Genetic characteristics of Human Immunodeficiency Virus-1, and deter-minants of late presentation for care and Diabetes mellitus amongst newly diagnosed Human Immunodeficiency Virus positive patients in the Eastern Cape, South Africa.
- Authors: Sogbanmu, Olufunso Oladipo
- Date: 2019
- Subjects: HIV infections
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/${Handle} , vital:40495
- Description: Phylogenies may help to characterize transmission pairs, enhance contact tracing and outbreak investigations, track the origin and spread of epidemics over place and time, and to identify patterns of onward Human Immunodeficiency-Virus (HIV) transmission among risk groups. If the pattern and evolution of HIV drug resistance can be mapped, this may influence the development of guidelines in the clinical management of HIV especially with issues relating to prevalence of primary drug resistance and its impact on outcomes of present antiretroviral treatment (ART) regimen in use and the ability to trace and track the development of drug resistant strains. The roll-out of the test and treat Programme for newly diagnosed HIV infected pa-tient, seeks to identify HIV infected individuals early and to prevent morbidity and mortality associated with the late presentation for HIV care. The determination of the magnitude of ‘late presentation’ and or ‘presentation with advanced HIV disease’ can be used in very diverse settings and for many purposes. It provides a unified way to define the problem, thereby targeting appropriate interventions to prevent the detrimental outcomes associated with late presentation to care. The subtle relationship between HIV and diabetes mellitus (DM) may also help in formulating better preventive programs to aid the control of non-communicable diseases such as DM. This cross-sectional study includes a purposive selection of 335 HIV positive patients attending the voluntary counselling and Testing (VCT) and HIV Counselling and Testing (HCT) centres and outpatient departments at Cecilia Makiwane Hospital and the HCT sites at the Buffalo District municipality community health centres, Eastern Cape Province, South Africa. Late or delayed presentation of HIV infection was defined as CD4 cell count beneath 350 cells/μL and/or patients presenting with an AIDS-defining event at the first follow-up regardless of the CD4 cell count. Chapter 1 provides the general introduction had an overview of the introduction to the study, the statement of the research problem, hypothesis, the aim and the objectives. xx Chapter 2 looked in-depth at the HIV, case definition, the latest epidemiology of HIV, the HIV genome, the life cycle of HIV, its diagnosis, the classes of antiretroviral drugs, development of drug resistance. Chapter 3 highlighted the prevalence of Transmitted Drug Resistance (TDR) with focus on the protease gene. RNA was extracted from blood samples of 72 newly diagnosed HIV-1 patients attending some HIV testing and counselling clinics from August 2016 to July 2017. Protease fragments were amplified with specific primers by RT-PCR followed by nested PCR. The amplified products were sequenced using the ABI 360 sequencer, edited with Geneious version 9.1.5 and translated into amino acid with BioEdit software. Drug related resistance mutation (DRMs) analysis was performed on all the protease sequences in accordance with the 2009 WHO list of surveillance drug resistance mutations by submitting the edited sequences to Stanford HIV drug interpretation programme and the international AIDS society-USA guidelines for query of drug resistance associated mutations while phylogenetic analysis was performed using MEGA 6 to allocate all viral sequences into subtypes. In the study, a total of 52/72 (71.1%) reliable HIV-1 protease sequences were obtained in which subtyping and drug resistance mutations were performed. Two (3.8%) major Protease resistance associated mutation (V82A/L and L90M) were observed while another polymorphism like L10F, T74S, Q58E, L10I/V and M46V were also identified. Phylogenetic analyses delineated all the sequences as HIV-1 subtype C. Chapter 4 describes the prevalence and the determinants of late presentation amongst newly diagnosed HIV positive individuals in the Eastern Cape. It indicates the extent of the prevalence of patients presenting to care and at what HIV stage they were assessing health care services since the inception of the ‘test and treat’ strategy. It is a cross-sectional study where a total of 335 newly diagnosed patients were recruited consecutively be-tween August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/μL and/or when there is an established Aids- xxi defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis. The study showed that 60% of patients were late presenters, with 35% presenting with advanced disease. The major determinants identified were being male and low level of education. This led to recommendations directed at ensuring programmes that targets men in identifying their HIV status and assess care at early stage to prevents the morbidity and mortality associated with delayed presentation. Also, it was recommended that effort should be made to improve access to education and also include HIV related topics into the educational curriculum. Chapter 5 aimed to describe the prevalence and determinants of DM amongst newly diagnosed HIV positive individuals. This is a cross-sectional study which recruited 335 patients between August 2016 and September 2017. Definition for diabetes mellitus was made based on the SEDMSA 2015 guideline of HBA1C of above 6.5%. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of abnormal glycated haemoglobin. Findings showed the prevalence of DM at about 6% amongst newly diagnosed HIV positive individuals. This is similar to findings in other study within the country, but a bit lower than what was obtained in the developed countries. The role of older age (above 40 years) as predisposing factor to development of diabetes in newly diagnosed HIV positive individual was well noted and taken. This ensures that screening for DM should be targeted at elderly HIV positive individuals. The grey area of the appropriate mode of diagnostic test to use to diagnose HIV is still debatable, however, a combination of HBA1c and fasting blood sugar (FBS) may improve the diagnosis of DM in this population group. In chapter 6, the general conclusions, recommendations and future perspectives of the study are reflected.
