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Perceptions and experiences associated with abscondment of service users with severe mental illnesses at Chainama Mental Hospital in Zambia
(2023) Shamayinda, Charles Mungenisa; Brooke-Sumner, Carrie; Ashraf, Kagee
Background: Research suggests that for some people living with severe mental illness, they have experiences that lead them to leave the hospital without permission. This affects service users adversely in terms of their mental and physical health, including an interruption to their treatment plans. Absconding can also create emotional distress such as fear, worry, and guilt among healthcare staff and family members. However, despite the serious consequences of abscondment, there are currently no studies available exploring the perceptions and experiences associated with abscondment of service users with severe mental illnesses in Zambia. Methods: The study was qualitative, exploratory, and descriptive in nature, using semi- structured, in-depth individual interviews with 20 participants. All interviews were audio-recorded with informed consent gained and took place in different wards, including male and female wards at the Chainama mental hospital. Service users recruited in the study were assessed as stable and competent to provide consent. Thematic analysis using the Nvivo 12 software package was employed to synthesise the findings. Data was thematically categorized, paying attention to prominent themes that addressed the study objectives while remaining open to new emerging themes in the data, and this procedure was repeated until no new themes appeared. Results: The main findings were: 1) routes and timing of absconding, such as jumping the fence, crawling through the ceiling board, and the main gate, often during meals and drug administration periods, which reduced nurses' and security officers' attentiveness; and 2) descriptions of the pressures that led them to abscond, including family responsibilities, boredom, fear of stigma, and in-patient violence. Most respondents attributed their absconding behaviours to the natural desire to provide for and be with their families and friends. They also complained about a lack of entertainment, which increased their boredom; 3) perception of hospital care, where the majority of respondents bemoaned the rundown hospital's physical infrastructure, describing it as being old, dilapidated, dirty, and generally unfit for human habitation, while others bemoaned the poor health worker-patient relationship and lack of service user involvement in their care as factors that motivated their desire for a hospital; and 4) experiences of absconding and forced return, where most service users expressed happiness after absconding and described their forced return as upsetting and disheartening.
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Open Access
Health-related quality of life among Kenyan adolescents in the context of HIV: measurement issues and risk factors
(2023) Denge, Adam Mabrouk Adan; Schneider, Marguerite; Carney, Tara; Abubakar, Amina
. Background: Lack of validated health-related quality of Life (HRQoL) measures is one of the significant challenges in describing HRQoL among adolescents in sub-Saharan Africa andparticularly Kenya. The aims of this study were (i) to assess the reliability and validity of the Swahili version KIDSCREEN-52 (a measure of HRQoL) when administered to adolescents in Coastal Kenya and (ii) to investigate risk factors associated with poor HRQoL as measured by KIDSCREEN-52 among these adolescents. Method: KIDSCREEN-52 was translated from its original language (English) to Swahilifollowing the translation guidelines developed by the original KIDSCREEN group. Data analysis was performed from 558 adolescents (158 adolescents living with HIV, 200 HIV exposed uninfected and 200 community controls) aged 11-17 to examine the reliability, construct validity and divergent validity of the Swahili version of KIDSCREEN-52. Multivariable linear regression was conducted to determine the correlates of HRQoL among adolescents. Results: The Swahili version of KIDSCREEN-52 demonstrated good internal consistency with Cronbach alpha ranges of 0.74-0.91 and McDonald's omega ranges of 0.71-0.93 across the three study groups. The measure had a good construct validity, and the one-factor structure of the tool was obtained from the confirmatory factor analysis (CFA) ([overall Comparative Fit Index = 1.00, Tucker Lewis Index = 1.04, Root Mean Square of Error Approximation = 0.000 and p-value of 1.00]. The Swahili version of KIDCSREEN-52 significantly correlated with PHQ-9 scores (r = -0.107, p= 0.011) indicating divergent validity. Among all adolescents (i.e. from the three groups),HIV status, male sex and depressive symptoms were independent predictors of poor HRQoL. Conclusion: The findings demonstrate that the Swahili version of KIDSCREEN-52 is a reliable and valid HRQoL assessment tool. Additionally, the results indicate that we need to prioritize interventions to enhance the quality of life of prenatally infected adolescents alongside those who present with depressive symptoms.
