Analysis of early-phase contact tracing during the coronavirus disease 2019 outbreak in Mangaung Metro, Free State
- Monyobo, Priscilla Kesaletseng
- Authors: Monyobo, Priscilla Kesaletseng
- Date: 2022-09
- Subjects: COVID-19 (Disease) , Contact tracing (Epidemiology) , Public health
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23533 , vital:58105
- Description: Background and Aim Contact tracing is a critical public health measure for controlling and preventing the spread of infectious diseases. Although the principles underlying this strategy are not novel, understanding the changes in infectiousness of COVID-19 is indeed novel. As are the capacity and operating procedures required to support disease investigation in Mangang Metro during the SARS-CoV-2 (COVID-19) pandemic. On 16 March 2020, the first coronavirus disease case in the area, which led to a larger outbreak, occurred in Mangaung Metro, Free State province, South Africa. To date, Mangaung Metro remains the epicentre of the COVID-19 pandemic and the primary driver of the caseload in the Free State province. The aim of this study was to analyse contact tracing data in Mangaung Metro during the early phase of the COVID-19 outbreak (16 March 2020 – 30 June 2020) in order to measure the viral transmissibility of COVID-19 in the early stages of the outbreak, specifically in the context of Mangaung Metro. Methods A descriptive systematic analysis of index COVID-19 cases and their contacts in Mangaung Metro was conducted. The review period ran from 16 March to 30 June 2020, during which there was a total of 1 001 cases in Mangaung Metro. Data was captured on an Excel spreadsheet using the contact line list variables from the established National Institute of Communicable Disease contact line list framework. The inferential statistics were based on a time series analysis to compare the impact of contact tracing stratified by symptomatology and the root cause of the cases to the overall cases in Mangaung Metro. The study determined whether isolation, quarantine, and contact tracing were able to control outbreaks in the early phase using characteristics of disease transmission and parameters particularised to the COVID- 19 pathogen. Results As of 30 June 2020, the Free State province had a total of 2 072 COVID-19 cases. Mangaung Metro contributed 1 001 cases (48percent) of the total number of cases in the study period. Between March and June 2020, 3 553 contacts were traced in Mangaung Metro. This number translates to at least three investigated and traced contacts per index or laboratory confirmed positive case. From the traced contacts, 1 080 samples were collected and sent for laboratory testing. In April 2020, the greatest number of samples were collected. This high rate in sample collection is posited to be the result of the high rate of contacts traced, as well as the initial clinical guidelines followed for contact tracing. Most positive contacts were discovered in March 2020. One of the possible reasons for the high detection of COVID-19 confirmed positive contacts during the early stages of the outbreak was the focus and importance of contact tracing while the caseload remained relatively low. However, as the outbreak progressed in the Mangaung Metro context, the number and relative percentage of positive cases detected through contact tracing decreased. In total, the positive contacts recorded in March 2020 amounted to 92 (51.3percent), 18 in April (10.5percent), 41 in May (22.9percent), and 28 in June (15.6percent). The March 2020 tracking rate was the highest at 73.2percent, with an average contact tracing rate of 15.5percentby the end of June 2020. Of all the contacts traced, 7.9percent involved healthcare workers in the Free State. Conclusion The study’s findings show that contact tracing was an effective control measure during the early stages of the COVID-19 outbreak in Mangung Metro district. Furthermore, the impact was greatest when the caseload was low and the burden on the healthcare system less severe. Mangaung Metro demonstrated the capability of tracing more contacts in the early-early phase of the outbreak; however, as the outbreak progressed to the latent early phase, the caseload increased and fewer contacts were traced. The consequence of contact tracing not being as effective during the latent early phase relates to the increase in both exposed and untraceable contacts, which in turn fueled the increase of new cases. This further impacted the at-risk and vulnerable population, especially the elderly, who were at an increased risk if not traced in a timely manner, possibly resulting in mortality. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
- Authors: Monyobo, Priscilla Kesaletseng
- Date: 2022-09
- Subjects: COVID-19 (Disease) , Contact tracing (Epidemiology) , Public health
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23533 , vital:58105