- Full Text:
- Date Issued: 2019
- Authors: Sogbanmu, Olufunso Oladipo
- Date: 2019
- Subjects: HIV infections
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/${Handle} , vital:40495
- Description: Phylogenies may help to characterize transmission pairs, enhance contact tracing and outbreak investigations, track the origin and spread of epidemics over place and time, and to identify patterns of onward Human Immunodeficiency-Virus (HIV) transmission among risk groups. If the pattern and evolution of HIV drug resistance can be mapped, this may influence the development of guidelines in the clinical management of HIV especially with issues relating to prevalence of primary drug resistance and its impact on outcomes of present antiretroviral treatment (ART) regimen in use and the ability to trace and track the development of drug resistant strains. The roll-out of the test and treat Programme for newly diagnosed HIV infected pa-tient, seeks to identify HIV infected individuals early and to prevent morbidity and mortality associated with the late presentation for HIV care. The determination of the magnitude of ‘late presentation’ and or ‘presentation with advanced HIV disease’ can be used in very diverse settings and for many purposes. It provides a unified way to define the problem, thereby targeting appropriate interventions to prevent the detrimental outcomes associated with late presentation to care. The subtle relationship between HIV and diabetes mellitus (DM) may also help in formulating better preventive programs to aid the control of non-communicable diseases such as DM. This cross-sectional study includes a purposive selection of 335 HIV positive patients attending the voluntary counselling and Testing (VCT) and HIV Counselling and Testing (HCT) centres and outpatient departments at Cecilia Makiwane Hospital and the HCT sites at the Buffalo District municipality community health centres, Eastern Cape Province, South Africa. Late or delayed presentation of HIV infection was defined as CD4 cell count beneath 350 cells/μL and/or patients presenting with an AIDS-defining event at the first follow-up regardless of the CD4 cell count. Chapter 1 provides the general introduction had an overview of the introduction to the study, the statement of the research problem, hypothesis, the aim and the objectives. xx Chapter 2 looked in-depth at the HIV, case definition, the latest epidemiology of HIV, the HIV genome, the life cycle of HIV, its diagnosis, the classes of antiretroviral drugs, development of drug resistance. Chapter 3 highlighted the prevalence of Transmitted Drug Resistance (TDR) with focus on the protease gene. RNA was extracted from blood samples of 72 newly diagnosed HIV-1 patients attending some HIV testing and counselling clinics from August 2016 to July 2017. Protease fragments were amplified with specific primers by RT-PCR followed by nested PCR. The amplified products were sequenced using the ABI 360 sequencer, edited with Geneious version 9.1.5 and translated into amino acid with BioEdit software. Drug related resistance mutation (DRMs) analysis was performed on all the protease sequences in accordance with the 2009 WHO list of surveillance drug resistance mutations by submitting the edited sequences to Stanford HIV drug interpretation programme and the international AIDS society-USA guidelines for query of drug resistance associated mutations while phylogenetic analysis was performed using MEGA 6 to allocate all viral sequences into subtypes. In the study, a total of 52/72 (71.1%) reliable HIV-1 protease sequences were obtained in which subtyping and drug resistance mutations were performed. Two (3.8%) major Protease resistance associated mutation (V82A/L and L90M) were observed while another polymorphism like L10F, T74S, Q58E, L10I/V and M46V were also identified. Phylogenetic analyses delineated all the sequences as HIV-1 subtype C. Chapter 4 describes the prevalence and the determinants of late presentation amongst newly diagnosed HIV positive individuals in the Eastern Cape. It indicates the extent of the prevalence of patients presenting to care and at what HIV stage they were assessing health care services since the inception of the ‘test and treat’ strategy. It is a cross-sectional study where a total of 335 newly diagnosed patients were recruited consecutively be-tween August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/μL and/or when there is an established Aids- xxi defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis. The study showed that 60% of patients were late presenters, with 35% presenting with advanced disease. The major determinants identified were being male and low level of education. This led to recommendations directed at ensuring programmes that targets men in identifying their HIV status and assess care at early stage to prevents the morbidity and mortality associated with delayed presentation. Also, it was recommended that effort should be made to improve access to education and also include HIV related topics into the educational curriculum. Chapter 5 aimed to describe the prevalence and determinants of DM amongst newly diagnosed HIV positive individuals. This is a cross-sectional study which recruited 335 patients between August 2016 and September 2017. Definition for diabetes mellitus was made based on the SEDMSA 2015 guideline of HBA1C of above 6.5%. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of abnormal glycated haemoglobin. Findings showed the prevalence of DM at about 6% amongst newly diagnosed HIV positive individuals. This is similar to findings in other study within the country, but a bit lower than what was obtained in the developed countries. The role of older age (above 40 years) as predisposing factor to development of diabetes in newly diagnosed HIV positive individual was well noted and taken. This ensures that screening for DM should be targeted at elderly HIV positive individuals. The grey area of the appropriate mode of diagnostic test to use to diagnose HIV is still debatable, however, a combination of HBA1c and fasting blood sugar (FBS) may improve the diagnosis of DM in this population group. In chapter 6, the general conclusions, recommendations and future perspectives of the study are reflected.
