharmacy Council
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/61940 , vital:28086
- Description: Dysphagia, or swallowing impairment, is a growing problem that affects 13.5% of the general population. The ability to swallow is essential for patients taking oral medicines, so this presents a challenge for swallowing-impaired (SI) patients as tablets and capsules will usually require modification prior to ingestion. Pharmacists should play a central role in advising SI patients about their medicine use, as well as problems that may impact on safety, adherence and therapeutic outcome. However, little is known about pharmacists’ level of knowledge, their practice and their information needs when dealing with SI patients and their use of medicines. The aim of this study was to investigate pharmacist knowledge, practice and information needs relating to the support of SI patients and their medicine-related needs. The study design included both quantitative and qualitative methods. A quantitative questionnaire was developed to collect data on the knowledge, practice and information needs of pharmacists and was piloted in 10 pharmacists, which resulted in minor modifications. The questionnaire was converted to a web-based survey and emailed to all pharmacists registered with the South African Pharmacy Council. Two knowledge scores were generated by summating correct responses: knowledge of dysphagia (KOD) and knowledge of medicine use (KOMU) in SI patients. Correlation analysis was used to investigate the strength of the relationship between specific variables with KOD and KOMU using the Pearson correlation coefficient. Qualitative semi-structured interviews were conducted with pharmacists from community, hospital and primary healthcare clinics in both a small town and a major metropole. The aim was to gain deeper understanding of issues arising from the survey, and to explore preferences for topic-specific information materials. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. A total of 439 pharmacists responded to the survey, with 67% being females.The mean KOD score out of a maximum score of 10 was 6.1 ± 1.8. KOD was inadequate (<5) in just over one-third (37.8%) of pharmacists. The mean KOMU score achieved (maximum score 17) was 9.4 ± 2.0, with inadequate knowledge (<10) being established in just over two-thirds of pharmacists (70.8%). Age, length of registration as a pharmacist, and years of practice in a setting with direct patient interaction were significantly but weakly correlated with KOMU, whereas KOD showed no significant association with these variables. Qualification significantly influenced both KOD and KOMU; the highest group with adequate knowledge had either a Masters or a PharmD degree. Fewer than half the pharmacists (44%) never ask patients about their swallowing ability, and most (86%) reported no knowledge of locally available viscosity enhancers. Almost all pharmacists were interested in receiving information materials on assisting SI patients with their medicine use. Three major themes emerged from the semi-structured interviews. Pharmacists recognised their knowledge deficit and felt that lack of both undergraduate training and formal training during practice, as well as limited exposure to SI patients, were contributing factors. Barriers to their practice with SI patients included lack of time, lack of institutional support and lack of easily accessible references on the pharmacists’ role in supporting medicine use in SI patients. Lastly, most pharmacists were not prepared to take ownership of medicine-related problems in SI patients and had conflicting opinions of the pharmacists’ role, usually shifting the responsibility of medicine use in SI patients to nurses. This is the first study to investigate pharmacist knowledge of medicine use in SI patients. The findings indicate that pharmacists do not have the requisite knowledge when dealing with SI patients and their medicine-taking issues despite being the most highly trained healthcare professionals in this field. Lack of undergraduate training, in-house training and limited exposure to SI patients were reported to contribute to poor knowledge. Current practice revealed that there appears to be poor communication among different healthcare professionals, pharmacists were reluctant to work with and/or train nurses on appropriate medicine use in SI patients, and there appeared to be ambiguity surrounding the role of a pharmacist. This research identified that pharmacists regard this topic to be highly relevant to their everyday practice and are keen to receive more information and training relating to this area of study. Information materials were designed and will be made accessible to all pharmacists registered in South Africa.
- Full Text:
- Date Issued: 2018
Medicine use in swallowing-impaired patients: Pharmacists’ knowledge, practice and information needs
- Authors: Masilamoney, Mehrusha
- Date: 2018
- Subjects: Deglutition disorders , Drugs -- Administration , Oral medication -- Administration , Pharmacists -- Practice , South African Pharmacy Council
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/61940 , vital:28086
- Description: Dysphagia, or swallowing impairment, is a growing problem that affects 13.5% of the general population. The ability to swallow is essential for patients taking oral medicines, so this presents a challenge for swallowing-impaired (SI) patients as tablets and capsules will usually require modification prior to ingestion. Pharmacists should play a central role in advising SI patients about their medicine use, as well as problems that may impact on safety, adherence and therapeutic outcome. However, little is known about pharmacists’ level of knowledge, their practice and their information needs when dealing with SI patients and their use of medicines. The aim of this study was to investigate pharmacist knowledge, practice and information needs relating to the support of SI patients and their medicine-related needs. The study design included both quantitative and qualitative methods. A quantitative questionnaire was developed to collect data on the knowledge, practice and information needs of pharmacists and was piloted in 10 pharmacists, which resulted in minor modifications. The questionnaire was converted to a web-based survey and emailed to all pharmacists registered with the South African Pharmacy Council. Two knowledge scores were generated by summating correct responses: knowledge of dysphagia (KOD) and knowledge of medicine use (KOMU) in SI patients. Correlation analysis was used to investigate the strength of the relationship between specific variables with KOD and KOMU using the Pearson correlation coefficient. Qualitative semi-structured interviews were conducted with pharmacists from community, hospital and primary healthcare clinics in both a small town and a major metropole. The aim was to gain deeper understanding of issues arising from the survey, and to explore preferences for topic-specific information materials. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. A total of 439 pharmacists responded to the survey, with 67% being females.The mean KOD score out of a maximum score of 10 was 6.1 ± 1.8. KOD was inadequate (<5) in just over one-third (37.8%) of pharmacists. The mean KOMU score achieved (maximum score 17) was 9.4 ± 2.0, with inadequate knowledge (<10) being established in just over two-thirds of pharmacists (70.8%). Age, length of registration as a pharmacist, and years of practice in a setting with direct patient interaction were significantly but weakly correlated with KOMU, whereas KOD showed no significant association with these variables. Qualification significantly influenced both KOD and KOMU; the highest group with adequate knowledge had either a Masters or a PharmD degree. Fewer than half the pharmacists (44%) never ask patients about their swallowing ability, and most (86%) reported no knowledge of locally available viscosity enhancers. Almost all pharmacists were interested in receiving information materials on assisting SI patients with their medicine use. Three major themes emerged from the semi-structured interviews. Pharmacists recognised their knowledge deficit and felt that lack of both undergraduate training and formal training during practice, as well as limited exposure to SI patients, were contributing factors. Barriers to their practice with SI patients included lack of time, lack of institutional support and lack of easily accessible references on the pharmacists’ role in supporting medicine use in SI patients. Lastly, most pharmacists were not prepared to take ownership of medicine-related problems in SI patients and had conflicting opinions of the pharmacists’ role, usually shifting the responsibility of medicine use in SI patients to nurses. This is the first study to investigate pharmacist knowledge of medicine use in SI patients. The findings indicate that pharmacists do not have the requisite knowledge when dealing with SI patients and their medicine-taking issues despite being the most highly trained healthcare professionals in this field. Lack of undergraduate training, in-house training and limited exposure to SI patients were reported to contribute to poor knowledge. Current practice revealed that there appears to be poor communication among different healthcare professionals, pharmacists were reluctant to work with and/or train nurses on appropriate medicine use in SI patients, and there appeared to be ambiguity surrounding the role of a pharmacist. This research identified that pharmacists regard this topic to be highly relevant to their everyday practice and are keen to receive more information and training relating to this area of study. Information materials were designed and will be made accessible to all pharmacists registered in South Africa.
- Full Text:
- Date Issued: 2018
Development and implementation of health promotion activities for the prevention of adolescent pregnancies
- Authors: Chemuru, Nomsa Rutendo
- Date: 2017
- Subjects: Teenage pregnancy -- South Africa -- Makhanda , Teenage pregnancy -- Prevention -- South Africa -- Makhanda
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/5115 , vital:20776
- Description: Of the eight Millennium Development Goals (MDGs) established in 2000 by the World Health Organisation, Millennium Development Goals 5 aimed at improving maternal health by addressing the high maternal mortality rate and increasing universal access to reproductive health by 2015.Adolescent pregnancy contributes to maternal, perinatal and infant mortality and also worsens the empowerment of young girls by negatively affecting their physical, educational, social, and economic development.This is a pressing public health concern in South Africa. The reduction of adolescent pregnancy is vital for achieving the sustainable human, health social and economic development of society at large. Culturally sensitive interventions to prevent adolescent pregnancies not only integrate the communities' norms, values, practices and behavioural patterns into the intervention's design and implementation but also the historical, social and economic contexts in which they exist. Progress has been made on the research on health promotion and education in South Africa; however communities are often not consulted on the design and conduct of health promotion research projects.The aim of the study was to develop and implement culturally sensitive and appropriate health promotion activities for the prevention of adolescent pregnancy in Grahamstown, Glenmore and Ndwayana communities in the Eastern Cape, South Africa.Two community based organisations and community care workers associated with them participated in this Community Based Participatory Research using the PEN-3 cultural model. The first phase of this study involved semi-structured interviews carried out with 14 community care workers to identify factors and consequences of adolescent pregnancies in their respective communities. The audio-recorded interviews were transcribed and coded using NVivo® 2010 software. The PEN 3 cultural model was adopted in the studyto address the socio-cultural factors contributing to adolescent pregnancy in the communities. The second phase involved a series of interactive workshops with CCWs for a participatory development of the facilitator's manual. Responses from CCWs informed the design of this study's intervention strategies. A facilitator's manual was developed to implement health promotion intervention, leading to the third phase of this study. The guided implementationof the health promotion intervention for the prevention of adolescent pregnancy was carried out over a period of 14 months and evaluated in the final phase of the study. The facilitator's manual was modified based on feedback fromCCWs, on possible improvements and cultural appropriateness. Readability testing guided the final modification of the manual. According to the community care workers, there were a number of adolescents who fell pregnant in their communities each year. The CCWs identified the influence of family members, friends and other stakeholders as contributory factors to adolescent pregnancy. They identified the lack of parental support in informing and educating adolescents about sexual health. Adolescents themselves lacked the maturity to recognise the risks and consequences of adolescent pregnancy. The negative perceptions of contraception in the community were discouraging contraceptive use amongst the adolescents. However, the results showed that enablers such as home and school visits done by the community care workers can be utilised to prevent adolescent pregnancy. Other factors included lack of health promotion materials and activities with information about preventing of adolescent pregnancy, and if available, the material is in English, that the adolescents may not comprehend. Socio-economic factors such as poverty, the Child Support Grant, cross generational relationships and coerced sex further contributed to adolescent pregnancy in the communities.CCWs identified the need for a more comprehensive health promotion intervention to prevent of adolescent pregnancy. A facilitator's manual addressing the prevention of adolescent pregnancy was developed and modified through a series participatory workshops with the community care workers.The facilitator's manual was used by CCWs to conducthealth promotion activities encouraging the prevention of adolescent pregnancies within the community's clinics, schools and during home visits. Community based participatory research methods and the PEN-3cultural model were used to develop this culturally sensitive and community specific adolescent pregnancy intervention for and by the CCWs. The participatory development of the facilitator's manual and the regular interactive workshops with the CCWs were strengthened by embedding this project into the development programs of the two non-governmental organisations contributing to sustainable development programs for women and children.
- Full Text:
- Date Issued: 2017
- Authors: Chemuru, Nomsa Rutendo
- Date: 2017
- Subjects: Teenage pregnancy -- South Africa -- Makhanda , Teenage pregnancy -- Prevention -- South Africa -- Makhanda
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/5115 , vital:20776
- Description: Of the eight Millennium Development Goals (MDGs) established in 2000 by the World Health Organisation, Millennium Development Goals 5 aimed at improving maternal health by addressing the high maternal mortality rate and increasing universal access to reproductive health by 2015.Adolescent pregnancy contributes to maternal, perinatal and infant mortality and also worsens the empowerment of young girls by negatively affecting their physical, educational, social, and economic development.This is a pressing public health concern in South Africa. The reduction of adolescent pregnancy is vital for achieving the sustainable human, health social and economic development of society at large. Culturally sensitive interventions to prevent adolescent pregnancies not only integrate the communities' norms, values, practices and behavioural patterns into the intervention's design and implementation but also the historical, social and economic contexts in which they exist. Progress has been made on the research on health promotion and education in South Africa; however communities are often not consulted on the design and conduct of health promotion research projects.The aim of the study was to develop and implement culturally sensitive and appropriate health promotion activities for the prevention of adolescent pregnancy in Grahamstown, Glenmore and Ndwayana communities in the Eastern Cape, South Africa.Two community based organisations and community care workers associated with them participated in this Community Based Participatory Research using the PEN-3 cultural model. The first phase of this study involved semi-structured interviews carried out with 14 community care workers to identify factors and consequences of adolescent pregnancies in their respective communities. The audio-recorded interviews were transcribed and coded using NVivo® 2010 software. The PEN 3 cultural model was adopted in the studyto address the socio-cultural factors contributing to adolescent pregnancy in the communities. The second phase involved a series of interactive workshops with CCWs for a participatory development of the facilitator's manual. Responses from CCWs informed the design of this study's intervention strategies. A facilitator's manual was developed to implement health promotion intervention, leading to the third phase of this study. The guided implementationof the health promotion intervention for the prevention of adolescent pregnancy was carried out over a period of 14 months and evaluated in the final phase of the study. The facilitator's manual was modified based on feedback fromCCWs, on possible improvements and cultural appropriateness. Readability testing guided the final modification of the manual. According to the community care workers, there were a number of adolescents who fell pregnant in their communities each year. The CCWs identified the influence of family members, friends and other stakeholders as contributory factors to adolescent pregnancy. They identified the lack of parental support in informing and educating adolescents about sexual health. Adolescents themselves lacked the maturity to recognise the risks and consequences of adolescent pregnancy. The negative perceptions of contraception in the community were discouraging contraceptive use amongst the adolescents. However, the results showed that enablers such as home and school visits done by the community care workers can be utilised to prevent adolescent pregnancy. Other factors included lack of health promotion materials and activities with information about preventing of adolescent pregnancy, and if available, the material is in English, that the adolescents may not comprehend. Socio-economic factors such as poverty, the Child Support Grant, cross generational relationships and coerced sex further contributed to adolescent pregnancy in the communities.CCWs identified the need for a more comprehensive health promotion intervention to prevent of adolescent pregnancy. A facilitator's manual addressing the prevention of adolescent pregnancy was developed and modified through a series participatory workshops with the community care workers.The facilitator's manual was used by CCWs to conducthealth promotion activities encouraging the prevention of adolescent pregnancies within the community's clinics, schools and during home visits. Community based participatory research methods and the PEN-3cultural model were used to develop this culturally sensitive and community specific adolescent pregnancy intervention for and by the CCWs. The participatory development of the facilitator's manual and the regular interactive workshops with the CCWs were strengthened by embedding this project into the development programs of the two non-governmental organisations contributing to sustainable development programs for women and children.
