PhD for Study on Effective and Cheaper Treatment for Parkinson’s Disease

PhD for Study on Effective and Cheaper Treatment for Parkinson’s Disease
PhD in Physiology graduate, Dr Adu Temitope Samson.

Dr Adu Temitope Samson was awarded a PhD in Physiology for his study on an alternative, effective and cheaper method to manage Parkinson’s disease.

Parkinson’s disease is a movement disorder characterised by the degeneration of the dopaminergic system and manifests through muscle rigidity, involuntary tremor and dyskinesia. Samson’s study investigated whether it could be managed by an anti-inflammatory drug. The results indicated a significant improvement following drug administration but no change in the dopaminergic system; however, systemic inflammation as well neuroinflammation were significantly reduced.

Although this is not a novel study, it is the first time that stereotaxic brain surgery was successfully used as a model at UKZN. The model has been shared with other students in the Discipline of Physiology.

The Nigerian born academic completed his Master’s degree in Physiology at the University of Ibadan before pursuing his PhD at UKZN.

‘I have mixed feelings of excitement and sadness. I am excited because of the successful completion of the research and sad as a result of challenges encountered,’ he said.

‘Using an animal model to test and model Parkinson’s disease was a challenge as I encountered a 0% survival rate with the stereotaxic brain surgery performed during my pilot study.’

Following on-going consultation of related online articles as well as professional input from his supervisor, Professor Musa Mabandla and the former Head of the Biomedical Research Unit at UKZN, Dr Sanil Singh, he eventually succeeded in performing the first-ever reproducible stereotaxic brain surgery in the scientific history of UKZN.

Another challenge was obtaining a licence from the South African Veterinary Council (SAVC). ‘The cost of registration was expensive and the time of training was also longer than expected; however, I now have both the SAVC licence and my doctoral degree,’ said an excited Samson. He is currently employed at the Obafemi Awolowo University, Nigeria and is preparing for post-doctoral studies.

Words: Lihle Sosibo

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Study Explores Long-Term Effect of Pre-Eclampsia on the Brain

Study Explores Long-Term Effect of Pre-Eclampsia on the Brain
Dr Olayemi Ijomone received a Doctor of Philosophy in Health Sciences.

Dr Olayemi Ijomone’s research study found that a history of pre-eclampsia predisposes the mother and her offspring to a higher risk of long-term neurological complications/deficits later in life through neuroinflammation.

The study, which was conducted at UKZN’s School of Laboratory Medicine and Medical Sciences, earned her a Doctor of Philosophy in Health Sciences (Optics and Imaging).

‘I’m very grateful for the support I received from my supervisor Professor Thajasvarie Naicker, my husband Dr Omamuyovwi Ijomone and my precious daughter Sparkle throughout this study. I feel blessed,’ said 34-year-old Ijomone who plans to pursue a career in neuroscience research and grow her teaching career back home in Nigeria.

Words: Lihle Sosibo

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CAPRISA Staff Member Completes a PhD in Record Time

CAPRISA Staff Member Completes a PhD in Record Time
Pioneering study leads to a PhD for Dr Buyisile Chibi.

Dr Buyisile Chibi, a Research Associate at the Centre for the AIDS Programme of Research in South Africa (CAPRISA), graduated with a doctoral degree in Public Health within two-and-a-half years whilst also publishing six papers in peer-reviewed scientific journals and one scientific report.

Her study encourages the KwaZulu-Natal health authorities to invest more effort in protecting vulnerable groups if it is to achieve the UNAIDS 90-90-90 targets to end AIDS.

Chibi was supervised by Public Health specialist, Professor Tivani Mashamba-Thompson who was ecstatic to receive the news of her graduation. She commented, ‘This is a story of a South African Black female who completed her PhD within two-and-a-half years whilst holding a full-time job. I feel very blessed to have supervised her.’

Chibi’s study focused on Public Health Pharmacy and aimed to determine the factors that contribute to prescription drug diversion, misuse and abuse among people living with HIV (PLWH) in eThekwini district, KwaZulu-Natal. Substance use, mental health problems, homelessness, lower educational levels, past experience with diversion, misuse or abuse practices, being in possession of addictive prescriptions drugs, unemployment and residing in disordered neighborhoods were some of the risk factors identified.