- Full Text:
- Date Issued: 2019
Teachers and learners’ perspectives towards English as a language of learning and teaching : a case of two selected secondary schools in the Amathole West Education District
- Osunkunle, Atinuke Oluwatoyin
- Authors: Osunkunle, Atinuke Oluwatoyin
- Date: 2019
- Subjects: English language -- Study and teaching Second language acquisition
- Language: English
- Type: Thesis , Masters , MEd
- Identifier: http://hdl.handle.net/10353/16243 , vital:40702
- Description: The study aimed at examining teachers and learners’ perspectives towards English as a language of learning and teaching (LoLT), using two selected secondary schools in the Amathole West Education District as a case study and to see if English is indeed a language of choice among learners and teachers. The researcher employed an interpretative qualitative research paradigm and purposive non-probability sampling method was used to draw samples of participants for in-depth interviews and focus group discussions. The school principal and two teachers were purposively selected in each of the two schools, making a total of two school principals and four teachers that were interviewed. In addition, a member of the School Governing Body (SGB) was selected in each of the two schools and interviewed. The study also had one focus group discussion with learners in each of the two selected schools, making two focus groups in total. All the one-on-one in-depth interviews as well as the focus group discussions with the learners were recorded and then transcribed. The collected data was later analysed thematically to infer the meaning and present the findings. The findings revealed that most of the students in public schools are torn between two divides as they struggle with the use of English as a language of learning and teaching but seem to have no choice, as they all believed that the use of English is quite beneficial to them in many ways. Another critical finding is that some teachers find it difficult to teach in English because they do not have a good command of the language. This makes them to code-switch regularly using IsiXhosa along with English while they are supposed to teach in English. Thus, this affects the learners proper understanding of and grounding in the English language. The study also found out that the schools lack adequate support to ensure the effective use of English for learning and teaching. The study recommended that various support systems from the government are needed in order to ensure the acceptance and successful use of English as LoLT in South African public schools. In this regard, the participants assured that these would result in positive outcomes, as they would provide quality education through government support. The study concluded that English is the preferred LoLT by both teachers and learners, thus, it needs to be prioritised.
- Full Text:
- Date Issued: 2019
- Authors: Osunkunle, Atinuke Oluwatoyin
- Date: 2019
- Subjects: English language -- Study and teaching Second language acquisition
- Language: English
- Type: Thesis , Masters , MEd
- Identifier: http://hdl.handle.net/10353/16243 , vital:40702
- Description: The study aimed at examining teachers and learners’ perspectives towards English as a language of learning and teaching (LoLT), using two selected secondary schools in the Amathole West Education District as a case study and to see if English is indeed a language of choice among learners and teachers. The researcher employed an interpretative qualitative research paradigm and purposive non-probability sampling method was used to draw samples of participants for in-depth interviews and focus group discussions. The school principal and two teachers were purposively selected in each of the two schools, making a total of two school principals and four teachers that were interviewed. In addition, a member of the School Governing Body (SGB) was selected in each of the two schools and interviewed. The study also had one focus group discussion with learners in each of the two selected schools, making two focus groups in total. All the one-on-one in-depth interviews as well as the focus group discussions with the learners were recorded and then transcribed. The collected data was later analysed thematically to infer the meaning and present the findings. The findings revealed that most of the students in public schools are torn between two divides as they struggle with the use of English as a language of learning and teaching but seem to have no choice, as they all believed that the use of English is quite beneficial to them in many ways. Another critical finding is that some teachers find it difficult to teach in English because they do not have a good command of the language. This makes them to code-switch regularly using IsiXhosa along with English while they are supposed to teach in English. Thus, this affects the learners proper understanding of and grounding in the English language. The study also found out that the schools lack adequate support to ensure the effective use of English for learning and teaching. The study recommended that various support systems from the government are needed in order to ensure the acceptance and successful use of English as LoLT in South African public schools. In this regard, the participants assured that these would result in positive outcomes, as they would provide quality education through government support. The study concluded that English is the preferred LoLT by both teachers and learners, thus, it needs to be prioritised.