- Full Text:
- Date Issued: 2017
Evaluation of the acceptability of ambulatory blood pressure monitoring in a semi-rural, Eastern Cape population
- Authors: Chiwanza, Farisai
- Date: 2017
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59161 , vital:27447
- Description: Expected release date-April 2019
- Full Text:
- Date Issued: 2017
- Authors: Chiwanza, Farisai
- Date: 2017
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59161 , vital:27447
- Description: Expected release date-April 2019
- Full Text:
- Date Issued: 2017
Health promotion: approaches to dietary salt reduction
- Authors: Mushoriwa, Fadzai
- Date: 2017
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/44761 , vital:25439
- Description: Background Globally, non-communicable diseases are the leading causes of mortality and morbidity, with the majority of these occurring in low-middle income countries. The devastating consequences of non-communicable diseases could be curtailed through better management of four modifiable factors: physical inactivity; tobacco use; harmful use of alcohol; and unhealthy diets. The World Health Organisation has recommended dietary salt reduction as a cost-effective strategy in combatting the burden of NCDs. Consumer awareness and education is one of three primary strategies that have been identified by the World Health Organisation to achieve population-wide salt reduction. It involves the provision of salt reduction knowledge and the promotion of healthy salt related practices. These campaigns are a necessity in populations with high discretionary salt use such as South Africa. For these health promotion activities to succeed, they need to be developed with consideration of factors such as the environment, culture, and socio-economic standing of the intended target population. This two-phase health promotion study was conducted at St Mary’s Development and Care Centre and the Assumption Sisters Nutrition Centre. These are two community based organisations located in Grahamstown, South Africa. A needs assessment was conducted to identify the knowledge and practices of cooks and guardians from these centres on dietary salt reduction. The aim of the second phase of the study was to conduct an educational intervention and to develop a culturally appropriate and contextually specific health information intervention through a participatory process. Method: This was a qualitative study that was supported by elements of quantitative research.. The first phase of the current study was a needs assessment. The first step involved an observational phase with cooks from the centres. The aim was to observe their discretionary salt use during food preparation and to document the salt content in the processed foods available at each centre. Semi-structured interviews were then conducted, with 3 cooks and 16 guardians1 from the centres, to assess their knowledge and practices regarding salt reduction.Parents or the people responsible for the care of the children attending both centres. Guided by findings from the needs assessment phase, an educational intervention was developed. This phase involved the participatory development of three health information leaflets and a series of educational interactive sessions were conducted. Quantitative tests to assess the readability, suitability, and actionability were conducted on the leaflets. Qualitative assessment of the leaflets involved formative evaluations conducted by health care professionals, phase 1 participants, Rhodes University peer educators, an African languages and cultural expert, and a Rhodes University student wellness manager. This step was included to assess the content validity, context specificity, acceptability, and cultural appropriateness of the materials. Educational interactive sessions were guided by constructs of the Social Cognitive Theory and were conducted on three main topics: ‘Salt and my health’, ‘Reducing salt in my diet’, and ‘Reading food labels’. Results: The majority of the processed foods available at both centres contained low to medium levels of salt. Children at the centres were not provided with salt shakers on the tables during meal times. Cooks did not use measuring utensils when adding salt during meal preparation. Semistructured interviews revealed that participants lacked both declarative and procedural knowledge. In terms of declarative knowledge, they were unaware of the daily salt intake recommendations and the relationship between salt and sodium. Participants were able to identify hypertension as one of the health related consequences of high salt consumption. Most participants were responsible for purchasing groceries in their households. Their selfreported food label reading behaviours and inability to read food labels highlighted their lack of procedural knowledge. Most participants reported that they added salt during meal preparation and at mealtimes, highlighting high discretionary salt use. Some participants were also aware of cultural or religious uses of salt. The developed health information leaflets were considered to be written at a readability level appropriate for the target audience. The leaflets were also deemed to be actionable, culturally appropriate, and contextually specific and suitable materials. The educational interactive sessions were found to be interesting and informative. Conclusions: Findings from the needs assessment revealed the need for an educational intervention to address the identified gaps in the participants’ knowledge and practices regarding dietary salt reduction. The developed health information leaflets were found to be informative, culturally appropriate, and contextually specific, as planned. Interactive sessions provided an excellent platform to supply participants with concise and accurate information, increasing the possibility of improving their salt reduction related knowledge.
- Full Text:
- Date Issued: 2017
- Authors: Mushoriwa, Fadzai
- Date: 2017
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/44761 , vital:25439
- Description: Background Globally, non-communicable diseases are the leading causes of mortality and morbidity, with the majority of these occurring in low-middle income countries. The devastating consequences of non-communicable diseases could be curtailed through better management of four modifiable factors: physical inactivity; tobacco use; harmful use of alcohol; and unhealthy diets. The World Health Organisation has recommended dietary salt reduction as a cost-effective strategy in combatting the burden of NCDs. Consumer awareness and education is one of three primary strategies that have been identified by the World Health Organisation to achieve population-wide salt reduction. It involves the provision of salt reduction knowledge and the promotion of healthy salt related practices. These campaigns are a necessity in populations with high discretionary salt use such as South Africa. For these health promotion activities to succeed, they need to be developed with consideration of factors such as the environment, culture, and socio-economic standing of the intended target population. This two-phase health promotion study was conducted at St Mary’s Development and Care Centre and the Assumption Sisters Nutrition Centre. These are two community based organisations located in Grahamstown, South Africa. A needs assessment was conducted to identify the knowledge and practices of cooks and guardians from these centres on dietary salt reduction. The aim of the second phase of the study was to conduct an educational intervention and to develop a culturally appropriate and contextually specific health information intervention through a participatory process. Method: This was a qualitative study that was supported by elements of quantitative research.. The first phase of the current study was a needs assessment. The first step involved an observational phase with cooks from the centres. The aim was to observe their discretionary salt use during food preparation and to document the salt content in the processed foods available at each centre. Semi-structured interviews were then conducted, with 3 cooks and 16 guardians1 from the centres, to assess their knowledge and practices regarding salt reduction.Parents or the people responsible for the care of the children attending both centres. Guided by findings from the needs assessment phase, an educational intervention was developed. This phase involved the participatory development of three health information leaflets and a series of educational interactive sessions were conducted. Quantitative tests to assess the readability, suitability, and actionability were conducted on the leaflets. Qualitative assessment of the leaflets involved formative evaluations conducted by health care professionals, phase 1 participants, Rhodes University peer educators, an African languages and cultural expert, and a Rhodes University student wellness manager. This step was included to assess the content validity, context specificity, acceptability, and cultural appropriateness of the materials. Educational interactive sessions were guided by constructs of the Social Cognitive Theory and were conducted on three main topics: ‘Salt and my health’, ‘Reducing salt in my diet’, and ‘Reading food labels’. Results: The majority of the processed foods available at both centres contained low to medium levels of salt. Children at the centres were not provided with salt shakers on the tables during meal times. Cooks did not use measuring utensils when adding salt during meal preparation. Semistructured interviews revealed that participants lacked both declarative and procedural knowledge. In terms of declarative knowledge, they were unaware of the daily salt intake recommendations and the relationship between salt and sodium. Participants were able to identify hypertension as one of the health related consequences of high salt consumption. Most participants were responsible for purchasing groceries in their households. Their selfreported food label reading behaviours and inability to read food labels highlighted their lack of procedural knowledge. Most participants reported that they added salt during meal preparation and at mealtimes, highlighting high discretionary salt use. Some participants were also aware of cultural or religious uses of salt. The developed health information leaflets were considered to be written at a readability level appropriate for the target audience. The leaflets were also deemed to be actionable, culturally appropriate, and contextually specific and suitable materials. The educational interactive sessions were found to be interesting and informative. Conclusions: Findings from the needs assessment revealed the need for an educational intervention to address the identified gaps in the participants’ knowledge and practices regarding dietary salt reduction. The developed health information leaflets were found to be informative, culturally appropriate, and contextually specific, as planned. Interactive sessions provided an excellent platform to supply participants with concise and accurate information, increasing the possibility of improving their salt reduction related knowledge.
- Full Text:
- Date Issued: 2017
Microbial water quality monitoring of raw and treated water sources in Harare and the effect of gender in disaster management due to water related disasters
- Authors: Chirenda, Tatenda Grace
- Date: 2017
- Subjects: Drinking water Microbiology Zimbabwe Harare , Heterotrophic bacteria Zimbabwe Harare , Emergency management Zimbabwe Harare , Disasters Social aspects Zimbabwe Harare , Water quality management Zimbabwe Harare , Public health Zimbabwe Harare , Sex role Zimbabwe Harare
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59156 , vital:27444
- Description: Background - Microbial water quality monitoring is essential to the provision of potable water for domestic use. Unsafe water sources increase the risk of waterborne diseases. There is a need to raise awareness of legislature that supports management of water related disasters. Gender, education, health, and economic vulnerability contribute to the success of disaster management. Aim - This study aimed to investigate the microbial water quality of treated water in the Harare area. The study also researched the microbial water quality monitoring practices in Zimbabwe and how these contribute to the management of water borne diseases. The impact of gender, marriage, education, and disease in disaster management practices in Zimbabwe and South Africa was analysed. Method - Literature review was conducted on microbial water quality monitoring practices in Zimbabwe and legislature that supports disaster management. Practices of disaster management in Zimbabwe, and South Africa were investigated and compared. The perspective of the Harare community on the quality of their potable water was investigated through the use of a questionnaire and water quality testing was conducted using hydrogen sulphide test and R2A based heterotrophic plate count. Raw water supplying Manyame River and tap water in Harare households were assessed for microbial quality. Results and Discussion - Raw water sources were found to be contaminated by faecal matter. Household water sources had no faecal contamination, but tested positive for heterotrophic bacteria. The CFU/ml quantities obtained ranged from 1- 452 CFU/ml for all samples. The WHO guidelines for domestic water sources recommend that domestic water should have no coliforms/100 ml sample. Disaster management protocols were available in disaster prone areas such as the Matabeleland South Province. No guidelines were in place for monitoring microbial water quality as a disaster prevention method. Conclusion - The current state of treated water supplied by the Morton Jaffray Treatment Plant was found to be suitable for domestic use, but not sufficient to meet the Harare population’s needs. The need to push for legislature supporting microbial water quality monitoring was recognised. Initiating public / private partnerships in water distribution and water quality monitoring in Zimbabwe was encouraged.
- Full Text:
- Date Issued: 2017
- Authors: Chirenda, Tatenda Grace
- Date: 2017
- Subjects: Drinking water Microbiology Zimbabwe Harare , Heterotrophic bacteria Zimbabwe Harare , Emergency management Zimbabwe Harare , Disasters Social aspects Zimbabwe Harare , Water quality management Zimbabwe Harare , Public health Zimbabwe Harare , Sex role Zimbabwe Harare
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59156 , vital:27444
- Description: Background - Microbial water quality monitoring is essential to the provision of potable water for domestic use. Unsafe water sources increase the risk of waterborne diseases. There is a need to raise awareness of legislature that supports management of water related disasters. Gender, education, health, and economic vulnerability contribute to the success of disaster management. Aim - This study aimed to investigate the microbial water quality of treated water in the Harare area. The study also researched the microbial water quality monitoring practices in Zimbabwe and how these contribute to the management of water borne diseases. The impact of gender, marriage, education, and disease in disaster management practices in Zimbabwe and South Africa was analysed. Method - Literature review was conducted on microbial water quality monitoring practices in Zimbabwe and legislature that supports disaster management. Practices of disaster management in Zimbabwe, and South Africa were investigated and compared. The perspective of the Harare community on the quality of their potable water was investigated through the use of a questionnaire and water quality testing was conducted using hydrogen sulphide test and R2A based heterotrophic plate count. Raw water supplying Manyame River and tap water in Harare households were assessed for microbial quality. Results and Discussion - Raw water sources were found to be contaminated by faecal matter. Household water sources had no faecal contamination, but tested positive for heterotrophic bacteria. The CFU/ml quantities obtained ranged from 1- 452 CFU/ml for all samples. The WHO guidelines for domestic water sources recommend that domestic water should have no coliforms/100 ml sample. Disaster management protocols were available in disaster prone areas such as the Matabeleland South Province. No guidelines were in place for monitoring microbial water quality as a disaster prevention method. Conclusion - The current state of treated water supplied by the Morton Jaffray Treatment Plant was found to be suitable for domestic use, but not sufficient to meet the Harare population’s needs. The need to push for legislature supporting microbial water quality monitoring was recognised. Initiating public / private partnerships in water distribution and water quality monitoring in Zimbabwe was encouraged.