Chibi holds a Bachelor of Science and a Master’s degree in Medical Sciences (Pharmaceutical Chemistry). She has always had a passion for health and medicine. ‘From a young age, the impact of medicines on humankind had always drawn my attention. During my master’s degree, I was introduced to drug design mainly in relation to HIV-1 protease inhibitors and drug-substrate interactions through computational studies. Following my MSc, I joined the Research and Development Lab at Buckman Laboratories, where I was exposed to synthesis and quality control of polymers. Here, my interest was instilled in health and medicines,’ said Chibi.

Whilst working at the Human Sciences Research Council (HSRC), Chibi was introduced to Public Health research, which presented her with the opportunity to focus on research impacting on people’s lives in local communities. It was this interest that persuaded her to pursue her PhD in Public Health at UKZN.

‘Pharmaceutical research has always had a special place in my heart and being at CAPRISA is a great opportunity for learning and developing new skills,’ said Chibi who works with Professor Quarraisha Abdool-Karim, Associate Scientific Director of CAPRISA and a global expert epidemiologist who has made pioneering contributions to the understanding of the HIV epidemic among young people, especially young women.

Words: MaryAnn Francis

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PhD Study Aims to Reduce Neonatal Mortality Rate

PhD Study Aims to Reduce Neonatal Mortality Rate
PhD in Nursing graduate, Dr Adenike Adebola Olaniyi.

Dr Adenike Adebola Olaniyi was awarded a PhD in Nursing for her study on a neonatal resuscitation training model for semi-skilled birth attendants to manage neonatal emergencies in Oyo State, Nigeria.

Olaniyi, who hails from Nigeria, noted that Nigeria has one of the highest neonatal mortality rates in the world, with most deaths occurring in rural areas during the first week of life.

‘The poor primary healthcare system is a major challenge to child health. Poverty and illiteracy also limit access to healthcare. This calls for the use of Community Health Workers in primary healthcare centres.’

The study tested an existing model to enhance and assess basic newborn resuscitation techniques and employed it to train semi-skilled birth attendants to manage asphyxia resulting from neonatal emergencies. Evaluating and refining the model increased the standard of care and service. The study recommends that it be incorporated into the Community Health Extension Workers’ curriculum in Nigeria.

The study produced three published research articles, with a further three under review by high-impact journals.

A registered nurse with 15 years’ teaching experience at the School of Nursing, University College Hospital, Ibadan, Olaniyi is currently an Assistant Director (Nursing Training) at the School. She was awarded her BSc (Nursing) and MPH (Reproductive and Family Health) by the University of Ibadan before embarking on doctoral studies at UKZN. Her future plans include joining the University as a lecturer and participating in research.

‘Completing this PhD is a great accomplishment. I am grateful to my husband, Professor John Ayodele Olaniyi for his encouragement and my supervisor, Deputy Vice-Chancellor in the College of Health Sciences, Professor Busisiwe Ncama. Despite her tight schedule, she diligently supervised my work and supported me throughout the project and beyond,’ said Olaniyi.

Words: Nombuso Dlamini

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Sport Science PhD focuses on Physical Activity among People with Disabilities

Sport Science PhD focuses on Physical Activity among People with Disabilities
Ethiopian national, Dr Getachew Basha.

Dr Getachew Basha’s research study on Physical Activity Participation among People with Disability in Ethiopia revealed poor understanding and participation in adapted physical activity among Ethiopians with limb and vision impairment.

Supervised by Professor Johan van Heerden, the study concluded that, while social engagement was a strong motivator, inaccessible built environments, time constraints and a lack of engagement were significant barriers to participation in physical activity.

‘Aside from the lack of facilities and adaptation of the environment to be “disability-friendly”, the main barrier to participation in physical activity among people with disability is the same as for most abled-bodied people, namely, finding the time to train and exercise,’ explained Basha.

One of the participants in Basha’s study, was Gemechu Dinsa an Ethiopian para-athlete who won a Bronze Medal in the 2019 World Para-Athletics Championships in November 2019 in Dubai. The 1 500m race in the T46 category is for athletes who have lost one arm from an amputation at or below the elbow joint, with normal function in both legs.

‘All things considered, this was an exceptional achievement because, although the number of people with disabilities in Ethiopia is very large, participation in adapted physical activity is very limited, with very few representatives in the all African Para-games and Paralympic games,’ said Basha.

