Supporting undergraduate research capacity development: A process evaluation of an Undergraduate Research Office at a South African Faculty of Medicine and Health Sciences

Background. University-based research capacity development (RCD) mechanisms tend to focus on staff and postgraduate students, with few structures targeted at undergraduate students. Support for undergraduate research must be tailored to the unique requirements of research at this level, while maintaining links with relevant structures in both the RCD and teaching and learning domains. Objective. To conduct a process evaluation of the Undergraduate Research Office (URO) in the Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa, using RCD and characteristics of excellence in undergraduate research criteria as benchmarks. Methods. A process evaluation of URO's first 6 years was conducted using a logic model of URO's inputs, activities, and outputs. Through a retrospective document review, a descriptive analysis of URO's inputs and activities (narrative) and URO's outputs (statistical) was conducted. Results. Following a description of inputs and activities, results present URO's outputs as a measure of the uptake of these activities. From 2015 to 2020, 259 undergraduate research projects were completed. Research consultations, workshops and undergraduate presentations at the faculty's Annual Academic Day have more than doubled since URO's inception. The Undergraduate Research Ethics Committee has reviewed 243 ethics applications since 2015, with a 1 - 2-week turnaround time. A total of 134 funding applications worth ZAR705 986 have been awarded for research project, conference presentation and publication costs. Conclusion. Results show the potential impact of a formal undergraduate research support entity on the undergraduate research outputs of a Faculty of Medicine and Health Sciences. This article highlights elements for success for formal undergraduate research support, and identifies gaps going forward.

High Prevalence of Primary Dyslipidaemia in Black South African Patients at a Tertiary Hospital in Northern Gauteng; South Africa

BACKGROUND:The prevalence of cardiovascular disease is projected to be 38.7% for the USA in 2020; including coronary heart disease at 8.6% and stroke at 3.6%. In South Africa (SA); premature deaths due to heart and blood vessel diseases in people of working age (35 - 64 years) have been predicted to increase by 41% between 2007 and 2030; with enormous negative economic impact. Atherosclerosis underlies much of the pathogenesis; which involves risk factors including dyslipidaemia. Secondary dyslipidaemia associated with diabetes mellitus; hypothyroidism; chronic renal disease; cholestasis; nephrotic syndrome; alcohol excess; drugs such as thiazide diuretics and antiretroviral agents may respond to treatment of underlying causes; but residual dyslipidaemia may in such cases be due to primary disorders of metabolism. Primary dyslipidaemias are uncommon and to a large extent underdiagnosed; especially in the black population of SA; reflecting a lack of clinical and laboratory awareness or expertise. Specific diagnoses enable effective intervention in the patients as well as the families.OBJECTIVE:To assess the burden and prevalence of dyslipidaemia in the SA black population at Dr George Mukhari Hospital in the north region of Gauteng.METHOD:A retrospective data analysis of 12-month lipid profiles comprising triglyceride (TG); total cholesterol (TC); high-density lipoprotein cholesterol and directly measured low-density lipoprotein (LDL) cholesterol (LDLC).RESULTS:There were 24 656 requests for 6 348 patients. The lipid cut-off levels were somewhat arbitrary but were based on the commonly used decision-making levels in the treatment guidelines. Severe hypercholesterolaemia (etgt;7 mmol/L) was seen in 299 (4.7%) patients and extreme hypercholesterolaemia (etgt;12 mmol/L) was seen in 30 (0.5%) patients. LDLC (etgt;5 mmol/L) occurred in 80 (1.3%) patients and etgt;10 mmol/L in 19 (0.3%) patients. A predominant triglyceride problem was seen in 578 (9.1%) patients with TG (etgt;2 mmol/L) and TC (etlt;5 mmol/L); whereas moderate hypertriglyceridaemia (etgt;5 mmol/L) was present in 113 (1.8%) patients; and more severe hypertriglyceridaemia (etgt;10 mmol/L) in 10 (0.2%). TC (etgt;5 mmol/L) with LDL (etgt;3 mmol/L) but TG in the normal range was seen in 369 (5.8%) patients; indicating a cholesterol-predominant problem. In contrast; LDLC (etgt;3 mmol/L) and TG (etgt;1.7 mmol/L) was seen in 249 (3.87%) representing mixed hyperlipidaemia. Paediatric patients with severe dyslipidaemia mostly suffered from nephrotic syndrome.CONCLUSION:A significant burden and a high prevalence of dyslipidaemias were present in adults in whom a monogenic disorder should be considered. The extent and severity of dyslipidaemia justify a special clinic and laboratory to ensure accurate diagnosis with effective intervention for patients and their families

Breastfeeding Policies and Practices in Healthcare Facilities in the Western Cape Province; South Africa