- Full Text:
- Date Issued: 2017
Studies in the thiophenol mediated substitution and reductive dehalogenation of 3 bromoacetylcoumarins
- Authors: Magwenzi, Faith N
- Date: 2017
- Subjects: 3-bromoacetylcoumarins , Coumarins , Halogens -- Decontamination , Thiols , Plasmodium falciparum , Malaria -- Chemotherapy
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/45769 , vital:25546
- Description: A previous study conducted by our group identified indolyl-3-ethanone-a-thioethers (2.1a and 2.1b) as non-toxic, nanomolar, in vitro inhibitors of Plasmodium falciparum. Since the coumarin scaffold is associated with numerous biologically active compounds including antiprotozoal, anti-viral, anti-bacterial, and anti-inflammatory agents we were prompted to investigate coumaryl-3-ethanone-a-thioethers (2.1c) inspired by the activity of 2.1a and 2.1b against P. falciparum. We proposed a three-step synthesis of our target compounds 2.1c. The first step involved the Knoevenagel synthesis of 3-acetyl coumarins (2.3.1a - e) followed by a selective a-bromination to yield 3-bromoacetyl coumarin (2.2a). The final proposed step involved the nucleophilic displacement of the bromine by appropriately substituted thiophenols in either the presence or absence of base (K2CO3). Our initial findings revealed an unexpected major reductive dehalogenation of 2.2a into 2.3.1a. Further investigation revealed a close relationship between the electron withdrawing or donating nature of the thiophenol substituents and the relative formation of nucleophilic substitution or reductive dehalogenation products. Desired thioether products were obtained in higher yields when thiophenol was substituted with electron donating groups i.e. more nucleophilic thiophenols, while conversely, electron withdrawing substituents (i.e. lowered nucleophilicity) resulted in an increase of reductive dehalogenation. Furthermore, these results were consistent when experiments were conducted using either 2 or 1.2 equivalents of thiophenols which was an important observation in the context of two previous studies, by Oki et. al. and Israel et. al. Oki proposed that dehalogenation of a-chloro carbonyls occurs via sequential nucleophilic displacement of a-thioethers, while the study of Israel concluded that the dehalogenation of a-iodo carbonyls occurred in a single discreet step. Finally, in an effort to enhance nucleophilic substitution through the addition of K2CO3, we observed a Robinson annulation resulting in previously undescribed C-8 thiophenol functionalised dibenzo[b,d]pyran-6-ones (3.4a - e). In the introduction to this thesis, we briefly summarise the utility of coumarins in medicinal chemistry and related fields. Chapter two describes the rationalisation of our original research question and a retrosynthetic analysis of our desired compounds, followed by an initial description of the unexpected reductive dehalogenation. Chapter 3, begins with a brief review of reductive dehalogenation of a-halocarbonyls, and is followed by an analysis and discussion of our results in the context of the studies by Israel et. al. and Oki et. al.
- Full Text:
- Date Issued: 2017
- Authors: Magwenzi, Faith N
- Date: 2017
- Subjects: 3-bromoacetylcoumarins , Coumarins , Halogens -- Decontamination , Thiols , Plasmodium falciparum , Malaria -- Chemotherapy
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/45769 , vital:25546
- Description: A previous study conducted by our group identified indolyl-3-ethanone-a-thioethers (2.1a and 2.1b) as non-toxic, nanomolar, in vitro inhibitors of Plasmodium falciparum. Since the coumarin scaffold is associated with numerous biologically active compounds including antiprotozoal, anti-viral, anti-bacterial, and anti-inflammatory agents we were prompted to investigate coumaryl-3-ethanone-a-thioethers (2.1c) inspired by the activity of 2.1a and 2.1b against P. falciparum. We proposed a three-step synthesis of our target compounds 2.1c. The first step involved the Knoevenagel synthesis of 3-acetyl coumarins (2.3.1a - e) followed by a selective a-bromination to yield 3-bromoacetyl coumarin (2.2a). The final proposed step involved the nucleophilic displacement of the bromine by appropriately substituted thiophenols in either the presence or absence of base (K2CO3). Our initial findings revealed an unexpected major reductive dehalogenation of 2.2a into 2.3.1a. Further investigation revealed a close relationship between the electron withdrawing or donating nature of the thiophenol substituents and the relative formation of nucleophilic substitution or reductive dehalogenation products. Desired thioether products were obtained in higher yields when thiophenol was substituted with electron donating groups i.e. more nucleophilic thiophenols, while conversely, electron withdrawing substituents (i.e. lowered nucleophilicity) resulted in an increase of reductive dehalogenation. Furthermore, these results were consistent when experiments were conducted using either 2 or 1.2 equivalents of thiophenols which was an important observation in the context of two previous studies, by Oki et. al. and Israel et. al. Oki proposed that dehalogenation of a-chloro carbonyls occurs via sequential nucleophilic displacement of a-thioethers, while the study of Israel concluded that the dehalogenation of a-iodo carbonyls occurred in a single discreet step. Finally, in an effort to enhance nucleophilic substitution through the addition of K2CO3, we observed a Robinson annulation resulting in previously undescribed C-8 thiophenol functionalised dibenzo[b,d]pyran-6-ones (3.4a - e). In the introduction to this thesis, we briefly summarise the utility of coumarins in medicinal chemistry and related fields. Chapter two describes the rationalisation of our original research question and a retrosynthetic analysis of our desired compounds, followed by an initial description of the unexpected reductive dehalogenation. Chapter 3, begins with a brief review of reductive dehalogenation of a-halocarbonyls, and is followed by an analysis and discussion of our results in the context of the studies by Israel et. al. and Oki et. al.
- Full Text:
- Date Issued: 2017
Workplace health promotion: a case of Rhodes University support staff
- Chigumete, Tinatsei Gabriella
- Authors: Chigumete, Tinatsei Gabriella
- Date: 2017
- Subjects: Rhodes University -- Employees -- Health and hygiene , Employee health promotion -- South Africa -- Makhanda
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/44509 , vital:25414
- Description: Background: Non-communicable diseases are rapidly advancing as leading causes of morbidity and mortality across social classes, exerting pressure on existing financial, organizational, and human resources. Health promotion is a common practice in the prevention of noncommunicable diseases, but workplace health promotion has not yet been well established in many workplaces. Identification of past workplace initiatives and exploring their facilitating and limiting factors is thus important to take into consideration when planning future initiatives. Well-informed and guided workplace health promotion initiatives are essential to improve the general health of staff, and these also need to take the broader cultural, socioeconomic, and environmental factors influencing non-communicable diseases in the target population into account. This two-phase study was conducted at Rhodes University. A needs assessment was conducted to identify current policies and practices of workplace health promotion and to identify any shortcomings of the initiatives that have previously been attempted to raise awareness of non-communicable diseases at Rhodes University. The second phase of this project aimed to address concerns raised in the first phase through a health promotion initiative for support staff that focuses on the prevention of noncommunicable diseases through heart healthy diets and physical activity. Method: The first phase of the current study involved working with the support staff and key stakeholders. Using the participatory action research approach and the PRECEDE-PROCEED model to guide the research, 11 semi-structured interviews with key stakeholders and 10 focus group discussions were conducted with support staff members to identify factors affecting workplace health promotion. Participant opinions on how to improve these initiatives were sought. The participants were asked to identify areas on which the intended intervention should focus, as well as to identify their preferred means of communicating health messages. During this phase, a group of support staff members who volunteered their involvement in the design and delivery of the educational intervention was also identified. They chose to go by the name, the Health Awareness Group.In an interim phase of the study, three health information leaflets informed by the results from the above activities were designed. These leaflets underwent a series of qualitative evaluations by other health professionals, a culture and African languages expert, and the Health Awareness Group, to assess content validity, context specificity, and cultural appropriateness for the target group. A series of quantitative tests for readability, suitability, and actionability was also conducted. The health information leaflets were then used as written materials in the educational intervention of the project. Members of the Health Awareness Group were also trained as peer educators through a series of workshops. This enabled them to promote and raise awareness of heart healthy diets and physical activity to others in the workplace. Workshops were participatory in nature and were guided by the Social Cognitive Theory. They were also equipped with the completed health information leaflets to distribute to their peers and to use as reference sources of information when needed. Results: Participants in the semi-structured interviews reported that some health promotion initiatives have previously been attempted and advertised to support staff, but the turnout was poor and most staff did not seem to understand the health benefits of these initiatives. The support staff, in turn, stated that most health talks were conducted in English, contained medical jargon, and that they would have preferred these initiatives either to be simplified or presented in their home language, and to display cultural sensitivity. Support staff have also reported that advertisements were too cliche to elicit their interest. They also suggested incentivising initiatives for better participation. Another key suggestion was to facilitate these initiatives in the university departments they work or other convenient venues, rather than at central venues. It was also suggested that these initiatives be part of the work calendar, as they are often 'impromptu' and, as a result, staff members did not have enough notice to take time off work. Several staff members requested 're-runs of these initiatives because one-time show cases are often inadequate'. Colourful visual representations on posters or leaflets, short plays or films were also proposed as modes of delivering health information. During the design of the material to be used for this project's intended intervention, the health information leaflets were deemed readable, suitable, actionable, context-specific, and culturally appropriate. Workshops conducted during Phase 2 of the study proved to be valuable in training peer educators. Members of the Health Awareness Group also deemed the workshops useful, and reported their readiness to be agents of change in the workplace. Conclusions: Based on the input of key stakeholders and support staff, health promotion policies and protocols for non-communicable diseases have not yet been developed. Health promotion initiatives, especially for support staff, that address non-communicable diseases have previously been attempted at the university but were not well-received. Factors affecting workplace health promotion were identified. Knowledge of these factors was useful in designing and tailoring the written educational materials and the educational intervention to the needs of the support staff and to redress the deficiencies of previous initiatives. The health leaflets were deemed appropriate for use by the target population. They addressed pertinent information needs. The health information leaflets and workshops were useful in equipping the Health Awareness Group with knowledge on heart healthy diets and promotion of physical activity. Continued the involvement of representatives from the Human Resources and Wellness offices will assist in ensuring the sustainability of this workplace health initiative.
- Full Text:
- Date Issued: 2017
- Authors: Chigumete, Tinatsei Gabriella
- Date: 2017
- Subjects: Rhodes University -- Employees -- Health and hygiene , Employee health promotion -- South Africa -- Makhanda
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/44509 , vital:25414
- Description: Background: Non-communicable diseases are rapidly advancing as leading causes of morbidity and mortality across social classes, exerting pressure on existing financial, organizational, and human resources. Health promotion is a common practice in the prevention of noncommunicable diseases, but workplace health promotion has not yet been well established in many workplaces. Identification of past workplace initiatives and exploring their facilitating and limiting factors is thus important to take into consideration when planning future initiatives. Well-informed and guided workplace health promotion initiatives are essential to improve the general health of staff, and these also need to take the broader cultural, socioeconomic, and environmental factors influencing non-communicable diseases in the target population into account. This two-phase study was conducted at Rhodes University. A needs assessment was conducted to identify current policies and practices of workplace health promotion and to identify any shortcomings of the initiatives that have previously been attempted to raise awareness of non-communicable diseases at Rhodes University. The second phase of this project aimed to address concerns raised in the first phase through a health promotion initiative for support staff that focuses on the prevention of noncommunicable diseases through heart healthy diets and physical activity. Method: The first phase of the current study involved working with the support staff and key stakeholders. Using the participatory action research approach and the PRECEDE-PROCEED model to guide the research, 11 semi-structured interviews with key stakeholders and 10 focus group discussions were conducted with support staff members to identify factors affecting workplace health promotion. Participant opinions on how to improve these initiatives were sought. The participants were asked to identify areas on which the intended intervention should focus, as well as to identify their preferred means of communicating health messages. During this phase, a group of support staff members who volunteered their involvement in the design and delivery of the educational intervention was also identified. They chose to go by the name, the Health Awareness Group.In an interim phase of the study, three health information leaflets informed by the results from the above activities were designed. These leaflets underwent a series of qualitative evaluations by other health professionals, a culture and African languages expert, and the Health Awareness Group, to assess content validity, context specificity, and cultural appropriateness for the target group. A series of quantitative tests for readability, suitability, and actionability was also conducted. The health information leaflets were then used as written materials in the educational intervention of the project. Members of the Health Awareness Group were also trained as peer educators through a series of workshops. This enabled them to promote and raise awareness of heart healthy diets and physical activity to others in the workplace. Workshops were participatory in nature and were guided by the Social Cognitive Theory. They were also equipped with the completed health information leaflets to distribute to their peers and to use as reference sources of information when needed. Results: Participants in the semi-structured interviews reported that some health promotion initiatives have previously been attempted and advertised to support staff, but the turnout was poor and most staff did not seem to understand the health benefits of these initiatives. The support staff, in turn, stated that most health talks were conducted in English, contained medical jargon, and that they would have preferred these initiatives either to be simplified or presented in their home language, and to display cultural sensitivity. Support staff have also reported that advertisements were too cliche to elicit their interest. They also suggested incentivising initiatives for better participation. Another key suggestion was to facilitate these initiatives in the university departments they work or other convenient venues, rather than at central venues. It was also suggested that these initiatives be part of the work calendar, as they are often 'impromptu' and, as a result, staff members did not have enough notice to take time off work. Several staff members requested 're-runs of these initiatives because one-time show cases are often inadequate'. Colourful visual representations on posters or leaflets, short plays or films were also proposed as modes of delivering health information. During the design of the material to be used for this project's intended intervention, the health information leaflets were deemed readable, suitable, actionable, context-specific, and culturally appropriate. Workshops conducted during Phase 2 of the study proved to be valuable in training peer educators. Members of the Health Awareness Group also deemed the workshops useful, and reported their readiness to be agents of change in the workplace. Conclusions: Based on the input of key stakeholders and support staff, health promotion policies and protocols for non-communicable diseases have not yet been developed. Health promotion initiatives, especially for support staff, that address non-communicable diseases have previously been attempted at the university but were not well-received. Factors affecting workplace health promotion were identified. Knowledge of these factors was useful in designing and tailoring the written educational materials and the educational intervention to the needs of the support staff and to redress the deficiencies of previous initiatives. The health leaflets were deemed appropriate for use by the target population. They addressed pertinent information needs. The health information leaflets and workshops were useful in equipping the Health Awareness Group with knowledge on heart healthy diets and promotion of physical activity. Continued the involvement of representatives from the Human Resources and Wellness offices will assist in ensuring the sustainability of this workplace health initiative.