He is currently focused on publishing the results of his study, and also plans to study physical activity in other types of disability, such as autism. 

He recently moved to the west part of Ethiopia, in Oromia region and lecturers at the Wollega University College of Natural and Computational Science’s Department of Sport Science. 

Words: Nombuso Dlamini

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Eco-friendly Methods for Peptide-based Drugs

Eco-friendly Methods for Peptide-based Drugs
PhD in Pharmaceutical Chemistry recipient, Dr Othman Al Musaimi.

Dr Othman Al Musaimi’s PhD in Pharmaceutical Chemistry presents various new strategies to synthesise solid-phase peptides (SPPs) through greener, more carbon-friendly methods. It was supervised by Professors Beatriz G de la Torre and Fernando Albericio.

‘I identified several eco-friendly alternatives. In addition, in collaboration with a company in the United Kingdom that specialises in developing polymeric support, we developed various resins with various functionalities for SPPs as well as for chromatographic separation,’ explained Al Musaimi who is a Jordan national.

Al Musaimi and his group published several papers in scientific journals highlighting this new method.

‘Due to their biological activity, peptides are gaining considerable attention as promising potential drug candidates. Based on the pioneering work on peptide synthesis by Merrifield Bruce in 1963, SPP synthesis emerged as a method of choice for the preparation of these compounds due to the straightforward nature of the procedure, and the high purity and yield of the target product,’ said Al Musaimi.

He added that this methodology is undergoing continuous manipulation to enhance its efficiency and to comply with rules set down by regulatory agencies.

‘The introduction of automatic synthesisers (especially microwave-assisted ones) also greatly facilitated the process by reducing the time and amount of chemicals required for the synthetic process,’ said Al Musaimi.

‘Furthermore, this development has facilitated access to peptides that were difficult to synthesise using conventional methods. The greatest concern relating to SPP synthesis is its dependence on non-green solvents in various steps, including the washings. This implies a huge amount of chemical waste. Consequently, it is timely to re-evaluate these processes, as well as the chemicals involved, with respect to their impact on the environment and human health.’

The study successfully introduced several green solvents for various steps of the synthetic process. ‘Cyclopentyl methyl ether was used as a green precipitating ether for the replacement of hazardous ethers like diethyl ether and tert-butyl methyl ether. In addition, 2-methyltetrahydrofuran proved to be a good alternative to the hazardous dichloromethane for the incorporation of the first amino acid onto Wang and 2-chlorotrityl chloride resins,’ he explained.

The efficiency of the amino acid incorporation was exemplified by loading, racemisation, and dipeptide formation tests, while that of precipitation was monitored through the purity and percentage yields of the final product.

‘We have also proposed a standardised method for determining the incorporation yield of the first amino acid onto the resin, rather than using the non-standardised approach.’

Al Musaimi hopes to secure a position in academia or industry where he would be able to apply his knowledge.

Words: Nombuso Dlamini

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Master’s Degree for Study on Dentistry Students’ Perceptions of Antimicrobials

Master’s Degree for Study on Dentistry Students’ Perceptions of Antimicrobials
Ms Jaynitha Gangiah received a Master’s degree in Dentistry.

Ms Jaynitha Gangiah, an academic in the Discipline of Dentistry, graduated with a Master’s degree in Dentistry for her study that was motivated by the fact that in South Africa prescribing antimicrobials for dental use by dental practitioners (including dental therapists) is not standardised.

Gangiah’s study was titled: Perceptions and Attitudes of Antimicrobial Prescription for Dental Use Between the University of KwaZulu-Natal’s Recent Graduates in Dental Therapy Practicing in KwaZulu-Natal and the Undergraduate Dental Therapy Students.

Gangiah who describes herself as a proud dental therapist said, ‘Dental professionals commonly prescribe antimicrobials to control and treat dental infections. A firm grounding in the principles of prescribing and therapeutics, an understanding of how antimicrobials work and a basic knowledge of commonly used antimicrobials are essential for the management of dental conditions requiring antimicrobials. However, in South Africa, prescribing antimicrobials for dental use by dental practitioners is not standardised, which may leave it open to interpretation by the various professionals.’

As an academic, Gangiah was also interested in assessing whether what students are taught is implemented once they qualify. The study included a questionnaire for academics that teach Clinical Pharmacology. The results indicated that, despite there being no standardised guidelines, the academics used structured module content on prescribing antimicrobials that complies with the Health Professional Council of South Africa’s (HPCSA) scope of practice for dental therapists.