- Description: Background and Aim Contact tracing is a critical public health measure for controlling and preventing the spread of infectious diseases. Although the principles underlying this strategy are not novel, understanding the changes in infectiousness of COVID-19 is indeed novel. As are the capacity and operating procedures required to support disease investigation in Mangang Metro during the SARS-CoV-2 (COVID-19) pandemic. On 16 March 2020, the first coronavirus disease case in the area, which led to a larger outbreak, occurred in Mangaung Metro, Free State province, South Africa. To date, Mangaung Metro remains the epicentre of the COVID-19 pandemic and the primary driver of the caseload in the Free State province. The aim of this study was to analyse contact tracing data in Mangaung Metro during the early phase of the COVID-19 outbreak (16 March 2020 – 30 June 2020) in order to measure the viral transmissibility of COVID-19 in the early stages of the outbreak, specifically in the context of Mangaung Metro. Methods A descriptive systematic analysis of index COVID-19 cases and their contacts in Mangaung Metro was conducted. The review period ran from 16 March to 30 June 2020, during which there was a total of 1 001 cases in Mangaung Metro. Data was captured on an Excel spreadsheet using the contact line list variables from the established National Institute of Communicable Disease contact line list framework. The inferential statistics were based on a time series analysis to compare the impact of contact tracing stratified by symptomatology and the root cause of the cases to the overall cases in Mangaung Metro. The study determined whether isolation, quarantine, and contact tracing were able to control outbreaks in the early phase using characteristics of disease transmission and parameters particularised to the COVID- 19 pathogen. Results As of 30 June 2020, the Free State province had a total of 2 072 COVID-19 cases. Mangaung Metro contributed 1 001 cases (48percent) of the total number of cases in the study period. Between March and June 2020, 3 553 contacts were traced in Mangaung Metro. This number translates to at least three investigated and traced contacts per index or laboratory confirmed positive case. From the traced contacts, 1 080 samples were collected and sent for laboratory testing. In April 2020, the greatest number of samples were collected. This high rate in sample collection is posited to be the result of the high rate of contacts traced, as well as the initial clinical guidelines followed for contact tracing. Most positive contacts were discovered in March 2020. One of the possible reasons for the high detection of COVID-19 confirmed positive contacts during the early stages of the outbreak was the focus and importance of contact tracing while the caseload remained relatively low. However, as the outbreak progressed in the Mangaung Metro context, the number and relative percentage of positive cases detected through contact tracing decreased. In total, the positive contacts recorded in March 2020 amounted to 92 (51.3percent), 18 in April (10.5percent), 41 in May (22.9percent), and 28 in June (15.6percent). The March 2020 tracking rate was the highest at 73.2percent, with an average contact tracing rate of 15.5percentby the end of June 2020. Of all the contacts traced, 7.9percent involved healthcare workers in the Free State. Conclusion The study’s findings show that contact tracing was an effective control measure during the early stages of the COVID-19 outbreak in Mangung Metro district. Furthermore, the impact was greatest when the caseload was low and the burden on the healthcare system less severe. Mangaung Metro demonstrated the capability of tracing more contacts in the early-early phase of the outbreak; however, as the outbreak progressed to the latent early phase, the caseload increased and fewer contacts were traced. The consequence of contact tracing not being as effective during the latent early phase relates to the increase in both exposed and untraceable contacts, which in turn fueled the increase of new cases. This further impacted the at-risk and vulnerable population, especially the elderly, who were at an increased risk if not traced in a timely manner, possibly resulting in mortality. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
Explaining the endurance of poverty and inequality : social policy and the social division of welfare in the South African health system
- Authors: Du Plessis, Ulandi
- Date: 2013
- Subjects: Health system , Private health , Public health , Poor , Subsidies , Profit motive , Quality , Efficiency , Public health -- Finance -- Research -- South Africa , Medical care -- Research -- South Africa , Poverty -- Research -- South Africa , Equality -- Research -- South Africa , South Africa -- Social conditions
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2755 , http://hdl.handle.net/10962/d1002002
- Description: This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
- Full Text:
- Date Issued: 2013
- Authors: Du Plessis, Ulandi