- Full Text:
- Date Issued: 2017
Community care workers in TB care: identifying and meeting their information needs
- Authors: Okeyo, Ida L A
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4211 , vital:20633
- Description: According to the 2015 World Health Organisation global tuberculosis report, South Africa had 155,473 new TB cases in the last year, 61% of whom were HIV-positive. The tuberculosis (TB) epidemic in South Africa has resulted in the increasing use of community care workers (CCWs) for the management and supervision of TB patients on treatment. CCWs are increasingly being deployed to address the shortages of healthcare workers. CCWs supervising TB patients often act as information providers, advising and counselling patients on general care and medication use. Their effectiveness depends on appropriate knowledge, adequate training and access to good quality information about TB and TB medicines. The hypothesis for this study was that user-friendly, simple, illustrated information can enhance TB knowledge of CCWs, as well as serve as a practice tool in facilitating their counselling and education of patients. A conceptual framework was used to guide the development of an intervention to test this hypothesis through the following objectives: exploring the roles and TB information needs of CCWs working with TB patients; evaluating baseline TB knowledge and health literacy levels of CCWs; developing simple, illustrated information materials to address CCW TB information needs; and assessing the influence of the information materials on TB knowledge and practice of CCWs. Six CCWs from Grahamstown Hospice and 25 CCWs from six primary healthcare clinics in Grahamstown participated in the study, which was conducted in three main phases. Phase 1 began with focus group discussions and individual semi-structured interviews with 14 CCWs to explore their perceptions regarding their roles in TB care and their information needs. This was followed by individual interviews with all 31 CCWs using a structured questionnaire to collect quantitative data on health literacy and establish baseline TB knowledge. For Phase 2, the design of an A5 booklet was informed by the findings from Phase 1 and contained information about TB and TB medication. Pictograms were designed using a rigorous, iterative design process and were included in the booklet which was translated into isiXhosa and Afrikaans. The booklets were individually distributed to CCWs during an information session in which the topics in the booklet were discussed. Three months after completion of Phase 2, individual follow-up interviews were conducted with all CCWs to measure post-intervention TB knowledge. Focus group discussions or semi-structured interviews were conducted with 19 of the CCWs to explore the role and impact of the information materials on everyday CCW practice. Qualitative data were transcribed and analysed thematically by developing codes and identifying themes. Quantitative results were analysed using the t-test, Pearson Chi-square and a Z-test of proportions at a 0.05 level of significance. The conceptual framework provided a useful lens through which to view, and reflect on, the interaction between the elements of the healthcare system in relation to the results obtained. CCWs associated their roles in TB control with helping patients and having an impact in patients’ lives which they perceived as being meaningful. The good relationships with patients noted by study CCWs, as well as the appreciation they received from patients, contributed to their confidence and belief that they were well positioned and able to positively influence health outcomes. This study found that CCWs in the healthcare system were disadvantaged by the lack of support and supervision, deficiencies in training and lack of information materials, all of which reflect a negative interaction between CCWs with the healthcare system. Use of the booklet resulted in an improvement in CCW knowledge about the disease, TB medication, MDR and XDR-TB and HIV/AIDS and TB co-infection. The mean knowledge score significantly increased from 76.1% at baseline to 85.4% at follow up showing that the use of the booklet had a positive impact on TB knowledge. Poor knowledge areas were identified as being related to TB medication-related knowledge and drug-resistant TB, highlighting the need for additional intervention to improve knowledge in these areas. The health literacy level of CCWs, which was assessed using the modified Newest Vital Signs– South Africa test, showed that the majority of CCWs had only marginal health literacy, indicating the need for wider assessment of health literacy within CCWs, and the need to tailor training and information materials to cater for their health literacy levels. The pictorial-based, simple booklet tailored for CCWs was also found to enhance confidence in decision making, and reduce their uncertainty when confronted with difficult care scenarios. CCWs were enthusiastic about the inclusion of pictograms which were reported to enhance recall of TB information and understanding of text. The booklet also served as a patient educational tool, where it reportedly improved communication and had a positive effect on the CCW-patient interpersonal relationship. The simplicity of the booklet and the inclusion of pictograms resulted in a user-friendly appealing information source for patients. Factors contributing to the success of the booklet can be attributed to paying attention to CCW information needs, involving CCWs in the design process, translating the booklet into local dialect, ensuring simplicity of the text and including pictograms that had undergone a rigorous design process. This study was the first to design TB information materials targeted specifically for CCWs that were also suitable as patient education materials. The study demonstrated that these information materials can have a positive outcome on CCW roles in TB care by improving their knowledge and facilitating patient communication and education.
- Full Text:
- Date Issued: 2016
- Authors: Okeyo, Ida L A
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4211 , vital:20633
- Description: According to the 2015 World Health Organisation global tuberculosis report, South Africa had 155,473 new TB cases in the last year, 61% of whom were HIV-positive. The tuberculosis (TB) epidemic in South Africa has resulted in the increasing use of community care workers (CCWs) for the management and supervision of TB patients on treatment. CCWs are increasingly being deployed to address the shortages of healthcare workers. CCWs supervising TB patients often act as information providers, advising and counselling patients on general care and medication use. Their effectiveness depends on appropriate knowledge, adequate training and access to good quality information about TB and TB medicines. The hypothesis for this study was that user-friendly, simple, illustrated information can enhance TB knowledge of CCWs, as well as serve as a practice tool in facilitating their counselling and education of patients. A conceptual framework was used to guide the development of an intervention to test this hypothesis through the following objectives: exploring the roles and TB information needs of CCWs working with TB patients; evaluating baseline TB knowledge and health literacy levels of CCWs; developing simple, illustrated information materials to address CCW TB information needs; and assessing the influence of the information materials on TB knowledge and practice of CCWs. Six CCWs from Grahamstown Hospice and 25 CCWs from six primary healthcare clinics in Grahamstown participated in the study, which was conducted in three main phases. Phase 1 began with focus group discussions and individual semi-structured interviews with 14 CCWs to explore their perceptions regarding their roles in TB care and their information needs. This was followed by individual interviews with all 31 CCWs using a structured questionnaire to collect quantitative data on health literacy and establish baseline TB knowledge. For Phase 2, the design of an A5 booklet was informed by the findings from Phase 1 and contained information about TB and TB medication. Pictograms were designed using a rigorous, iterative design process and were included in the booklet which was translated into isiXhosa and Afrikaans. The booklets were individually distributed to CCWs during an information session in which the topics in the booklet were discussed. Three months after completion of Phase 2, individual follow-up interviews were conducted with all CCWs to measure post-intervention TB knowledge. Focus group discussions or semi-structured interviews were conducted with 19 of the CCWs to explore the role and impact of the information materials on everyday CCW practice. Qualitative data were transcribed and analysed thematically by developing codes and identifying themes. Quantitative results were analysed using the t-test, Pearson Chi-square and a Z-test of proportions at a 0.05 level of significance. The conceptual framework provided a useful lens through which to view, and reflect on, the interaction between the elements of the healthcare system in relation to the results obtained. CCWs associated their roles in TB control with helping patients and having an impact in patients’ lives which they perceived as being meaningful. The good relationships with patients noted by study CCWs, as well as the appreciation they received from patients, contributed to their confidence and belief that they were well positioned and able to positively influence health outcomes. This study found that CCWs in the healthcare system were disadvantaged by the lack of support and supervision, deficiencies in training and lack of information materials, all of which reflect a negative interaction between CCWs with the healthcare system. Use of the booklet resulted in an improvement in CCW knowledge about the disease, TB medication, MDR and XDR-TB and HIV/AIDS and TB co-infection. The mean knowledge score significantly increased from 76.1% at baseline to 85.4% at follow up showing that the use of the booklet had a positive impact on TB knowledge. Poor knowledge areas were identified as being related to TB medication-related knowledge and drug-resistant TB, highlighting the need for additional intervention to improve knowledge in these areas. The health literacy level of CCWs, which was assessed using the modified Newest Vital Signs– South Africa test, showed that the majority of CCWs had only marginal health literacy, indicating the need for wider assessment of health literacy within CCWs, and the need to tailor training and information materials to cater for their health literacy levels. The pictorial-based, simple booklet tailored for CCWs was also found to enhance confidence in decision making, and reduce their uncertainty when confronted with difficult care scenarios. CCWs were enthusiastic about the inclusion of pictograms which were reported to enhance recall of TB information and understanding of text. The booklet also served as a patient educational tool, where it reportedly improved communication and had a positive effect on the CCW-patient interpersonal relationship. The simplicity of the booklet and the inclusion of pictograms resulted in a user-friendly appealing information source for patients. Factors contributing to the success of the booklet can be attributed to paying attention to CCW information needs, involving CCWs in the design process, translating the booklet into local dialect, ensuring simplicity of the text and including pictograms that had undergone a rigorous design process. This study was the first to design TB information materials targeted specifically for CCWs that were also suitable as patient education materials. The study demonstrated that these information materials can have a positive outcome on CCW roles in TB care by improving their knowledge and facilitating patient communication and education.
- Full Text:
- Date Issued: 2016
Gradient high performance liquid chromatographic method for the simultaneous analysis of efavirenz, emtricitabine and tenofovir
- Authors: Koekemoer, Sonya Mariana
- Date: 2016
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54679 , vital:26599
- Description: In 2014, approximately 6.8 million people in South Africa were HIV-positive, and the majority of those affected are aged 15 or older. A fixed-dose combination (FDC) antiretroviral (ARV) dosage form containing one non-nucleotide reverse transcriptase inhibitor (efavirenz) and two nucleotide reverse transcriptase inhibitors (emtricitabine and tenofovir) was licensed in South Africa in April 2013. New consolidated guidelines for HIV management and prevention of mother to child transmission (PMTCT) were published by the South African Department of Health in December 2014 and the FDC is now the recommended first-line treatment for HIV-positive patients. According to these guidelines all such people aged 15 and older, and weighing more than 40 kg, with a CD4 count of ≤ 500/ μl will be eligible for antiretroviral therapy (ART) using the FDC. In addition every pregnant and breastfeeding woman is eligible for lifelong ART regardless of CD4 count and EFV can be used as first-line treatment for pregnant women regardless of the length of gestation state of the pregnancy at that time. The use of this simplified regime is likely to promote much needed and improved adherence to therapy. An investigation into the development of a stability-indicating reversed-phase high performance liquid chromatography (RP-HPLC) method for the simultaneous quantitation of EFV, FTC and TNF was undertaken. Isocratic HPLC analysis was found to be unsuitable due to the highly polar FTC molecule eluting in the void. Therefore a gradient HPLC method was developed and validated. The method was validated according to the International Conference on Harmonisation, now known as International Council for Harmonization (ICH). Correlation coefficients > 0.999 were obtained for each assessment of linearity and FTC, TNF and EFV are linear in the range 0.4-40 μg/ml, 0.6-60 μg/ml and 1.2-120 μg/ml. The equation of the best-fit least squares regression lines for FTC, TNF and EFV were y = 0.0191x+0.0007, y = 0.0163x+0.0116 and y = 0.01x+0.016, respectively. The method is accurate as the y-intercept was < 2% of the detector response for all ARV, and the method is precise in terms of intra- and inter-assay precision as all % RSD < 2%. The stability-indicating nature of the method was demonstrated under acidic, alkaline and oxidative stress in addition to UV exposure and elevated temperatures, and the individual chromatograms were overlaid using Empower® 3 Software to establish whether there was interference with the peaks of interest. The forced degradation studies demonstrated the selectivity of the method for the ARV compounds. The method was applied to assay and in vitro dissolution studies of commercially available tablets. The amount of each active ingredient released from Atripla® was determined and compared to the amount of each drug released from Aspen Efavirenz® and Truvada® (a combination of FTC and TNF). The percent FTC released from Atripla® and Truvada® was similar based on the acceptance criteria for immediate-release BCS class 1 compounds. Statistical analysis was undertaken to compare the dissolution profiles of FTC, TNF and EFV. The percent of these compounds released in these studies indicate that bioequivalence testing would be required to declare these products interchangeable. The validated RP-HPLC and in vitro dissolution test method are suitable for routine quality control testing of solid oral dosage forms containing EFV, FTC and TNF, and as the dissolution method can discriminate between different formulations of the same molecule, these tools can also be used for analysis during formulation development studies. The method is not suitable for the analysis of the ARV plasma due to lack of sensitivity and an inability to quantitate the compounds at the required concentration levels. The use of HPLC with mass spectroscopy for quantitation would enhance the sensitivity of the method and may eliminate the quantitation of the molecules in the presence of interference that was observed when using UV detection. Fixed dose combination tablets are convenient for patient therapy and it is likely that in the future more molecules will be formulated into such dosage forms. However formulations such as these can pose significant difficulties when developing and using analytical methods for the quantitation of all compounds in the dosage form at the same time, in particular when the compounds have vastly different physico-chemical properties that impact the quality of a separation and therefore the analysis. Therefore when embarking on the development of FDC product cognisance of the difficulties of developing single methods for the analyses is required and approaches to overcome these difficulties should be considered.
- Full Text:
- Date Issued: 2016
- Authors: Koekemoer, Sonya Mariana
- Date: 2016
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54679 , vital:26599
- Description: In 2014, approximately 6.8 million people in South Africa were HIV-positive, and the majority of those affected are aged 15 or older. A fixed-dose combination (FDC) antiretroviral (ARV) dosage form containing one non-nucleotide reverse transcriptase inhibitor (efavirenz) and two nucleotide reverse transcriptase inhibitors (emtricitabine and tenofovir) was licensed in South Africa in April 2013. New consolidated guidelines for HIV management and prevention of mother to child transmission (PMTCT) were published by the South African Department of Health in December 2014 and the FDC is now the recommended first-line treatment for HIV-positive patients. According to these guidelines all such people aged 15 and older, and weighing more than 40 kg, with a CD4 count of ≤ 500/ μl will be eligible for antiretroviral therapy (ART) using the FDC. In addition every pregnant and breastfeeding woman is eligible for lifelong ART regardless of CD4 count and EFV can be used as first-line treatment for pregnant women regardless of the length of gestation state of the pregnancy at that time. The use of this simplified regime is likely to promote much needed and improved adherence to therapy. An investigation into the development of a stability-indicating reversed-phase high performance liquid chromatography (RP-HPLC) method for the simultaneous quantitation of EFV, FTC and TNF was undertaken. Isocratic HPLC analysis was found to be unsuitable due to the highly polar FTC molecule eluting in the void. Therefore a gradient HPLC method was developed and validated. The method was validated according to the International Conference on Harmonisation, now known as International Council for Harmonization (ICH). Correlation coefficients > 0.999 were obtained for each assessment of linearity and FTC, TNF and EFV are linear in the range 0.4-40 μg/ml, 0.6-60 μg/ml and 1.2-120 μg/ml. The equation of the best-fit least squares regression lines for FTC, TNF and EFV were y = 0.0191x+0.0007, y = 0.0163x+0.0116 and y = 0.01x+0.016, respectively. The method is accurate as the y-intercept was < 2% of the detector response for all ARV, and the method is precise in terms of intra- and inter-assay precision as all % RSD < 2%. The stability-indicating nature of the method was demonstrated under acidic, alkaline and oxidative stress in addition to UV exposure and elevated temperatures, and the individual chromatograms were overlaid using Empower® 3 Software to establish whether there was interference with the peaks of interest. The forced degradation studies demonstrated the selectivity of the method for the ARV compounds. The method was applied to assay and in vitro dissolution studies of commercially available tablets. The amount of each active ingredient released from Atripla® was determined and compared to the amount of each drug released from Aspen Efavirenz® and Truvada® (a combination of FTC and TNF). The percent FTC released from Atripla® and Truvada® was similar based on the acceptance criteria for immediate-release BCS class 1 compounds. Statistical analysis was undertaken to compare the dissolution profiles of FTC, TNF and EFV. The percent of these compounds released in these studies indicate that bioequivalence testing would be required to declare these products interchangeable. The validated RP-HPLC and in vitro dissolution test method are suitable for routine quality control testing of solid oral dosage forms containing EFV, FTC and TNF, and as the dissolution method can discriminate between different formulations of the same molecule, these tools can also be used for analysis during formulation development studies. The method is not suitable for the analysis of the ARV plasma due to lack of sensitivity and an inability to quantitate the compounds at the required concentration levels. The use of HPLC with mass spectroscopy for quantitation would enhance the sensitivity of the method and may eliminate the quantitation of the molecules in the presence of interference that was observed when using UV detection. Fixed dose combination tablets are convenient for patient therapy and it is likely that in the future more molecules will be formulated into such dosage forms. However formulations such as these can pose significant difficulties when developing and using analytical methods for the quantitation of all compounds in the dosage form at the same time, in particular when the compounds have vastly different physico-chemical properties that impact the quality of a separation and therefore the analysis. Therefore when embarking on the development of FDC product cognisance of the difficulties of developing single methods for the analyses is required and approaches to overcome these difficulties should be considered.