This is important as it lays the foundation for students to follow good practice in the workplace. The study also found that undergraduate students followed what was prescribed to them in their module as well as their clinical supervisor’s advice, whilst recent graduates’ prescribing trends were influenced by their work exposure during their supervised training, which resulted in some prescribing antimicrobials which were not on the HPCSA approved list.

Gangiah proposes that antimicrobial guidelines should be standardised and that students as well as recent graduates should advocate for this. She also recommends clinical protocol and patient management that focus on prevention. She said that graduates should be trained to raise awareness and educate the patient about antimicrobial resistance, thus maintaining a balance between minimal and effective treatment.

A school presentation in her matric year influenced Gangiah to pursue a career in Dental Therapy: ‘Growing up in a little town (Campbells Town) and having been subjected to limited dental facilities, made me realise that I should do something to improve this. A presentation at my school by staff at the Oral and Dental Training Hospital (linked to the then University of Durban-Westville) impressed me ... so here I am!’

Gangiah who recently became a grandma, loves travelling to India and spending time with her family. She hopes to pursue a doctoral degree and make a contribution to the recognition of the dental therapy profession.

Words: MaryAnn Francis

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Summa Cum Laude Pass for High Flyer

<em>Summa Cum Laude</em> Pass for High Flyer
Miss Karishma Naidoo, Best Overall B Med Science (Physiology) student.

‘I am proud of myself because of the hard work and dedication I put into my studies,’ said Miss Karishma Naidoo who was awarded her degree summa cum laude and was named Best Overall B Med Science (Physiology) student in the School of Laboratory Medicine and Medical Sciences.

Naidoo is currently pursuing a B Med Science Honours degree at UKZN. Growing up, she dreamed of pursuing a degree in Medicine for which she was accepted. However, due to a lack of funding, she opted for Medical Sciences.

Naidoo hails from Tongaat to the north of Durban and matriculated from Belverton Secondary School. She says her family is her source of inspiration. Her mom Sharmaine taught her to be a strong woman and her dad, Don inspires her to be the best she can be. ‘I had to wake up as early as 4h00 every day and would only get home after 19h00. This was very challenging but personal sacrifices had to be made to succeed and secure funding in the form of scholarships and bursaries.’

Her hard work paid off when she received an undergraduate scholarship for her second and third-years of study. She obtained the Emma Smith bursary in third-year and received a College award for the Top student in Environmental Biotechnology. Naidoo was also invited to join the prestigious Golden Key International Society after having obtained 13 certificates of merit and five Dean’s commendations.

‘My time at UKZN is really exciting - the lecturers are friendly and I really enjoy the Westville campus student environment,’ said Naidoo who enjoys gardening and playing with her beloved dog Medusa.

Words: Lihle Sosibo

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Study Examines the Toxic Effect of Fusaric Acid on Human and Animal Health

Study Examines the Toxic Effect of Fusaric Acid on Human and Animal Health
Dr Terisha Ghazi received a PhD in Medical Biochemistry.

Changes in epigenetic mechanisms are the initiating factors for several underlying diseases. It is hence important to understand the changes induced by food-borne toxins such as Fusaric Acid.

Dr Terisha Ghazi was awarded a PhD in Medical Biochemistry for her study that showed that Fusaric Acid induces changes in DNA methylation, histone methylation, RNA methylation and microRNA expression, leading to liver toxicity

According to Ghazi, ‘To date, the majority of studies have focused on the effect of food-borne toxins on human and animal health; however, few have examined how these toxins cause adverse health effects.’

She said, ‘I am extremely happy and proud of myself for achieving this milestone. This would not have been possible without the support and encouragement of both my family and supervisor, Professor Anil Chuturgoon.’

The 27-year-old researcher is a Postdoctoral Fellow in the Discipline of Medical Biochemistry at UKZN and hopes that this fellowship will enable her to gain experience that will open doors for her future employment as a senior lecturer at the University. Prior to this, she worked at UKZN as a student lecturer, tutor and teaching assistant.

‘Like all lab-based studies, one encounters many highs and lows; however, with hard work, perseverance and self-belief there is no limit to what you can achieve. Studying at UKZN has been a pleasant experience that has provided me with endless opportunities to showcase my talent both in the lab as well as in research symposiums and conferences. It also gave me the opportunity to learn under the guidance of individuals such as my supervisor who are at the top of the research field,’ she said.