- Date: 2013
- Subjects: Health system , Private health , Public health , Poor , Subsidies , Profit motive , Quality , Efficiency , Public health -- Finance -- Research -- South Africa , Medical care -- Research -- South Africa , Poverty -- Research -- South Africa , Equality -- Research -- South Africa , South Africa -- Social conditions
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2755 , http://hdl.handle.net/10962/d1002002
- Description: This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
- Full Text:
- Date Issued: 2013
An investigation into the roles and functions of community health committees
- Authors: Wood, Sally Dawn
- Date: 2012
- Subjects: Community health services , Public health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:9071 , http://hdl.handle.net/10948/d1008403 , Community health services , Public health
- Description: Community participation has been a popular method of people centred, grassroots development in many developing countries. With an emphasis on primary health care (PHC) through the signing of the Declaration of Alma Atta in 1978, there was a renewed commitment to community participation within the health care system. In South Africa, the end of the apartheid era announced a new dedication towards the principles of a comprehensive, promotive and preventative health care in line with the principles of PHC. These changes were outlined in The White Paper on Transformation of the Health System (1997) and advocated the importance of community involvement in the health care system. These roles were formalised in the National Act Health (61 of 2003) with the provision for the establishment of the clinic and community health centre committees as statutory bodies. The initial implementation of the committees had no guidelines or policy to direct their functioning and therefore led to them being differentiated and poorly functioning. In 2009, the Eastern Cape Department of Health issued a Policy on the Establishment and Effective functioning of Clinic and Community Health Centre Committees. In 2010, the Nelson Mandela Metropolitan University’s Community Development Unit, in collaboration with the Health Department, provided a program to formally establish and train all the community health committees in the Nelson Mandela Bay Municipality in accordance with the new policy. This research aimed to investigate the community health committees (CHCs) in the Nelson Mandela Bay District, specifically the way in which they were functioning, three years on from this establishment process, with regards to the roles and functions outlined in the Policy document. This report highlights the extent to which the roles are being met, the challenges impeding the fulfilment of these roles and other factors which inhibit the effective functioning of the CHCs. A qualitative research method was used including focus group discussions and in-depth interviews with key informants to illicit the necessary data. These results were transcribed and analysed to identify recurring themes in order to draw conclusions. The CHCs were found to have varying levels of functionality but had similar challenges in fulfilling the roles. Generally there was a poor level of awareness of the policy and the roles defined within and in addition to this there was confusion over the terminology used within the Policy. The role of Advocacy was undertaken enthusiastically by the CHCs with many forms of education and health programs being promoted. However, a lack of knowledge of the PHC model was evident, which inhibited the CHCs from advocating the importance of this. Oversight was seen by the CHC members as being the most important role for them to fulfil, as the level of medical care received in the clinic was perceived to be poor. The CHC members readily monitor levels of medication, staff presence and service provision but do not feel that they have much power to improve the situation. The role of Social Mobilisation was poorly fulfilled due to a lack of outreach into the community and therefore social upliftment only takes place when community members come to the clinic to use the services. Finally, fundraising was the most unsuccessfully achieved role of the CHCs. A combination of a lack of formal recognition and misguided ideas, have resulted in little means of funding for the CHCs. Generally the major inhibiting factors that the CHCs face are; an incomplete fulfilment of the outlined membership of the committees, lack of comprehensive community representation, a lack of commitment from the Health Department and a feeling of isolation. All of these factors are reducing the motivation of the dedicated CHC members. Recommendations were made at the end of the study to help increase the impact these committees are having on their communities. It is hoped that the Provincial Health Department can work together with the CHCs and other stakeholders to implement these recommendations to help sustain the CHCs further.