- Full Text:
- Date Issued: 2016
Investigation of α-aryl substituted 3-indolylethanones as potential antiplasmodial agents
- Authors: Svogie, Archibald Lesley
- Date: 2016
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/55487 , vital:26704
- Description: According to the World Health Organisation (WHO), deaths attributed to Plasmodium falciparum exceeded 584 000 in 2013, with 198 million new cases of malaria being reported. One contributing factor to these alarming figures is the emergence of drug resistance against available antimalarial agents. Therefore, there is a pressing need to develop new therapeutic antimalarial drugs with novel mechanisms of action in order to curb the increasing spread of malaria. The indole scaffold is often associated with biologically active compounds, recently exemplified by the antimalarial agent NITD609, which is currently in phase 1 clinical trials. Based on the biological evaluation of a small series of indolyl-3-amides and esters which showed moderate antimalarial activity, coupled to significant toxicity, we were prompted to investigate the synthesis of a series of indolyl-3-ethanone-α-amines (3.37 and 3.41), ethers (3.39 and 3.44) and thioethers (3.42, 3.43, 3.40, 3.45 – 3.73), where the carbonyl moiety and respective heteroatom were separated by a methine spacer. We further investigated these compounds for in vitro biological activity against P. falciparum and a human HeLa cell line. Our study explored the synthetic pathway of a three-step procedure toward our target compounds, with the initial Friedel-Crafts acetylation of indole, followed by α-bromination of the respective 3-acetylindoles. Finally, the halogen of the α-bromo ketone was substituted with an appropriate nucleophile, to yield our desired compounds. Various reagents were explored to optimise the nucleophilic displacement step, including potassium carbonate and various silver containing compounds. While many of the silver salts were found to assist in nucleophilic substitution, none were superior to the addition of potassium carbonate. The majority of compounds, chiefly the thioethers, displayed promising antimalarial activity, against the chloroquine sensitive 3D7 P. falciparum strain, with two thioethers in particular (3.54 and 3.65) inhibiting P. falciparum in the low nanomolar range. Additionally, active compounds were generally found to be non-toxic against HeLa cells, indicating that indolyl-3-thioethers are selective for the malaria parasite. These findings allowed us to begin hypothesising a structure activity relationship of this class, as well as elucidating the possible pharmacophore. In a speculative attempt to uncover the possible mechanism of action of these active compounds, in silico docking studies were conducted against Staphylococcus aureus HPPK (PDB ID: 4CRJ), which is an enzyme that immediately precedes DHPS in the microbial folate biosynthesis. Inhibition of folate biosynthesis is a validated selective antimalarial pathway and HPPK also exists in P. falciparum. Results from these docking studies suggested that our inhibitors bound well in the HPPK ATP pocket and were supportive of our hypothesized structure activity relationship.
- Full Text:
- Date Issued: 2016
- Authors: Svogie, Archibald Lesley
- Date: 2016
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/55487 , vital:26704
- Description: According to the World Health Organisation (WHO), deaths attributed to Plasmodium falciparum exceeded 584 000 in 2013, with 198 million new cases of malaria being reported. One contributing factor to these alarming figures is the emergence of drug resistance against available antimalarial agents. Therefore, there is a pressing need to develop new therapeutic antimalarial drugs with novel mechanisms of action in order to curb the increasing spread of malaria. The indole scaffold is often associated with biologically active compounds, recently exemplified by the antimalarial agent NITD609, which is currently in phase 1 clinical trials. Based on the biological evaluation of a small series of indolyl-3-amides and esters which showed moderate antimalarial activity, coupled to significant toxicity, we were prompted to investigate the synthesis of a series of indolyl-3-ethanone-α-amines (3.37 and 3.41), ethers (3.39 and 3.44) and thioethers (3.42, 3.43, 3.40, 3.45 – 3.73), where the carbonyl moiety and respective heteroatom were separated by a methine spacer. We further investigated these compounds for in vitro biological activity against P. falciparum and a human HeLa cell line. Our study explored the synthetic pathway of a three-step procedure toward our target compounds, with the initial Friedel-Crafts acetylation of indole, followed by α-bromination of the respective 3-acetylindoles. Finally, the halogen of the α-bromo ketone was substituted with an appropriate nucleophile, to yield our desired compounds. Various reagents were explored to optimise the nucleophilic displacement step, including potassium carbonate and various silver containing compounds. While many of the silver salts were found to assist in nucleophilic substitution, none were superior to the addition of potassium carbonate. The majority of compounds, chiefly the thioethers, displayed promising antimalarial activity, against the chloroquine sensitive 3D7 P. falciparum strain, with two thioethers in particular (3.54 and 3.65) inhibiting P. falciparum in the low nanomolar range. Additionally, active compounds were generally found to be non-toxic against HeLa cells, indicating that indolyl-3-thioethers are selective for the malaria parasite. These findings allowed us to begin hypothesising a structure activity relationship of this class, as well as elucidating the possible pharmacophore. In a speculative attempt to uncover the possible mechanism of action of these active compounds, in silico docking studies were conducted against Staphylococcus aureus HPPK (PDB ID: 4CRJ), which is an enzyme that immediately precedes DHPS in the microbial folate biosynthesis. Inhibition of folate biosynthesis is a validated selective antimalarial pathway and HPPK also exists in P. falciparum. Results from these docking studies suggested that our inhibitors bound well in the HPPK ATP pocket and were supportive of our hypothesized structure activity relationship.
- Full Text:
- Date Issued: 2016
The participatory development and implementation of a facilitator’s manual for the promotion of exclusive breastfeeding
- Authors: Katsinde, Shingirai Miranda
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4201 , vital:20632
- Description: Background: Breastfeeding is a common practice, but exclusive breastfeeding for the first six months is no longer a cultural norm in the majority of South African communities. Identification of facilitating and constraining factors which affect breastfeeding and exclusive breastfeeding practices is thus important. The promotion of exclusive breastfeeding is essential for improved infant health and development, especially if it takes into consideration the broader cultural and socio-economic aspects influencing these practices. This study follows up on an initial project conducted in Glenmore and Ndwayana, two rural communities in the Eastern Cape, South Africa. The current study aimed at working with community care workers who are associated with two community based organisations, who work within three communities, Glenmore, Ndwayana and Grahamstown. The study objectives were to identify the factors that influence the adoption of exclusive breastfeeding in the communities researched, to conduct workshops with the community workers on exclusive breastfeeding practices, as well as to develop and implement a facilitator’s manual for the promotion of exclusive breastfeeding. Method: Using the community based participatory research approach and the PEN-3 theoretical framework to guide the research process, individual semi-structured interviews were conducted with 14 community care workers to identify the factors that affect breastfeeding and exclusive breastfeeding. Through participatory involvement and a cyclical research process, a facilitator’s manual on breastfeeding was developed, which was used during the workshops in the training of community care workers on breastfeeding and exclusive breastfeeding practices. A pre and post intervention knowledge questionnaire was given to the community care workers to complete before and after the workshops. The facilitator’s manual was modified based on 14 months of consistent interaction with the community care workers, who provided feedback on improving the content as well as on how to enhance the cultural appropriateness of the facilitator’s manual during guided focus group discussions. Readability testing also guided further modification of the facilitator’s manual. Results:The major findings confirmed that exclusive breastfeeding for six months was no longer a common practice in these three communities. Factors affecting breastfeeding and exclusive breastfeeding were classified as perceptions (knowledge attitudes and beliefs), enablers (resources and facilities) and nurturers (people), in accordance with the PEN-3 model thematic categories. The knowledge questionnaire, semi-structured interview results, and data from the workshops showed that the community care workers were not sufficiently equipped with information on breastfeeding and exclusive breastfeeding. The facilitator’s manual development and modification was made possible by inputs from the community care workers and the community based organisation liaisons. A culturally appropriate, community specific facilitator’s manual for the promotion of breastfeeding and exclusive breastfeeding was produced. Conclusion: The factors affecting breastfeeding and exclusive breastfeeding were identified. These factors were useful in facilitating discussions on how to improve breastfeeding and exclusive breastfeeding practices in the communities researched. The facilitator’s manual and the workshops were useful in equipping community care workers with knowledge on breastfeeding and exclusive breastfeeding. The involvement of community based organisations will assist to ensure sustainability of breastfeeding promotion by community care workers by adopting the facilitator’s manual as part of their women and child development programmes.
- Full Text:
- Date Issued: 2016
- Authors: Katsinde, Shingirai Miranda
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4201 , vital:20632
- Description: Background: Breastfeeding is a common practice, but exclusive breastfeeding for the first six months is no longer a cultural norm in the majority of South African communities. Identification of facilitating and constraining factors which affect breastfeeding and exclusive breastfeeding practices is thus important. The promotion of exclusive breastfeeding is essential for improved infant health and development, especially if it takes into consideration the broader cultural and socio-economic aspects influencing these practices. This study follows up on an initial project conducted in Glenmore and Ndwayana, two rural communities in the Eastern Cape, South Africa. The current study aimed at working with community care workers who are associated with two community based organisations, who work within three communities, Glenmore, Ndwayana and Grahamstown. The study objectives were to identify the factors that influence the adoption of exclusive breastfeeding in the communities researched, to conduct workshops with the community workers on exclusive breastfeeding practices, as well as to develop and implement a facilitator’s manual for the promotion of exclusive breastfeeding. Method: Using the community based participatory research approach and the PEN-3 theoretical framework to guide the research process, individual semi-structured interviews were conducted with 14 community care workers to identify the factors that affect breastfeeding and exclusive breastfeeding. Through participatory involvement and a cyclical research process, a facilitator’s manual on breastfeeding was developed, which was used during the workshops in the training of community care workers on breastfeeding and exclusive breastfeeding practices. A pre and post intervention knowledge questionnaire was given to the community care workers to complete before and after the workshops. The facilitator’s manual was modified based on 14 months of consistent interaction with the community care workers, who provided feedback on improving the content as well as on how to enhance the cultural appropriateness of the facilitator’s manual during guided focus group discussions. Readability testing also guided further modification of the facilitator’s manual. Results:The major findings confirmed that exclusive breastfeeding for six months was no longer a common practice in these three communities. Factors affecting breastfeeding and exclusive breastfeeding were classified as perceptions (knowledge attitudes and beliefs), enablers (resources and facilities) and nurturers (people), in accordance with the PEN-3 model thematic categories. The knowledge questionnaire, semi-structured interview results, and data from the workshops showed that the community care workers were not sufficiently equipped with information on breastfeeding and exclusive breastfeeding. The facilitator’s manual development and modification was made possible by inputs from the community care workers and the community based organisation liaisons. A culturally appropriate, community specific facilitator’s manual for the promotion of breastfeeding and exclusive breastfeeding was produced. Conclusion: The factors affecting breastfeeding and exclusive breastfeeding were identified. These factors were useful in facilitating discussions on how to improve breastfeeding and exclusive breastfeeding practices in the communities researched. The facilitator’s manual and the workshops were useful in equipping community care workers with knowledge on breastfeeding and exclusive breastfeeding. The involvement of community based organisations will assist to ensure sustainability of breastfeeding promotion by community care workers by adopting the facilitator’s manual as part of their women and child development programmes.