Words: Lihle Sosibo

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Passion for Anatomy Pays Dividends

Passion for Anatomy Pays Dividends
Mr Livashin Naidu, B Med Science Honours summa cum laude graduate.

‘I feel incredibly proud and elated that all the hard work, sacrifice and perseverance paid off in the end,’ said Mr Livashin Naidu after being awarded his B Med Science Honours degree summa cum laude and earning the titles of overall best B Med Science Honours Student, best overall achiever in Anatomy, Physiology, Microbiology, Biochemistry, and best research project in these subjects.

Naidu is currently pursuing a Master's in Anatomy in the School of Laboratory Medicine and Medical Sciences (Discipline of Anatomy) at UKZN. He hopes to complete a PhD and become an academic and researcher in the future.

‘I pursued this degree to enhance my knowledge in the field of research and make significant contributions to the field of Clinical Anatomy. Clinical Anatomical research is my passion. I discovered my deep interest in Anatomy and academia during my undergraduate degree and realised that this was the career path I wanted to pursue.’

Twenty-one-year-old Naidu matriculated with six distinctions in 2015 and registered for a Bachelor of Medical Science (Anatomy). Born in Chatsworth, Durban, he said his study experience was fantastic and that he would not have achieved all these accolades without the support of his family, friends and UKZN.

‘Studying can be very stressful and overwhelming at times; hence, constant self-motivation, perseverance and hard work are very important. You can always exceed your limits; you are capable as long as you believe,’ he said.

Words: Lihle Sosibo

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Model of Care for the Rehabilitation of CLHIV Earns UKZN Staff Member a Doctoral Degree

Model of Care for the Rehabilitation of CLHIV Earns UKZN Staff Member a Doctoral Degree
Dr Stacy Maddocks-Lawler enjoying time with her family during the COVID-19 national lockdown.

At the age of 14, Dr Stacy Maddocks-Lawler decided to pursue a career in Physiotherapy after being inspired by her late mum the night before she passed away, to consider this health profession.

Many years later, the mother of three who lectures Physiotherapy at UKZN, has graduated with a doctoral degree for her study on Designing a model of care for the rehabilitation of children living with HIV (CLHIV) in a semi-rural setting in KwaZulu-Natal, South Africa.

South Africa has the biggest and most high-profile HIV epidemic in the world, with an estimated 7.7 million people living with HIV in 2018. In the same year, there were 260 000 CLHIV in the country. KwaZulu-Natal remains the province with the highest number of people living with HIV with a recorded 2.1 million in 2018. These statistics paint a grim picture for the province and especially for the most vulnerable population, children.

Maddocks-Lawler’s study aimed to develop a model of care that addresses the rehabilitation needs of CLHIV within a resource-constrained setting and was conducted in a health facility on the outskirts of the greater eThekwini area. Participants included care givers, educators, and parents as well as a multi-disciplinary team of medical doctors, nurses, social workers, dieticians, psychologists, optometrists, an audiologist, speech and language pathologists, physiotherapists, occupational therapists and a biokineticist.

‘I want to make a tangible difference in the lives of children living with HIV. The need for healthcare services in this area is overwhelming. Together with my supervisors, Professor Verusia Chetty and Dr Saul Cobbing, we have devised a plan of action for implementation to effect improvements in identifying and treating disability in CLHIV in the community. Rehabilitation in the context of HIV is a neglected component of care,’ said Maddocks-Lawler.

Maddocks-Lawler’s proposed model of care includes a framework for identification, referral and rehabilitation of CLHIV with disabilities based on distinct settings including the home, the school, the clinic, the hospital and within community structures. The model includes wide scale screening based on the Washington Group/UNICEF Module on Child Functioning which is a screening tool used to identify HIV-related functional difficulties such as hearing, mobility, vision, learning and communication in people from ages 2-17.

Said Maddocks-Lawler, ‘Some fundamental principles that underpinned the model were to improve access to care; provide patient-centred care; engage in multi-disciplinary collaboration; provide equitable healthcare; structure co-ordinated pathways of care and linkages; and to provide education and training for healthcare workers, caregivers, educators and community care workers.’