- Full Text:
- Date Issued: 2012
- Authors: Wood, Sally Dawn
- Date: 2012
- Subjects: Community health services , Public health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:9071 , http://hdl.handle.net/10948/d1008403 , Community health services , Public health
- Description: Community participation has been a popular method of people centred, grassroots development in many developing countries. With an emphasis on primary health care (PHC) through the signing of the Declaration of Alma Atta in 1978, there was a renewed commitment to community participation within the health care system. In South Africa, the end of the apartheid era announced a new dedication towards the principles of a comprehensive, promotive and preventative health care in line with the principles of PHC. These changes were outlined in The White Paper on Transformation of the Health System (1997) and advocated the importance of community involvement in the health care system. These roles were formalised in the National Act Health (61 of 2003) with the provision for the establishment of the clinic and community health centre committees as statutory bodies. The initial implementation of the committees had no guidelines or policy to direct their functioning and therefore led to them being differentiated and poorly functioning. In 2009, the Eastern Cape Department of Health issued a Policy on the Establishment and Effective functioning of Clinic and Community Health Centre Committees. In 2010, the Nelson Mandela Metropolitan University’s Community Development Unit, in collaboration with the Health Department, provided a program to formally establish and train all the community health committees in the Nelson Mandela Bay Municipality in accordance with the new policy. This research aimed to investigate the community health committees (CHCs) in the Nelson Mandela Bay District, specifically the way in which they were functioning, three years on from this establishment process, with regards to the roles and functions outlined in the Policy document. This report highlights the extent to which the roles are being met, the challenges impeding the fulfilment of these roles and other factors which inhibit the effective functioning of the CHCs. A qualitative research method was used including focus group discussions and in-depth interviews with key informants to illicit the necessary data. These results were transcribed and analysed to identify recurring themes in order to draw conclusions. The CHCs were found to have varying levels of functionality but had similar challenges in fulfilling the roles. Generally there was a poor level of awareness of the policy and the roles defined within and in addition to this there was confusion over the terminology used within the Policy. The role of Advocacy was undertaken enthusiastically by the CHCs with many forms of education and health programs being promoted. However, a lack of knowledge of the PHC model was evident, which inhibited the CHCs from advocating the importance of this. Oversight was seen by the CHC members as being the most important role for them to fulfil, as the level of medical care received in the clinic was perceived to be poor. The CHC members readily monitor levels of medication, staff presence and service provision but do not feel that they have much power to improve the situation. The role of Social Mobilisation was poorly fulfilled due to a lack of outreach into the community and therefore social upliftment only takes place when community members come to the clinic to use the services. Finally, fundraising was the most unsuccessfully achieved role of the CHCs. A combination of a lack of formal recognition and misguided ideas, have resulted in little means of funding for the CHCs. Generally the major inhibiting factors that the CHCs face are; an incomplete fulfilment of the outlined membership of the committees, lack of comprehensive community representation, a lack of commitment from the Health Department and a feeling of isolation. All of these factors are reducing the motivation of the dedicated CHC members. Recommendations were made at the end of the study to help increase the impact these committees are having on their communities. It is hoped that the Provincial Health Department can work together with the CHCs and other stakeholders to implement these recommendations to help sustain the CHCs further.
- Full Text:
- Date Issued: 2012
In vitro cytotoxic effects of selected Nigerian medicinal plant extracts on cancer cell lines
- Authors: Baatjies, Lucinda
- Date: 2012
- Subjects: Cancer -- Treatment , Cancer cells , Medicinal plants , Plant extracts , Traditional medicine , Public health
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10316 , http://hdl.handle.net/10948/d1008191 , Cancer -- Treatment , Cancer cells , Medicinal plants , Plant extracts , Traditional medicine , Public health