- Full Text:
- Date Issued: 2016
An investigation into the feasibility of incorporating ketoconazole into solid lipid microparticles
- Authors: Jhundoo, Henusha Devi
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54701 , vital:26601
- Description: One of the major challenges of the oral administration of ketoconazole (KTZ), an inhibitor of sterol 14α demethylase, used in the management of systemic and topical mycoses in immuno-compromised and paediatric patients is the lack of availability of liquid dosage forms. In order to overcome this challenge, extemporaneous preparations have been manufactured by care-givers and health care providers by crushing or breaking solid oral dosage forms of KTZ and mixing with a vehicle to produce a liquid dosage form that can be swallowed by patients. However, the use of extemporaneous preparations may lead to under or over-dosing if the care-givers are not guided accordingly. Furthermore, the dearth of information on the stability of these KTZ-containing extemporaneous preparations may lead to ineffective antifungal therapy and complicate the problems of resistance as it is difficult to estimate the shelf-lives of these extemporaneous products under varying storage conditions due to the susceptibility of KTZ to chemical degradation. Therefore, there is a need for formulation scientists to develop novel drug delivery systems that avoid the need for extemporaneous preparations, possess well-established limits of stability and minimize the risks of systemic adverse effects to facilitate KTZ therapy. The use of solid lipid microparticles (SLM) as potential carriers for the oral administration of KTZ was investigated since solid lipid carriers are known to exhibit the advantages of traditional colloidal carriers. The research undertaken in these studies aimed to investigate the feasibility of developing and manufacturing solid lipid microparticles (SLM), using a simple micro-emulsion technique, as a carrier for KTZ. Prior to pre-formulation, formulation development and optimization studies of KTZ-loaded SLM, it was necessary to develop and validate an analytical method for the in vitro quantitation and characterization of KTZ in aqueous dispersions of SLM during development and assessment studies. An accurate, precise, specific and sensitive reversed-phase high performance liquid chromatographic (RP-HPLC) method coupled with UV detection at 206 nm was developed, optimized and validated for the analysis of KTZ in formulations. Formulation development studies were preceded by solubility studies of KTZ in different lipids. Labrafil® M2130 CS was found to exhibit the best solubilising potential for KTZ. Pre-formulation studies were also designed to determine the polymorphic behavior and the crystallinity of KTZ and Labrafil® M2130 CS that was used for subsequent manufacture of the solid lipid carriers. DSC and FTIR studies revealed that there were no changes in the crystallinity of KTZ or Labrafil® M2130 CS following exposure to a temperature of 60°C for 1 hour. In addition the potential for physicochemical interaction of KTZ with the lipid Labrafil® M2130 CS was investigated using DSC and FTIR and the results revealed that KTZ was molecularly dispersed in Labrafil® M2130 CS and that it is unlikely that KTZ would interact with the lipid. It was therefore established that KTZ and Labrafil® M2130 CS were thermo-stable at a temperature of 60°C and thus a micro-emulsion technique could be used to manufacture the KTZ-loaded SLM. Drug-free and KTZ-loaded SLM were prepared using a modified micro-emulsion technique that required the use of an Ultra-Turrax® homogenizer set at 24 000 rpm for 5 minutes followed by the use of the Erweka GmbH homogenizer. SLM were characterized in terms of particle size (PS), zeta potential (ZP), shape and surface morphology using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). In addition drug loading capacity (DLC) and encapsulation efficiency (EE) of SLM for KTZ were assessed using RP-HPLC. Formulation development and optimization studies of KTZ-loaded SLM were initially aimed at selecting an emulsifying system that was able to stabilize the SLM in an aqueous dispersion. Successful formulations were selected based on their ability to remain physically stable on the day of manufacture. Pluronic® F68 used in combination with Lutrol® E40, Soluphor® P, Soluplus® produced unstable dispersions on the day of manufacture and these combinations were not investigated further. However, the formulation of a stable KTZ-loaded SLM dispersion was accomplished by use of a combination of Pluronic® F68, Tween 80 and sodium cholate as the surfactant system. Increasing amounts of Labrafil® M2130 CS resulted in the production of particles with low DLC and EE, a large PS and a relatively unchanged ZP. An optimum concentration of 10% w/v Labrafil® M2130 CS was selected to manufacture the KTZ-loaded SLM. Studies to determine the influence of KTZ loading on the quality of SLM revealed that concentrations of KTZ > 5% w/v led to a reduction in DLC and EE and an increase in PS with minimal impact on the ZP. Stability studies conducted at 25°C/65% RH and 40°C/75% RH for up to 30 days following manufacture revealed that batch SLM 15 manufactured using 10% w/v Labrafil® M2130 CS, 5% w/v KTZ and a combination of 4% w/v Pluronic® F-68, 2% w/v Tween 80 and 1% w/v sodium cholate produced the most stable dosage form when stored at 25°C/65% RH for up to 30 days. However, storage at 40°C/75% RH resulted in instability of the formulation. An aqueous dispersion of KTZ-loaded SLM has been developed and assessed and may offer an alternative to extemporaneous preparations used for KTZ therapy in paediatric and immuno-compromised patients.
- Full Text:
- Date Issued: 2015
- Authors: Jhundoo, Henusha Devi
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54701 , vital:26601
- Description: One of the major challenges of the oral administration of ketoconazole (KTZ), an inhibitor of sterol 14α demethylase, used in the management of systemic and topical mycoses in immuno-compromised and paediatric patients is the lack of availability of liquid dosage forms. In order to overcome this challenge, extemporaneous preparations have been manufactured by care-givers and health care providers by crushing or breaking solid oral dosage forms of KTZ and mixing with a vehicle to produce a liquid dosage form that can be swallowed by patients. However, the use of extemporaneous preparations may lead to under or over-dosing if the care-givers are not guided accordingly. Furthermore, the dearth of information on the stability of these KTZ-containing extemporaneous preparations may lead to ineffective antifungal therapy and complicate the problems of resistance as it is difficult to estimate the shelf-lives of these extemporaneous products under varying storage conditions due to the susceptibility of KTZ to chemical degradation. Therefore, there is a need for formulation scientists to develop novel drug delivery systems that avoid the need for extemporaneous preparations, possess well-established limits of stability and minimize the risks of systemic adverse effects to facilitate KTZ therapy. The use of solid lipid microparticles (SLM) as potential carriers for the oral administration of KTZ was investigated since solid lipid carriers are known to exhibit the advantages of traditional colloidal carriers. The research undertaken in these studies aimed to investigate the feasibility of developing and manufacturing solid lipid microparticles (SLM), using a simple micro-emulsion technique, as a carrier for KTZ. Prior to pre-formulation, formulation development and optimization studies of KTZ-loaded SLM, it was necessary to develop and validate an analytical method for the in vitro quantitation and characterization of KTZ in aqueous dispersions of SLM during development and assessment studies. An accurate, precise, specific and sensitive reversed-phase high performance liquid chromatographic (RP-HPLC) method coupled with UV detection at 206 nm was developed, optimized and validated for the analysis of KTZ in formulations. Formulation development studies were preceded by solubility studies of KTZ in different lipids. Labrafil® M2130 CS was found to exhibit the best solubilising potential for KTZ. Pre-formulation studies were also designed to determine the polymorphic behavior and the crystallinity of KTZ and Labrafil® M2130 CS that was used for subsequent manufacture of the solid lipid carriers. DSC and FTIR studies revealed that there were no changes in the crystallinity of KTZ or Labrafil® M2130 CS following exposure to a temperature of 60°C for 1 hour. In addition the potential for physicochemical interaction of KTZ with the lipid Labrafil® M2130 CS was investigated using DSC and FTIR and the results revealed that KTZ was molecularly dispersed in Labrafil® M2130 CS and that it is unlikely that KTZ would interact with the lipid. It was therefore established that KTZ and Labrafil® M2130 CS were thermo-stable at a temperature of 60°C and thus a micro-emulsion technique could be used to manufacture the KTZ-loaded SLM. Drug-free and KTZ-loaded SLM were prepared using a modified micro-emulsion technique that required the use of an Ultra-Turrax® homogenizer set at 24 000 rpm for 5 minutes followed by the use of the Erweka GmbH homogenizer. SLM were characterized in terms of particle size (PS), zeta potential (ZP), shape and surface morphology using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). In addition drug loading capacity (DLC) and encapsulation efficiency (EE) of SLM for KTZ were assessed using RP-HPLC. Formulation development and optimization studies of KTZ-loaded SLM were initially aimed at selecting an emulsifying system that was able to stabilize the SLM in an aqueous dispersion. Successful formulations were selected based on their ability to remain physically stable on the day of manufacture. Pluronic® F68 used in combination with Lutrol® E40, Soluphor® P, Soluplus® produced unstable dispersions on the day of manufacture and these combinations were not investigated further. However, the formulation of a stable KTZ-loaded SLM dispersion was accomplished by use of a combination of Pluronic® F68, Tween 80 and sodium cholate as the surfactant system. Increasing amounts of Labrafil® M2130 CS resulted in the production of particles with low DLC and EE, a large PS and a relatively unchanged ZP. An optimum concentration of 10% w/v Labrafil® M2130 CS was selected to manufacture the KTZ-loaded SLM. Studies to determine the influence of KTZ loading on the quality of SLM revealed that concentrations of KTZ > 5% w/v led to a reduction in DLC and EE and an increase in PS with minimal impact on the ZP. Stability studies conducted at 25°C/65% RH and 40°C/75% RH for up to 30 days following manufacture revealed that batch SLM 15 manufactured using 10% w/v Labrafil® M2130 CS, 5% w/v KTZ and a combination of 4% w/v Pluronic® F-68, 2% w/v Tween 80 and 1% w/v sodium cholate produced the most stable dosage form when stored at 25°C/65% RH for up to 30 days. However, storage at 40°C/75% RH resulted in instability of the formulation. An aqueous dispersion of KTZ-loaded SLM has been developed and assessed and may offer an alternative to extemporaneous preparations used for KTZ therapy in paediatric and immuno-compromised patients.
- Full Text:
- Date Issued: 2015
Development and manufacture of sustained release captopril beads
- Authors: Mhaka, Farai Arthur
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54712 , vital:26602
- Description: Hypertension has a high mortality rate in developing countries such as South Africa. Although the prevention and control of hypertension is a health priority, efforts to decrease the global burden of hypertension and improve control over the condition are inadequate. The use of angiotensin converting enzyme (ACE) inhibitors such as captopril (CPT) have been effective for the management of hypertension when used as first line therapy alone or in combination. Commercially available immediate release dosage forms containing 12.5, 25 and 50 mg of CPT are administered two or three times a day to treat hypertension. CPT degrades in aqueous media with the sulfhydryl functional moiety responsible for adverse effects such as hypersensitivity, taste disturbances and/or presenting with a dry hacking cough. CPT has a short elimination half-life of between 1.6 and 1.9 hours, which means that the compound is a suitable candidate for inclusion in sustained release (SR) dosage forms. Manufacturing a SR dosage form of coated beads for twice daily dosing may reduce the incidence and intensity of undesirable adverse effects, improve the stability of CPT and improve patient adherence. A stability indicating reversed-phase high performance liquid chromatographic (RP-HPLC) method was developed and optimised using a central composite design approach. As part of this approach the interactive effects of input factors, viz. pH, methanol (MeOH) content and column temperature on retention time, were investigated to achieve a separation with well-resolved and symmetrical peaks for CPT and salicylic acid. The method was validated using ICH guidelines and was found to be simple, linear, precise, accurate, selective and rapid for the in vitro quantitation of CPT. The method was successfully applied for the analysis of both commercially available and test formulations. Preformulation studies were undertaken to establish the physical and chemical properties of CPT, excipients and dosage forms to ensure the production of stabile and bioavailable products. Powder blends were assessed for flow properties using angle of repose (AOR), and bulk and tapped density, which were subsequently used to calculate Carr’s Index (CI) and the Hausner ratio (HR). The addition of talc resulted in the most powder blends with AOR, CI and HR that were within a range indicative of satisfactory to good flow properties. The use of talc was necessary to ensure that blending prior to wet granulation and extrusion-spheronisation would produce homogenous powders. Thermogravimetric analysis (TGA), differential scanning calorimetry (DSC) and Fourier Transform Infrared Spectroscopy (FT-IR) were used for the identification and purity of CPT alone and 1:1 binary mixtures with excipients in an effort to establish if CPT was likely to undergo physical and/or chemical modification during production. The DSC thermograms for all CPT-excipient mixtures revealed the presence of a melting endotherm that was wider, occurring at 110.93 °C (Tpeak for pure CPT). The characteristic peaks for specific functional groups were present in the FT-IR spectra for powder mixtures, indicating the absence of incompatibilities. Dialysis studies were used to investigate if the ammonium oleate present in Surelease® E-7-19010 interacted with CPT. The results suggests that an interaction between CPT and Surelease® E-7-19010 during processing of CPT beads was unlikely to occur. Preliminary investigations reveal that Methocel® K100M, Methocel® E4M, Avicel® PH102, Eudragit® RS PO, Surelease® E-7-19010 and talc are compatible with CPT and could be used for the manufacture of SR CPT beads. CPT beads were manufactured using extrusion-spheronisation and coated using a fluidised bed drier fitted with a Wurster insert. The amount of granulating fluid, coating levels, curing time and formulation composition were varied to achieve CPT release with specific criteria to develop a preliminary formulation. The coated beads met all desired quality attributes in respect of micromeritic and flow properties, content uniformity and friability. Response Surface Methodology was used to further optimise the SR CPT formulation. The Plackett-Burman design was used for this process to produce an SR dosage form with desirable quality attributes achieved by altering formulation composition, extrusion-spheronisation variables and coating parameters. ANOVA data revealed significant responses for yield, aspect ratio, sphericity, coating efficiency and cumulative percent CPT released at 2 and 12 hours. Formulations in which the high molecular weight HPMC were used in increased concentrations resulted in the formation of a sticky wet mass and extrudate, resulting in a decrease in yield. The application of a permeable, but insoluble Surelease® coat onto the surface of the beads formed a barrier that complements the activity of the hydrophilic matrix in preventing rapid dissolution and retarding the release of CPT from the beads. The amount of CPT released over 12 hours revealed that increasing the Methocel® K100M content entrapped CPT and retained it more efficiently in the hydrated matrix, resulting in a slow rate of CPT release. In vitro release data were fitted to a number of models in an attempt to elucidate mechanistic aspects of transport processes specific to CPT from the coated bead formulations. The results of fitting data from optimised batches revealed that the goodness of fit based on the adjusted correlation coefficient ranged between 0.953 and 0.976 for the Higuchi model, indicating that diffusion is a predominant factor that controls CPT release from the coated beads. The results of fitting data to the Korsmeyer-Peppas model suggest that the mechanism of CPT release includes transport of the dissolution medium from the vessel reservoir into the core of the bead due to osmotic potential, dissolution of CPT, mass transfer of the dissolved CPT within the core, partitioning between the solution and polymeric film, mass transfer of dissolved CPT through the film to ultimately reach the bulk dissolution fluid. A SR CPT bead formulation that has potential for further development and optimisation for scaled-up production using RSM approaches and Design of Experiments such as CCD or Box-Behnken has been successfully developed and manufactured using extrusion, spheronisation and coating processes. Assessment of all batches of beads manufactured exhibited satisfactory to good flow properties and demonstrated SR profiles over 12 hours that met USP criteria for SR dosage forms.