Maddocks-Lawler grew up in the Sydenham/Overport area in Durban and completed high school at Sparks Estate Senior Secondary School. ‘I am married to the love of my life, Marvin Maddocks, my childhood sweetheart and we have three children aged 14, 11 and 9. Apart from the grace of God, my incredibly devoted supervisors, and supportive colleagues, my family played the most essential role in making my PhD study a success. My husband in particular is the champion of my success. He shouldered the burden of playing the role of both mum and dad within the last two years and my gratitude to him cannot be expressed,’ said Maddocks-Lawler.

Words: MaryAnn Francis

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Top of the Class for Bachelor of Sport Science Graduate

Top of the Class for Bachelor of Sport Science Graduate
Top Bachelor of Sport Science Honours (Biokinetics) graduate, Mrs Casey van den Berg.

‘This accomplishment was not expected, but I am honoured because I worked hard and tried to improve each year,’ said Mrs Casey Lee van den Berg after she graduated with a Bachelor of Sport Science Honours (Biokinetics).

She also received her Discipline’s two awards, the Academic and Clinical Trophies.

‘I decided to study Biokinetics because it allows me to help people and make a difference while doing what I love,’ she added.

She described UKZN as an ‘amazing university. I had incredible lecturers who were so passionate about their work and went above and beyond to help us succeed in every way possible.’

She spoke fondly of her mentor and friend Mr Siya Shezi, who helped her through all her years of study.

After completing matric in 2013, van den Berg moved from Pietermaritzburg to Durban to study for a two-year diploma in fitness at ETA College, where she specialised in exercise for the elderly, pregnancy and children. ‘While I was at ETA, I was lectured by biokineticists who inspired me to study biokinetics. I started at UKZN in 2016 and worked part-time until my honours year.’

She is currently completing her internship at a private practice in Ballito and hopes to start her own practice one day.

Van den Berg notes that young adults confront many challenges. ‘Finding a balance between studies, personal life and faith was probably the most difficult for me.’

She said that having a strong support system of family and friends helped her through her years of study.

The 24-year-old grew up in Pietermaritzburg, where she lived with her parents and younger brother. ‘My parents have recently started their own business and my brother is in the process of moving to Pretoria for work,’ she said. She currently lives near Ballito with her husband of two years so that she can be closer to work. Her hobbies include CrossFit, yoga, reading and baking.

Words: Nombuso Dlamini

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Optometrist Graduates with a PhD

Optometrist Graduates with a PhD
Nigerian national, Dr Okenwa-Vincent Emmanuel received a PhD in Optometry.

Dr Okenwa-Vincent Emmanuel was awarded a PhD in Optometry for his study on Health-related quality of life and utility for uncorrected refractive errors (URE) amongst school going adolescents of Kakamega County in Kenya.

Supervised by Professor Peter Clarke-Farr and Dr Jyotikumarie Naidoo, the cross-sectional study involved secondary school adolescents aged from 13 to 25. Trained teachers screened students from Forms 1 to 4 for the presence of URE, who were then clinically examined by optometrists for URE type and dioptric strength. The screened participants were then classified into two groups, namely, URE and normal-sighted groups.

From those with URE, 165 participants were randomly selected following detailed cycloplegic and non-cycloplegic refraction and other ocular co-morbidities’ assessments. The selected participants were all issued with appropriate corrected spectacles.

Questionnaires were administered to determine all 330 participants’ sociodemographic, wellbeing and socioeconomic variables. Previously validated questionnaires were also employed to determine health-related quality of life (HRQoL) and utility (preference-based QoL) – both adolescent and adult specific algorithms.

‘The findings showed that participants’ HRQoL and utilities are affected by URE. This is worsened in the presence of identified confounding variables – less favorable socio-demographic, wellbeing and socioeconomic statuses,’ said Emmanuel.

‘The results also showed that spectacles significantly improve HRQoL and utilities among school-going adolescents with URE and that adult specific utility methodologies underestimate QoL preferences in the study participants.’

Emmanuel recommended that the public health approach to alleviate URE in school-going adolescents should incorporate QoL considerations and methodologies that involve and are specific to adolescents.

Words: Nombuso Dlamini

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Exclusion of Clofazimine is a Barrier to Access

Exclusion of Clofazimine is a Barrier to Access
Dr Nirupa Misra received a PhD in Pharmacy.