- Description: Cancer is a disease that imposes a heavy burden on public health and poses a challenge to science. The World Health Organization estimates that 80 percent of people in developing countries of the world rely on traditional medicine for their primary health needs, and about 85 percent of traditional medicine involves the use of plant extracts. This is particularly true in Africa where a large percentage of the population depends upon medicinal plants for health care. Therefore, detailed screening and evaluation of bioactive substances for chemotherapeutic purposes of African plants are urgently warranted. Furthermore, this will serve to validate the efficacy and safety of African traditional medicine. The current study investigated the in vitro cytotoxic effects of 17 ethanolic extracts of the following 16 plants used in traditional anticancer medicine in Nigeria: Sapium ellipticum leaves, Sapium ellipticum stembark, Combretum paniculatum, Celosia trigyna, Pupalia lappacea, Justica extensa, Hedranthera barteri leaves, Alternanthera sessilis, Ethulia conyzoides leaves, Lannea nigritana stembark, Combretum zenkeri root, Combretum molle leaves, Adenanthera parvoniana, Lannea acida, Cyathula achyranthoides, Drymaria cordata, Cyathula prostrata, against HeLa cancer cells. Five of the most promising extracts (Sapium ellipticum leaves, Combretum paniculatum, Celosia trigyna, Drymaria cordata, Cyathula prostrata) were selected for further screening against HT29 and MCF-7 cancer cells. Of the five, the first two were investigated further based on their activities in the screening phase. The S. ellipticum leaf extract yielded IC50 values of 88.60 ± 0.03 and 93.03 ± 0.03 μg/ml against HeLa and MCF-7, respectively. The toxicity was also evaluated on normal cells and an IC50 of 77.66 μg/ml was obtained for peripheral blood mononuclear cells (PBMCs). The IC50 values for proliferating and confluent Chang liver cells were both >125 μg/ml. These results suggest that the extract may be selective for specific cell types. Bio-assay guided fractionation of the S. ellipticum ethanolic extract yielded two active fractions; chloroform and ethyl acetate. Two compounds isolated from the chloroform extract were screened against the three cancer cell lines and found to be inactive. Three compounds were isolated from the ethyl acetate fraction and revealed IC50 values < 62.5 and < 31 μg/ml against MCF-7. Unfortunately these two compounds soon lost activity before any further work could be done on them and work was continued with the crude extract.
- Full Text:
- Date Issued: 2012
- Authors: Baatjies, Lucinda
- Date: 2012
- Subjects: Cancer -- Treatment , Cancer cells , Medicinal plants , Plant extracts , Traditional medicine , Public health
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10316 , http://hdl.handle.net/10948/d1008191 , Cancer -- Treatment , Cancer cells , Medicinal plants , Plant extracts , Traditional medicine , Public health
- Description: Cancer is a disease that imposes a heavy burden on public health and poses a challenge to science. The World Health Organization estimates that 80 percent of people in developing countries of the world rely on traditional medicine for their primary health needs, and about 85 percent of traditional medicine involves the use of plant extracts. This is particularly true in Africa where a large percentage of the population depends upon medicinal plants for health care. Therefore, detailed screening and evaluation of bioactive substances for chemotherapeutic purposes of African plants are urgently warranted. Furthermore, this will serve to validate the efficacy and safety of African traditional medicine. The current study investigated the in vitro cytotoxic effects of 17 ethanolic extracts of the following 16 plants used in traditional anticancer medicine in Nigeria: Sapium ellipticum leaves, Sapium ellipticum stembark, Combretum paniculatum, Celosia trigyna, Pupalia lappacea, Justica extensa, Hedranthera barteri leaves, Alternanthera sessilis, Ethulia conyzoides leaves, Lannea nigritana stembark, Combretum zenkeri root, Combretum molle leaves, Adenanthera parvoniana, Lannea acida, Cyathula achyranthoides, Drymaria cordata, Cyathula prostrata, against HeLa cancer cells. Five of the most promising extracts (Sapium ellipticum leaves, Combretum paniculatum, Celosia trigyna, Drymaria cordata, Cyathula prostrata) were selected for further screening against HT29 and MCF-7 cancer cells. Of the five, the first two were investigated further based on their activities in the screening phase. The S. ellipticum leaf extract yielded IC50 values of 88.60 ± 0.03 and 93.03 ± 0.03 μg/ml against HeLa and MCF-7, respectively. The toxicity was also evaluated on normal cells and an IC50 of 77.66 μg/ml was obtained for peripheral blood mononuclear cells (PBMCs). The IC50 values for proliferating and confluent Chang liver cells were both >125 μg/ml. These results suggest that the extract may be selective for specific cell types. Bio-assay guided fractionation of the S. ellipticum ethanolic extract yielded two active fractions; chloroform and ethyl acetate. Two compounds isolated from the chloroform extract were screened against the three cancer cell lines and found to be inactive. Three compounds were isolated from the ethyl acetate fraction and revealed IC50 values < 62.5 and < 31 μg/ml against MCF-7. Unfortunately these two compounds soon lost activity before any further work could be done on them and work was continued with the crude extract.
- Full Text:
- Date Issued: 2012
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