- Full Text:
- Date Issued: 2019
The effective use of corporate social responsibility as a strategic marketing tool to achieve competitive advantage in the South African banking sector
- Authors: Sogoni, Shalene
- Date: 2019
- Subjects: Social responsibility of business , Business communication Mass media and business Marketing Banks and banking -- South Africa
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10948/44034 , vital:37094
- Description: The South African banking sector has increasingly grown, with the rise of new entrants in the market and a strong fintech focus, offering a completely digital banking service with products designed to improve the money management of clients. Competition within this sector has become rife, giving banks the option to compete by using traditional means or pursue alternative options. In the past, banks focused more on lowering costs, increasing sales, improve customer retention strategies and the development of superior digital products and services driven by new technology. However banking organisations also understand that is not enough. In order to survive in a highly competitive industry, firms will be have to diversify and follow alternative means outside of the standard traditional ways of doing banking. The business case for engaging in corporate social responsibility is clear and unavoidable as the scope and nature of the socio-economic problems within our communities persist, so has these societal problems become interdependent with the business environment. Therefore, executive managers and are now encouraged to become good corporate citizens, by becoming more socially responsible in the way it does its business. In other words, by strategically applying CSR, as a marketing tool, a company can be profitable, obtain a competitive advantage and simultaneously contribute towards making a sustainable difference in society. The intent of this study is to determine if corporate social responsibility is being effectively used as a strategic marketing tool to achieve competitive advantage in the South African banking sector. In addressing the main research question, and several other secondary objectives, this study seeks to enrich the discussion by presenting a theoretical review that demonstrates the relationship between several concepts, namely, corporate strategy, strategic marketing, corporate social responsibility and competitive advantage, interrelated in this study. The study employs a qualitative research approach by empirically conducting in-depth discussions with industry experts on the subject matter at hand, underpinned by academic literature. The study will justify the interdependencies of business and the society and explores the benefits of integrating CSR into the core strategy of business. The findings will be valuable to business executives, corporate social responsibility or marketing managers, academics and scholars who are trying to better understand the determinant’s of corporate social responsibility, strategic management and competitive advantage.
- Full Text:
- Date Issued: 2019
- Authors: Sogoni, Shalene
- Date: 2019
- Subjects: Social responsibility of business , Business communication Mass media and business Marketing Banks and banking -- South Africa
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10948/44034 , vital:37094
- Description: The South African banking sector has increasingly grown, with the rise of new entrants in the market and a strong fintech focus, offering a completely digital banking service with products designed to improve the money management of clients. Competition within this sector has become rife, giving banks the option to compete by using traditional means or pursue alternative options. In the past, banks focused more on lowering costs, increasing sales, improve customer retention strategies and the development of superior digital products and services driven by new technology. However banking organisations also understand that is not enough. In order to survive in a highly competitive industry, firms will be have to diversify and follow alternative means outside of the standard traditional ways of doing banking. The business case for engaging in corporate social responsibility is clear and unavoidable as the scope and nature of the socio-economic problems within our communities persist, so has these societal problems become interdependent with the business environment. Therefore, executive managers and are now encouraged to become good corporate citizens, by becoming more socially responsible in the way it does its business. In other words, by strategically applying CSR, as a marketing tool, a company can be profitable, obtain a competitive advantage and simultaneously contribute towards making a sustainable difference in society. The intent of this study is to determine if corporate social responsibility is being effectively used as a strategic marketing tool to achieve competitive advantage in the South African banking sector. In addressing the main research question, and several other secondary objectives, this study seeks to enrich the discussion by presenting a theoretical review that demonstrates the relationship between several concepts, namely, corporate strategy, strategic marketing, corporate social responsibility and competitive advantage, interrelated in this study. The study employs a qualitative research approach by empirically conducting in-depth discussions with industry experts on the subject matter at hand, underpinned by academic literature. The study will justify the interdependencies of business and the society and explores the benefits of integrating CSR into the core strategy of business. The findings will be valuable to business executives, corporate social responsibility or marketing managers, academics and scholars who are trying to better understand the determinant’s of corporate social responsibility, strategic management and competitive advantage.
- Full Text:
- Date Issued: 2019
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