‘Tuberculosis (TB) is a public health crisis despite being curable, and claims approximately 4 000 lives globally every day,’ noted Dr Nirupa Misra who graduated with a PhD in Pharmacy.

Supervised by Professors Panjasaram Naidoo and Nesri Padayatchi, Misra conducted a two-phase study focusing on access and evaluating dose-weight interactions on outcomes. She found that the fact that Clofazimine (CFZ) is not registered in South Africa and is not included in the country’s Standard Treatment Guidelines (STGs) or the Essential Medicines List (EML) is a barrier to access.

‘Despite huge investments in programmatic management, humankind seems to be losing the battle against this deadly bacterium with low treatment success rates reported globally. This has resulted in the emergence of drug resistant tuberculosis (DRTB) which is more difficult to treat than drug sensitive TB,’ she said.

‘Historically the treatment journey for DRTB has been long (18–20 months) with a daily injection and a handful of oral medicine. Overlapping side effects, mainly permanent hearing loss caused by the injectable and difficult treatment journey, contributes to poor outcomes with high loss to follow up and death rates. 

‘The medicine pipeline has been stagnant for years and recent registration of Bedaquiline and Delaminid and repurposing of Clofazimine hold promise of improved outcomes. Medicine must be available and accessible and used at a dose that is effective and safe in order to reduce further resistance,’ explained Misra.

Given that the optimal dose of CFZ that is safe and effective in the South African population is unknown. Misra’s study sought to fill this gap.

Whilst CFZ was being used as an unregistered product, she implemented a stock management system, distributing CFZ to all initiating sites in KwaZulu-Natal whilst ensuring that informed consent and progress reports were completed and submitted to the regulatory authorities. She assisted with quantification and forecasting of CFZ needs for the province.

An article on barriers to access was published in Ponte, an internationally recognised peer-reviewed journal. Misra also motivated for the inclusion of CFZ in STG and EML as part of the National TB Control Programme Committee.

CFZ is now registered in South Africa and included in guidelines; however, a gap still remains on the optimal dose of CFZ that is safe and effective.

Guidelines published in 2011 recommended weight-based dosing of CFZ at high doses for long periods of time despite a lack of evidence on safety and efficacy. The new guidelines upgrade CFZ from a group 5 medicine classified as medicine with unknown safety and efficacy to a core medicine to treat DRTB together with BDQ in a short course, all oral treatment regimen at a dose of 100mg daily. Misra said this recommendation appears to be based on low quality evidence and may be due to concerns of overlapping cardiotoxicity of CFZ and Bedaquiline.

Her study found that dose-weight interaction plays a role in the odds of a successful outcome. Patients >50kg prescribed 100mg CFZ were 60% less likely to have a successful outcome compared to those <50kg receiving 100mg. Patients <50kg who received >200mg were 40% less likely to have a successful treatment outcome (and were found to have a higher risk of adverse events) than patients <50kg receiving 100mg. Weight based dosing in patients <50kg and >50kg must be considered to achieve optimal treatment outcomes and reduce adverse events.

‘The recommended dose needs to be reviewed in light of the evidence provided. Active drug safety monitoring must be implemented as a package of care,’ she said.

Words: Nombuso Dlamini

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Master’s in Medical Sciences in Public Health for UKZN Project Officer

Master’s in Medical Sciences in Public Health for UKZN Project Officer
Mr Nkosinathi Mncwabe received his Master’s in Medical Sciences in Public Health.

Mr Nkosinathi Mncwabe graduated with a Master's in Medical Sciences in Public Health.

Supervised by Drs Themba Ginindza and Khumbulani Hlongwane, his ethnographic study explored cancer patients’ experiences of living with cancer in palliative care and support group settings in KwaZulu-Natal.

The study documented patients’ experiences of living with cancer, and explored their knowledge, use of local therapeutic rituals and discourses about the sickness as well as their cultural construction of illness.

The study population comprised adult cancer patients and their families at five study sites in Durban and Pietermaritzburg.

‘Patient-centred ethnography is important to improve understanding of cancer patients’ needs, both medical and non-medical, as they struggle to restore their wellbeing. Furthermore, this research demonstrated how the interpretation and understanding of illness can both alleviate as well as increase suffering,’ said Mncwabe.