- Full Text:
- Date Issued: 2015
- Authors: Mhaka, Farai Arthur
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54712 , vital:26602
- Description: Hypertension has a high mortality rate in developing countries such as South Africa. Although the prevention and control of hypertension is a health priority, efforts to decrease the global burden of hypertension and improve control over the condition are inadequate. The use of angiotensin converting enzyme (ACE) inhibitors such as captopril (CPT) have been effective for the management of hypertension when used as first line therapy alone or in combination. Commercially available immediate release dosage forms containing 12.5, 25 and 50 mg of CPT are administered two or three times a day to treat hypertension. CPT degrades in aqueous media with the sulfhydryl functional moiety responsible for adverse effects such as hypersensitivity, taste disturbances and/or presenting with a dry hacking cough. CPT has a short elimination half-life of between 1.6 and 1.9 hours, which means that the compound is a suitable candidate for inclusion in sustained release (SR) dosage forms. Manufacturing a SR dosage form of coated beads for twice daily dosing may reduce the incidence and intensity of undesirable adverse effects, improve the stability of CPT and improve patient adherence. A stability indicating reversed-phase high performance liquid chromatographic (RP-HPLC) method was developed and optimised using a central composite design approach. As part of this approach the interactive effects of input factors, viz. pH, methanol (MeOH) content and column temperature on retention time, were investigated to achieve a separation with well-resolved and symmetrical peaks for CPT and salicylic acid. The method was validated using ICH guidelines and was found to be simple, linear, precise, accurate, selective and rapid for the in vitro quantitation of CPT. The method was successfully applied for the analysis of both commercially available and test formulations. Preformulation studies were undertaken to establish the physical and chemical properties of CPT, excipients and dosage forms to ensure the production of stabile and bioavailable products. Powder blends were assessed for flow properties using angle of repose (AOR), and bulk and tapped density, which were subsequently used to calculate Carr’s Index (CI) and the Hausner ratio (HR). The addition of talc resulted in the most powder blends with AOR, CI and HR that were within a range indicative of satisfactory to good flow properties. The use of talc was necessary to ensure that blending prior to wet granulation and extrusion-spheronisation would produce homogenous powders. Thermogravimetric analysis (TGA), differential scanning calorimetry (DSC) and Fourier Transform Infrared Spectroscopy (FT-IR) were used for the identification and purity of CPT alone and 1:1 binary mixtures with excipients in an effort to establish if CPT was likely to undergo physical and/or chemical modification during production. The DSC thermograms for all CPT-excipient mixtures revealed the presence of a melting endotherm that was wider, occurring at 110.93 °C (Tpeak for pure CPT). The characteristic peaks for specific functional groups were present in the FT-IR spectra for powder mixtures, indicating the absence of incompatibilities. Dialysis studies were used to investigate if the ammonium oleate present in Surelease® E-7-19010 interacted with CPT. The results suggests that an interaction between CPT and Surelease® E-7-19010 during processing of CPT beads was unlikely to occur. Preliminary investigations reveal that Methocel® K100M, Methocel® E4M, Avicel® PH102, Eudragit® RS PO, Surelease® E-7-19010 and talc are compatible with CPT and could be used for the manufacture of SR CPT beads. CPT beads were manufactured using extrusion-spheronisation and coated using a fluidised bed drier fitted with a Wurster insert. The amount of granulating fluid, coating levels, curing time and formulation composition were varied to achieve CPT release with specific criteria to develop a preliminary formulation. The coated beads met all desired quality attributes in respect of micromeritic and flow properties, content uniformity and friability. Response Surface Methodology was used to further optimise the SR CPT formulation. The Plackett-Burman design was used for this process to produce an SR dosage form with desirable quality attributes achieved by altering formulation composition, extrusion-spheronisation variables and coating parameters. ANOVA data revealed significant responses for yield, aspect ratio, sphericity, coating efficiency and cumulative percent CPT released at 2 and 12 hours. Formulations in which the high molecular weight HPMC were used in increased concentrations resulted in the formation of a sticky wet mass and extrudate, resulting in a decrease in yield. The application of a permeable, but insoluble Surelease® coat onto the surface of the beads formed a barrier that complements the activity of the hydrophilic matrix in preventing rapid dissolution and retarding the release of CPT from the beads. The amount of CPT released over 12 hours revealed that increasing the Methocel® K100M content entrapped CPT and retained it more efficiently in the hydrated matrix, resulting in a slow rate of CPT release. In vitro release data were fitted to a number of models in an attempt to elucidate mechanistic aspects of transport processes specific to CPT from the coated bead formulations. The results of fitting data from optimised batches revealed that the goodness of fit based on the adjusted correlation coefficient ranged between 0.953 and 0.976 for the Higuchi model, indicating that diffusion is a predominant factor that controls CPT release from the coated beads. The results of fitting data to the Korsmeyer-Peppas model suggest that the mechanism of CPT release includes transport of the dissolution medium from the vessel reservoir into the core of the bead due to osmotic potential, dissolution of CPT, mass transfer of the dissolved CPT within the core, partitioning between the solution and polymeric film, mass transfer of dissolved CPT through the film to ultimately reach the bulk dissolution fluid. A SR CPT bead formulation that has potential for further development and optimisation for scaled-up production using RSM approaches and Design of Experiments such as CCD or Box-Behnken has been successfully developed and manufactured using extrusion, spheronisation and coating processes. Assessment of all batches of beads manufactured exhibited satisfactory to good flow properties and demonstrated SR profiles over 12 hours that met USP criteria for SR dosage forms.
- Full Text:
- Date Issued: 2015
Formulation, development and assessment of tenofovir disoproxil fumarate-loaded pellets
- Authors: Dube, Tawanda
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54690 , vital:26600
- Description: Tenofovir disoproxil fumarate (TDF) is a novel nucleotide analog reverse transcriptase inhibitor that is recommended by the WHO for use in first line treatment of HIV infections. Due to the high dose of TDF for anti-retroviral treatment the formulation of a pellet dosage form may improve patient adherence by incorporation of a large dose in a relatively small dosage form. TDF is currently only available in tablet form. A simple, sensitive, selective, rapid, accurate, precise, stability indicating reversed-phase HPLC method was developed and validated in accordance with ICH guidelines and was successfully used for the analysis of TDF raw material and pharmaceutical dosage forms. Preformulation studies included an investigation of TDF-excipient and excipient-excipient interactions with all materials that could potentially be used to produce extruded and spheronized pellets. Nuclear Magnetic Resonance spectroscopy (NMR), Infrared Spectroscopy (IR), Differential Scanning Colorimetry (DSC) and Thermogravimetric analysis were used for identification and purity testing of TDF and all excipients. DSC data revealed that no potential interactions between TDF and the excipients occurred suggesting that incompatibility reactions were unlikely during manufacture and storage. These findings were confirmed by IR analysis that revealed that no physical interaction was likely between any of the excipients used and TDF. DSC data also reveal the existence of the α and β-polymorphs of TDF as evidenced by two enthalpy changes observed on the resultant thermograms. The existence of two polymorphs is unlikely to result in incompatibility and was confirmed by IR analysis. The IR spectra reveal that all characteristic peaks for TDF were present in 1:1 binary mixtures. Therefore TDF is compatible with all excipients tested and thermal analysis confirmed the stability of TDF under manufacturing conditions. The temperature of degradation temperature established through DSC analysis confirmed that degradation during manufacture is unlikely as the temperature of manufacture is lower than that at which degradation occurs. Extrusion and spheronization were the processes used to manufacture TDF pellets as it is a simple and economic approach for production. The effects of extruder and spheronizer speed, amount of spheronization aid and diluents on the pellet size, shape, flow properties and TDF release characteristics were examined. In order to decrease the complexity of analysis and reduce the cost of development a Taguchi orthogonal array design of experiments was successfully applied to evaluate the impact of formulation variables on product characteristics and predict an optimized formulation with a minimum number of experiments. The use of Response Surface Methodology for the development and optimization of pharmaceutical systems, including the optimization of formulation composition, manufacturing processes and/or analytical methods is well established. However the application of RSM requires that accurate, precise and reproducible experimental conditions are used for the generation of reliable data and RSM use is limited due to sensitivity to experimental variability. The benefits of using RSM for formulation optimization include the fact that more than one variable can be investigated at a time and large amounts of information can be generated at the same time ensuring a more efficient process with respect to time and cost. An added advantage of this approach is that mathematical relationships can be generated for the models that are produced and provide formulation scientists with an indication of whether the effect(s) between factors are synergistic or antagonistic. There are several statistical design approaches that use RSM and a Taguchi orthogonal array design was selected for use in this optimization process as fewer experiments are required to generate data for the same number of factors to be investigated when compared to other statistical designs such as Central Composite (CCD) and Box-Behnken designs. The use of RSM clearly demonstrates the impact of different input variables on the % TDF released at 45 min and % TDF loaded into the particles. The amount of sorbitol and Kollidon® CL-M were the only significant variables that affected the % TDF released at 45 min and both excipients had an overall synergistic effect on the in vitro release of TDF. The prediction and manufacture of an optimized formulation led to the production of pellets that met predetermined specifications which was successfully achieved using RSM. The development of a TDF containing pellet dosage form has been achieved and the formulation, manufacture and characterization of the dosage form reveal that the product has the potential to be further developed.
- Full Text:
- Date Issued: 2015
- Authors: Dube, Tawanda
- Date: 2015
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54690 , vital:26600
- Description: Tenofovir disoproxil fumarate (TDF) is a novel nucleotide analog reverse transcriptase inhibitor that is recommended by the WHO for use in first line treatment of HIV infections. Due to the high dose of TDF for anti-retroviral treatment the formulation of a pellet dosage form may improve patient adherence by incorporation of a large dose in a relatively small dosage form. TDF is currently only available in tablet form. A simple, sensitive, selective, rapid, accurate, precise, stability indicating reversed-phase HPLC method was developed and validated in accordance with ICH guidelines and was successfully used for the analysis of TDF raw material and pharmaceutical dosage forms. Preformulation studies included an investigation of TDF-excipient and excipient-excipient interactions with all materials that could potentially be used to produce extruded and spheronized pellets. Nuclear Magnetic Resonance spectroscopy (NMR), Infrared Spectroscopy (IR), Differential Scanning Colorimetry (DSC) and Thermogravimetric analysis were used for identification and purity testing of TDF and all excipients. DSC data revealed that no potential interactions between TDF and the excipients occurred suggesting that incompatibility reactions were unlikely during manufacture and storage. These findings were confirmed by IR analysis that revealed that no physical interaction was likely between any of the excipients used and TDF. DSC data also reveal the existence of the α and β-polymorphs of TDF as evidenced by two enthalpy changes observed on the resultant thermograms. The existence of two polymorphs is unlikely to result in incompatibility and was confirmed by IR analysis. The IR spectra reveal that all characteristic peaks for TDF were present in 1:1 binary mixtures. Therefore TDF is compatible with all excipients tested and thermal analysis confirmed the stability of TDF under manufacturing conditions. The temperature of degradation temperature established through DSC analysis confirmed that degradation during manufacture is unlikely as the temperature of manufacture is lower than that at which degradation occurs. Extrusion and spheronization were the processes used to manufacture TDF pellets as it is a simple and economic approach for production. The effects of extruder and spheronizer speed, amount of spheronization aid and diluents on the pellet size, shape, flow properties and TDF release characteristics were examined. In order to decrease the complexity of analysis and reduce the cost of development a Taguchi orthogonal array design of experiments was successfully applied to evaluate the impact of formulation variables on product characteristics and predict an optimized formulation with a minimum number of experiments. The use of Response Surface Methodology for the development and optimization of pharmaceutical systems, including the optimization of formulation composition, manufacturing processes and/or analytical methods is well established. However the application of RSM requires that accurate, precise and reproducible experimental conditions are used for the generation of reliable data and RSM use is limited due to sensitivity to experimental variability. The benefits of using RSM for formulation optimization include the fact that more than one variable can be investigated at a time and large amounts of information can be generated at the same time ensuring a more efficient process with respect to time and cost. An added advantage of this approach is that mathematical relationships can be generated for the models that are produced and provide formulation scientists with an indication of whether the effect(s) between factors are synergistic or antagonistic. There are several statistical design approaches that use RSM and a Taguchi orthogonal array design was selected for use in this optimization process as fewer experiments are required to generate data for the same number of factors to be investigated when compared to other statistical designs such as Central Composite (CCD) and Box-Behnken designs. The use of RSM clearly demonstrates the impact of different input variables on the % TDF released at 45 min and % TDF loaded into the particles. The amount of sorbitol and Kollidon® CL-M were the only significant variables that affected the % TDF released at 45 min and both excipients had an overall synergistic effect on the in vitro release of TDF. The prediction and manufacture of an optimized formulation led to the production of pellets that met predetermined specifications which was successfully achieved using RSM. The development of a TDF containing pellet dosage form has been achieved and the formulation, manufacture and characterization of the dosage form reveal that the product has the potential to be further developed.
- Full Text:
- Date Issued: 2015
The quantification of fucoxanthin from selected South African marine brown algae (Phaeophyta) using HPLC-UV/Vis
- Authors: Mubaiwa, Byron Tawanda
- Date: 2015
- Subjects: Marine algae , Brown algae , High performance liquid chromatography , Functional foods , Xanthophylls , Carotenoids , Extraction (Chemistry)
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3868 , http://hdl.handle.net/10962/d1017879
- Description: Marine brown algae (seaweeds) are a rich source of fucoxanthin, a xanthophyll carotenoid that is naturally, an accessory pigment in the process of photosynthesis of sea vegetation such as Sargassum incisifolium. Fucoxanthin has been exploited by nutraceutical companies for its anti-obesity effects that has resulted in an increase of seaweed slimming preparations such as FucoThin™. The field is getting widespread consumer attention as interest in fucoxanthin has also transcended to its widespread biological potential which include cytotoxicity, anti-diabetic, anti-oxidant, anti-inflammatory and anti-plasmodium effects. We therefore wanted to identify a reliable source(s) of fucoxanthin from diverse samples of South African marine brown algae in order to explore our medicinal chemistry interests around the cytotoxicity and anti-malarial potential of fucoxanthin. A known source, Sargassum incisifolium, was used to isolate (maceration in CH₂Cl₂/MeOH at 35 °C followed by a hexane/EtOAc step gradient silica column of the crude extract and reversed phase semi-prep HPLC) and characterize (1D and 2D NMR) fucoxanthin (reference standard) in order to develop an analytical method for its determination in selected diverse brown algae commonly found in South Africa. The HPLC [Column: Phenomenex® Synergi™ (250 x 3.0 mm i.d); Mobile phase: ACN/H2O (95:5)] method developed for this analysis was validated according the guidelines set by the International Conference on Harmonization (ICH). Fifteen species were then assessed for fucoxanthin content (μg/g of dried weight) using the developed method. Stability studies on fucoxanthin were also carried out to assess photo- and pH degradation of fucoxanthin. Zonaria subarticulata (KOS130226-18) from Kenton-On-Sea beach and Sargassum incisifolium (PA130427-1) from Port Alfred beach were found to be the highest producers of fucoxanthin with 0.50 mg/g and 0.45 mg/g dried weight respectively. Fucoxanthin was found to be both photo-labile and sensitive to both acidic and basic pH environments. However, the pigment was more photostable in pure as opposed to extract form and also showed to be more stable at pH 10.0. Our findings show that Z. subarticulata and S. incisifolium could be reliable sources of fucoxanthin and can be considered as the algae to use in optimized extraction procedures in further studies. Also, when working with fucoxanthin, it is important to protect it from light. Any consideration of taking fucoxanthin preparation orally (as a nutraceutical) should consider protecting the active from the harsh conditions of the gastrointestinal tract. Any upscale production of fucoxanthin from seaweed should consider variations such as geographical, seasonal, lifecycle stage, etc. of identified algae as these may be important factors in obtaining effective concentrations of fucoxanthin.