The Baby-Friendly Hospital Initiative (BFHI) is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants; thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown; however; that the selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was therefore conducted to assess the extent of the implementation of the Ten Steps in both public and private maternity facilities. Poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of health care workers (HCWs) and mothers alike and to evaluate the exclusive BF (EBF) practices of mothers attending private BF clinics. Both studies followed descriptive; cross-sectional designs and were set in the Cape Metropole in the Western Cape. Twenty-six maternity facilities participated in the initial study; for which observation lists were completed and verified by interviewer-administered questionnaires to both HCWs and mothers. Eighteen private BF clinics participated in the follow-up study; which included observations and interviewer-administered questionnaires to 25 HCWs and 64 mothers. During the initial study; lower mean scores were noted for Steps 1; 2; 6 and 10. The overall implementation of the Ten Steps was average. The findings highlighted the importance of the establishment and implementation of BF policies; of appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF; EBF practices and support on an ongoing basis to ensure the best start in life for infants

Consumer Testing of the Preliminary Paediatric Food-Based Dietary Guidelines (PFBDG) Among Mothers with Infants Younger Than 6 Months in Selected Urban and Rural Areas in the Western Cape

Aim: To determine the comprehensibility of the preliminary paediatric food-based dietary guidelines (PFBDG) for infants younger than 6 months in South Africa.Methods: This qualitative study used focus group discussions held in the Western Cape to evaluate the comprehensibility and the understandability of the preliminary PFBDG. Groups were convened according to area of residence (rural; urban formal and urban informal) and ethnicity (white; coloured and black) to reflect the Western Cape population. Focus group discussions were conducted in the participant's home language; namely Afrikaans; eng or Xhosa. The purposive sample included 89 women with infants younger than 6 months divided in 20 groups.Results: In general; mothers understood the guidelines and could reportedly implement them; but constraints such as having to go back to work; being tired and not having enough breast-milk were volunteered. There were very few problems regarding the PFBDG terminology except with the word 'regularly' in the context of the oral hygiene guideline. With regard to the breast-feeding guideline there was some confusion over whether other foods could be included while breast-feeding. Suggestions were made to include 'only' in the breast-feeding guideline. Some of the participants did not know anything about cleaning the infant's mouth; and suggested it be changed to the overall hygiene of the infant. Conclusion: The findings from this study indicate that it may be possible to use one set of dietary guidelines for infants younger than 6 months for all ethnic groups living in the Western Cape; provided that these guidelines are accompanied by supportive documentation citing examples and reasons for the implementation of the guidelines. ecommendations were made for the PFBDG Work Group to revise the preliminary PFBDG for infants younger than 6 months for implementation and further action

Use of Knee Height as a Surrogate Measure of Height in Older South Africans

The study aimed to determine whether knee height would be a more appropriate surrogate measurement than armspan in determining height and body mass index (BMI) in a group of South African older people (.. 60 years). A random sample of adults (older than 18 years) who attended selected clinics or who lived in selected old-age homes in the Western Cape volunteered to participate in the study. Subjects were divided into a study group of older people (.. 60 years of age; N = 1 233) and a comparative group of younger adults (18 - 59 years; N = 1 038).Armspan; knee height; standing height and weight were measured using standardised techniques. The standing height measurements were significantly different between the two groups (p = 0.0001); with a mean for adults of 1.61 m (standard deviation (SD) 0.09) compared with that of older peole (1.57 m (SD 0.09)). Mean standing height decreased with age. Knee-height measurements were not significantly different between the two groups; but when used to calculate height; the adults were significantly taller (p = 0.0001); with a mean height of 1.67 m (SD 0.06) compared with that of the older people (1.59 m (SD 0.08)). Mean armspan also decreased with age; and derived standing height was significantly different (p = 0.0001) between the two groups; with adults being taller (1.67 m (SD 0.11)) than the older people (1.63 m (SD 0.11)). In this study group; the knee-height measurements were more closely related to the standing height than the armspan. The BMI calculated from armspan-derived height tended to classify the older people towards underweight. Knee-height measurement would appear to be a more accurate and appropriate method to determine height in older people in South Africa

Knowledge; Attitudes and Practices of Women Regarding the Prevention of Mother-To-Child Transmission (PMTCT) Programme at the Vanguard Community Health Centre; Western Cape - A Pilot Study

Objective.The aim of the study was to determine the knowledge; attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre (CHC). Method. A descriptive study was conducted using an administered; structured questionnaire.Subjects and setting. Thirty-six educated women aged 18 - 39 years and attending the clinic took part.Participants were from informal settlements and mostly unemployed; receiving government grants.Results. The majority (88.9) scored 80or more with regard to general HIV knowledge. Although the majority (78) were formula feeding; primarily owing to their HIV status and convenience while working; 24would not be able to sustain this feeding method after the initial 6 months' free supply provided by the provincial health services. The majority could not define the terms exclusive breastfeeding (89); mixed feeding (81) or cup feeding (94) correctly. Attitudes were found to be positive with regard to both breastfeeding and formula feeding; but HIV status influenced it significantly ( p 0.1). Conclusion. In conclusion; certain aspects of the PMTCT programme appear to have been effective at the CHC included in this study. The women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT); but they were uninformed about certain essential aspects; i.e. prevention; cure and infant feeding.Attitudes were similar towards breastmilk or formula milk as a feeding choice but were influenced by HIV status. It was indicated that an informed decision-making process was not followed; rather that the women were advised to formula feed. Sustainability of formula feeding after 6 months and training of health workers specifically regarding feeding options need to be addresse