Four themes emerged during fieldwork: reliance and trust towards health care providers; poor treatment from health care centres; local therapeutic rituals vs. Western medicine; and stigma. ‘Each is imbued with power and meanings within local worlds and thus extends our understanding and the meaning of illness,’ explained Mncwabe.

The study showed that cancer is a complex illness and that patients experience great suffering and stigma. ‘Apart from the structural conditions of community areas and the experience of illness, patients were also affected by their wider social and familial circumstances. Thus, patient suffering should be viewed within the context of a wider spectrum of adversity,’ he said.

Mncwabe added that new methods need to be explored to address the adversity faced by those living with cancer. ‘I suggest that emotional support is the most effective way to cope with the illness. The study will contribute to the ways that illnesses such as cancer can be best understood. It will also inform interventions to improve patients’ and health workers’ knowledge about the treatment of cancer.’

Mncwabe is currently the Project Officer in the Discipline of Public Health Medicine and is working on his PhD. ‘My goal is to expand on the gaps identified in my masters. My proposed research topic is Medical pluralism in the treatment of cancer in KwaZulu-Natal where the conversation will be between the oncology specialist and traditional medicine practitioners.

Words: Nombuso Dlamini

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Study Highlights Linkage between Febrile Seizures, Epilepsy and Depression

Study Highlights Linkage between Febrile Seizures, Epilepsy and Depression
Dr Alese Oluwole Ojo received a PhD in Health Sciences (Physiology).

Dr Alese Oluwole Ojo’s study on the link between prolonged febrile seizures, development of epilepsy later in life and depression earned him a PhD in Health Sciences (Physiology).

Supervised by Professor Musa Mabandla, Ojo found that prolonged febrile seizures affect the development of epilepsy and influences its complications, especially depression. The study focused on the effect across a generation of rats.

Forty-one-year-old Ojo, who is a lecturer in the Department of Physiology at the University of Ado Ekiti in Nigeria, said: ‘I am very happy and delighted about this accomplishment. My future aspiration is to continue as a researcher and then grow in the area.’

The main challenge he encountered was publishing in reputable journals as this entailed having to quickly acquaint himself with scientific writing through workshops and close consultation with his supervisor. He published three papers from his research, with more in the pipeline.

‘My overall experience at UKZN was a very good one. I had equipment at my disposal, my supervisor was very encouraging and students in our research group were willing to assist at all times.’

Happily married with three children, Ojo enjoys touring new places and making friends.

Words: Lihle Sosibo

Photograph: Supplied


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What Influences Our Choices of Healthcare Practices?

What Influences Our Choices of Healthcare Practices?
Human Physiology lecturer, Dr Hlengiwe Prosperity Mbongwa received an MBA.

Lecturer in Human Physiology in the School of Laboratory Medicine at UKZN, Dr Hlengiwe Mbongwa was awarded a Master of Business Administration (MBA) for her study on the reasons for using complementary and alternative medicine (CAM) to treat or manage an existing condition such as diabetes; or to promote health in general by taking supplements such as vitamins and minerals or going to gym.

The study was supervised by Dr Emmanuel Mutambara of the Graduate School of Business and Leadership and the participants included staff and students on UKZN’s Durban campuses.

Mbongwa established a link between the use of CAM and gender, with women likely to be more open to using CAM therapies and practices than men. No statistical evidence was found to suggest a relationship between using CAM and the participants’ race/ethnic group.

A significant relationship was found between the highest education attained and the reasons for using CAM practices and products. Culture and religion also proved to be significant influencers of CAM use for healthcare practices. The most used therapy was exercise, which was accompanied by the use of vitamins and minerals

‘I am excited and grateful that I had the opportunity to do an MBA. My excitement hasn’t sunk in yet - I dared myself and conquered,’ said Mbongwa who plans to apply her knowledge to harness leadership skills in academia.

Amongst the challenges she encountered was gathering data while supervising a PhD, four master’s and an honours student. This called for much reshuffling in order to ensure that her students received the support they required.

Born in Durban but raised in Odeke in uMzumbe, Port Shepstone, Mbongwa matriculated at Pholela High School in Bulwer. She is the eldest daughter among five siblings. Her mother will turn 75 this year, while her father passed on in 2010, at the age of 71. She dearly loves her nieces and nephews and has one child, Langelihle, who is her reason for waking up in the morning.

Words: Lihle Sosibo

Photograph: Supplied


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