- Full Text:
- Date Issued: 2015
- Authors: Mubaiwa, Byron Tawanda
- Date: 2015
- Subjects: Marine algae , Brown algae , High performance liquid chromatography , Functional foods , Xanthophylls , Carotenoids , Extraction (Chemistry)
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3868 , http://hdl.handle.net/10962/d1017879
- Description: Marine brown algae (seaweeds) are a rich source of fucoxanthin, a xanthophyll carotenoid that is naturally, an accessory pigment in the process of photosynthesis of sea vegetation such as Sargassum incisifolium. Fucoxanthin has been exploited by nutraceutical companies for its anti-obesity effects that has resulted in an increase of seaweed slimming preparations such as FucoThin™. The field is getting widespread consumer attention as interest in fucoxanthin has also transcended to its widespread biological potential which include cytotoxicity, anti-diabetic, anti-oxidant, anti-inflammatory and anti-plasmodium effects. We therefore wanted to identify a reliable source(s) of fucoxanthin from diverse samples of South African marine brown algae in order to explore our medicinal chemistry interests around the cytotoxicity and anti-malarial potential of fucoxanthin. A known source, Sargassum incisifolium, was used to isolate (maceration in CH₂Cl₂/MeOH at 35 °C followed by a hexane/EtOAc step gradient silica column of the crude extract and reversed phase semi-prep HPLC) and characterize (1D and 2D NMR) fucoxanthin (reference standard) in order to develop an analytical method for its determination in selected diverse brown algae commonly found in South Africa. The HPLC [Column: Phenomenex® Synergi™ (250 x 3.0 mm i.d); Mobile phase: ACN/H2O (95:5)] method developed for this analysis was validated according the guidelines set by the International Conference on Harmonization (ICH). Fifteen species were then assessed for fucoxanthin content (μg/g of dried weight) using the developed method. Stability studies on fucoxanthin were also carried out to assess photo- and pH degradation of fucoxanthin. Zonaria subarticulata (KOS130226-18) from Kenton-On-Sea beach and Sargassum incisifolium (PA130427-1) from Port Alfred beach were found to be the highest producers of fucoxanthin with 0.50 mg/g and 0.45 mg/g dried weight respectively. Fucoxanthin was found to be both photo-labile and sensitive to both acidic and basic pH environments. However, the pigment was more photostable in pure as opposed to extract form and also showed to be more stable at pH 10.0. Our findings show that Z. subarticulata and S. incisifolium could be reliable sources of fucoxanthin and can be considered as the algae to use in optimized extraction procedures in further studies. Also, when working with fucoxanthin, it is important to protect it from light. Any consideration of taking fucoxanthin preparation orally (as a nutraceutical) should consider protecting the active from the harsh conditions of the gastrointestinal tract. Any upscale production of fucoxanthin from seaweed should consider variations such as geographical, seasonal, lifecycle stage, etc. of identified algae as these may be important factors in obtaining effective concentrations of fucoxanthin.
- Full Text:
- Date Issued: 2015
Adolescent pregnancy: a community engaged participatory approach to design and implement an educational intervention
- Authors: Siruma, Amanda Tatenda
- Date: 2014
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54656 , vital:26597
- Description: Millennium Development Goal (MDG) 5 focuses on improving maternal health, due to global acknowledgment that no woman should have to die as a result of complications during pregnancy and childbirth. Adolescents have an increased risk of maternal death compared with older women. Adolescent pregnancy also poses a threat to the empowerment of young girls by mitigating their physical, educational, social, and economic development. In this context, maternal health promotion strategies which inclusively target adolescents are crucial, not only in improving maternal health outcomes, but also in optimising the overall transition of adolescent girls to adulthood. This study was a first time collaborative partnership of the Faculty of Pharmacy and Community Engagement Office of Rhodes University with the Angus Gillis Foundation (a non-profit community development organisation), and community participants of Glenmore and Ndwayana, two rural communities in the Eastern Cape. The aim of this study was to identify the maternal health issue of most concern to community participants and to design and implement an appropriate educational intervention for a suitable target group. During the baseline phase of this study, ten focus group discussions (FGDs) were conducted with 76 community stakeholders. Semi-structured interviews (SSIs) were conducted with two Sisters-in-Charge from each Primary Health Care (PHC) facility in the study setting. Data on the stock status of World Health Organization (WHO) identified lifesaving priority medicines for women’s health was also collected at both PHCs. Thereafter, pre- and posteducational interventions SSIs with female adolescent participants were conducted. The educational intervention was followed up with the development of a booklet on reproductive health. FGD participants identified adolescent pregnancy as the maternal health issue of most concern. They also highlighted challenges in service delivery of ambulance services for expectant mothers in urgent need of transportation to a referral hospital. A majority of preintervention SSI participants indicated coercion from both younger and older men as a factor influencing early sexual debut amongst adolescent girls in their communities. Despite availability in the PHCs, challenges in accessing contraceptives were highlighted by the participants. Additionally, a number of sexually active adolescent girls defaulted on their next allocated visit to the PHC due to myths regarding use of oral and injectable contraceptives. During the educational intervention sessions, participants recognised knowledge gaps regarding reproductive health issues and the influence of peer pressure as constraining factors in preventing adolescent pregnancy. During the post-intervention phase, participants highlighted that the educational intervention of this study had provided a forum to discuss ways of preventing adolescent pregnancy. The educational booklet developed is intended to serve as a resource tool of the educational programme on prevention of adolescent pregnancy, which is expected to be incorporated into the Angus Gillis Foundation’s existing ‘Positive Health’ Programme. The results of this study show that community-based participatory research facilitated the identification of the maternal health issue of most concern to these communities. Working synergistically with key stakeholders in designing and implementing an educational intervention for preventing adolescent pregnancy provides a good foundation for future up scaling and sustainability of this educational programme.
- Full Text:
- Date Issued: 2014
- Authors: Siruma, Amanda Tatenda
- Date: 2014
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54656 , vital:26597
- Description: Millennium Development Goal (MDG) 5 focuses on improving maternal health, due to global acknowledgment that no woman should have to die as a result of complications during pregnancy and childbirth. Adolescents have an increased risk of maternal death compared with older women. Adolescent pregnancy also poses a threat to the empowerment of young girls by mitigating their physical, educational, social, and economic development. In this context, maternal health promotion strategies which inclusively target adolescents are crucial, not only in improving maternal health outcomes, but also in optimising the overall transition of adolescent girls to adulthood. This study was a first time collaborative partnership of the Faculty of Pharmacy and Community Engagement Office of Rhodes University with the Angus Gillis Foundation (a non-profit community development organisation), and community participants of Glenmore and Ndwayana, two rural communities in the Eastern Cape. The aim of this study was to identify the maternal health issue of most concern to community participants and to design and implement an appropriate educational intervention for a suitable target group. During the baseline phase of this study, ten focus group discussions (FGDs) were conducted with 76 community stakeholders. Semi-structured interviews (SSIs) were conducted with two Sisters-in-Charge from each Primary Health Care (PHC) facility in the study setting. Data on the stock status of World Health Organization (WHO) identified lifesaving priority medicines for women’s health was also collected at both PHCs. Thereafter, pre- and posteducational interventions SSIs with female adolescent participants were conducted. The educational intervention was followed up with the development of a booklet on reproductive health. FGD participants identified adolescent pregnancy as the maternal health issue of most concern. They also highlighted challenges in service delivery of ambulance services for expectant mothers in urgent need of transportation to a referral hospital. A majority of preintervention SSI participants indicated coercion from both younger and older men as a factor influencing early sexual debut amongst adolescent girls in their communities. Despite availability in the PHCs, challenges in accessing contraceptives were highlighted by the participants. Additionally, a number of sexually active adolescent girls defaulted on their next allocated visit to the PHC due to myths regarding use of oral and injectable contraceptives. During the educational intervention sessions, participants recognised knowledge gaps regarding reproductive health issues and the influence of peer pressure as constraining factors in preventing adolescent pregnancy. During the post-intervention phase, participants highlighted that the educational intervention of this study had provided a forum to discuss ways of preventing adolescent pregnancy. The educational booklet developed is intended to serve as a resource tool of the educational programme on prevention of adolescent pregnancy, which is expected to be incorporated into the Angus Gillis Foundation’s existing ‘Positive Health’ Programme. The results of this study show that community-based participatory research facilitated the identification of the maternal health issue of most concern to these communities. Working synergistically with key stakeholders in designing and implementing an educational intervention for preventing adolescent pregnancy provides a good foundation for future up scaling and sustainability of this educational programme.
- Full Text:
- Date Issued: 2014
Development and assessment of sustained release stavudine loaded microparticles
- Authors: Zindove, Chiedza Cathrine
- Date: 2014
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54722 , vital:26603
- Description:
Stavudine (D4T) has been used as first line treatment for HIV/AIDS and is part of highly active anti retroviral treatment (HAART). It is an affordable medicine and its use is beneficial in resource limited settings. However D4T exhibits dose dependent side effects that may lead to non-adherence in patients. This study was undertaken to formulate, develop and manufacture a dosage form that could reduce dose dependent side effects by decreasing the dose of D4T but still exhibit antiretroviral (ARV) activity. The use of sustained release (SR) formulations of D4T that ensure constant levels of the D4T in the body would not only optimize therapy but also reduce the incidence of side effects thereby increasing patient adherence. SR microparticles containing 30mg D4T were manufactured and loaded into size 3 hard gelatine capsules prior to analysis. The D4T microparticles were manufactured by microencapsulation using non-aqueous oil-in-oil solvent evaporation approach. D4T-excipient, excipient-excipient interactions and D4T purity were assessed using Infrared Spectroscopy (IR), Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA). Copolymers synthesized from acrylic and methacrylic acid esters viz., Eudragit® RSPO and S100 were used as rate retardant materials and the effect of microcrystalline cellulose (Avicel® PH102) on the microparticles was also investigated. Magnesium stearate was used as a droplet stabilizer and n-hexane was added to harden the microspheres formed in a liquid paraffin continuous phase. The microparticles were optimized using a Box Behnken design and Response Surface Methodology (RSM). The microparticles were characterized in terms of their flow properties and encapsulation efficiency (% EE), in addition to visualization of the surface morphology with Scanning Electron Microscopy. In vitro D4T release studies were performed using USP Apparatus III in media of different pH and the samples were analysed using a validated High Performance Liquid Chromatographic (HPLC) method with ultraviolet (UV) detection that had been developed and optimized using a Central Composite Design (CCD). The method was validated according to ICH guidelines. The IR spectra and DSC thermographs revealed that D4T exhibited thermal stability and there was no evidence of D4T-excipient and excipient-excipient interactions. The microparticles that were produced were white, free flowing and were obtained in a high yield with high encapsulation efficiency. Scanning Electron Microscopy studies revealed that the microparticles were spherical and porous in nature. In vitro D4T release extended to 12 hours and the mechanism of release was established using model dependent methods by fitting the data to a Zero order, First order, Higuchi and Hixson Crowell model. It was observed that the mechanism of D4T release was diffusion-controlled and that the data was best fitted to the Higuchi model with correlation coefficients > 0.9. The release mechanism was confirmed using the Korsmeyer-Peppas model that revealed that most of the formulations exhibited anomalous transport kinetics with the release exponent, n, ranging from 0.5
- Full Text:
- Date Issued: 2014
- Authors: Zindove, Chiedza Cathrine
- Date: 2014
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/54722 , vital:26603
- Description:
Stavudine (D4T) has been used as first line treatment for HIV/AIDS and is part of highly active anti retroviral treatment (HAART). It is an affordable medicine and its use is beneficial in resource limited settings. However D4T exhibits dose dependent side effects that may lead to non-adherence in patients. This study was undertaken to formulate, develop and manufacture a dosage form that could reduce dose dependent side effects by decreasing the dose of D4T but still exhibit antiretroviral (ARV) activity. The use of sustained release (SR) formulations of D4T that ensure constant levels of the D4T in the body would not only optimize therapy but also reduce the incidence of side effects thereby increasing patient adherence. SR microparticles containing 30mg D4T were manufactured and loaded into size 3 hard gelatine capsules prior to analysis. The D4T microparticles were manufactured by microencapsulation using non-aqueous oil-in-oil solvent evaporation approach. D4T-excipient, excipient-excipient interactions and D4T purity were assessed using Infrared Spectroscopy (IR), Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA). Copolymers synthesized from acrylic and methacrylic acid esters viz., Eudragit® RSPO and S100 were used as rate retardant materials and the effect of microcrystalline cellulose (Avicel® PH102) on the microparticles was also investigated. Magnesium stearate was used as a droplet stabilizer and n-hexane was added to harden the microspheres formed in a liquid paraffin continuous phase. The microparticles were optimized using a Box Behnken design and Response Surface Methodology (RSM). The microparticles were characterized in terms of their flow properties and encapsulation efficiency (% EE), in addition to visualization of the surface morphology with Scanning Electron Microscopy. In vitro D4T release studies were performed using USP Apparatus III in media of different pH and the samples were analysed using a validated High Performance Liquid Chromatographic (HPLC) method with ultraviolet (UV) detection that had been developed and optimized using a Central Composite Design (CCD). The method was validated according to ICH guidelines. The IR spectra and DSC thermographs revealed that D4T exhibited thermal stability and there was no evidence of D4T-excipient and excipient-excipient interactions. The microparticles that were produced were white, free flowing and were obtained in a high yield with high encapsulation efficiency. Scanning Electron Microscopy studies revealed that the microparticles were spherical and porous in nature. In vitro D4T release extended to 12 hours and the mechanism of release was established using model dependent methods by fitting the data to a Zero order, First order, Higuchi and Hixson Crowell model. It was observed that the mechanism of D4T release was diffusion-controlled and that the data was best fitted to the Higuchi model with correlation coefficients > 0.9. The release mechanism was confirmed using the Korsmeyer-Peppas model that revealed that most of the formulations exhibited anomalous transport kinetics with the release exponent, n, ranging from 0.5
- Full Text:
- Date Issued: 2014