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Open Access
The Isocitrate Dehydrogenase mutation- and O6-methylguanine-DNA-methyltransferase promotor methylation status of glioblastomas at Groote Schuur Hospital
(2026) Rocher, Wilhelmus Diederiks; Singh, Shivani; Ikumi, Nadia
Background:
Glioblastoma (GBM) isocitrate dehydrogenase (IDH) wild type (IDHwt) and high grade astrocytoma (HGA) IDH mutant (IDHmt), WHO CNS grade 4, represents the most common primary malignant brain tumours in adults. Both tumours have a poor prognosis, with a median survival of 12 to 14 months. In 2021 the World Health Organization (WHO) updated the classification of high grade gliomas separating tumours based on their IDH mutation status, to guide prognosis and treatment. Furthermore, these lesions can be divided by their eligibility for alkylating chemotherapeutic drugs, such as Temozolomide (TMZ), based on their O6-methylguanine-DNA-methyltransferase (MGMT) methylation status.
Aim:
The aim of this study is to reclassify tumours diagnosed as GBM between 2016 and 2019, before the advent of the current WHO recommendations, according to their IDH mutation status, as well as to determine the MGMT methylation status of these lesions to possibly advocate for the use of TMZ in our setting. These results will then be compared to international studies to determine if the patients in our cohort have similar demographics related to the different types of high grade gliomas.
Methods:
Patients diagnosed with glioblastoma at Groote Schuur Hospital, between 2016 and 2019 were reviewed following data retrieval from TrakCare LAB as well as retrieval and review of histology slides and immunohistochemistry when available. Tissue blocks of the patients reviewed were collected and sent to Inqaba Biotech for DNA extraction, IDH sequencing and MGMT methylation studies. The results were then correlated with the newest WHO classification, assessed for TMZ eligibility and correlated with international studies.
Results:
After exclusion criteria was applied a total of 45 cases were reviewed, with 21 females and 24 males making up the cohort, with ages ranging between 21 years old and 76 years old (median 55 years). Radiological imaging analyses suggested that most tumours occur in the frontal and temporal lobes with right side predominance. IDH-mutation status, as determined by both immunohistochemistry and sequencing, was identified in three cases. Of the 32 patients who had methylation studies, 25 (78%) were MGMT methylated according to EpiTYPER data.
Discussion:
According to our data 29 cases were not tested for IDH mutation by immunohistochemistry, mostly prior to 2018, mirroring the WHO recommendations of the time. With the combination of immunohistochemistry and sequencing data 3 cases can be reclassified as HGA IDHmt, with the remainder of the cases classified as GBM IDHwt. In our cohort 25 patients would have benefitted from TMZ therapy. HGA IDHmt occurred in younger patients (50 years of age or less), correlating with current international data. Limitations of the study were the inability to correlate immunohistochemistry with sequencing data as well as the decreased yield of DNA on paraffin embedded tissue, which made sequencing and methylation studies impossible on some of the samples.
Conclusion:
IDH mutation status is crucial for diagnosing high grade gliomas, for prognosis and treatment. Our cohort mirrors the global demographics and IDH mutation status of high grade gliomas. MGMT testing in our cohort showed potential benefits for some patients.
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Open Access
Assessing the performance, prospects, and priority of Africa's protected areas
(2026) Robson, Ashley Stephen; O'riain, Justin; Nattrass, Nicoli; Lindsey, Peter
Protected areas (PAs) are a critical tool for conserving Earth's natural ecosystems and have become the centrepiece of global conservation targets (e.g. Aichi 11; 30 by 30). With a vast PA network, Africa is positioned to contribute substantially to these targets. For this to happen, it is essential to understand the current performance of Africa's PAs, their prospects in the predicted rapid change of socioeconomic and climatic variables, and priorities for investment in the face of severe financial and technical constraints. To address these needs, I first used a questionnaire-based dataset on budget adequacy, management effectiveness, and threat severity to calculate a Conservation Area Performance Index for 516 PAs in savannah Africa. Relating this index to a proxy of biodiversity conservation – the population status of the African lion (Panthera leo) – I categorised 82% of surveyed conservation land as either failing to, or deteriorating in its ability to, effectively conserve biodiversity. I then examined human demographic, socio-economic, threat, management effectiveness, and biodiversity variables for a subset of 332 savannah PAs. Using a Structural Equation Modelling (SEM) framework, I found that levels of poverty, human density and industrial development around PAs were strongly related to the severity of anthropogenic threats to both wildlife and natural habitat. Lion population status was negatively affected by high threats to wildlife and natural habitats, however, effective PA management facilitated by state, NGO, and/or for-profit funding could alleviate these threats. Given predicted growth in Africa's population and shifts in economic activity, these findings underscore the need to address the socioeconomic drivers of biodiversity loss while enhancing PA effectiveness. Lastly, I used data on biodiversity irreplaceability, ecosystem service provision, connectivity, and human modification to calculate a composite conservation value index for Africa's PAs and, in doing so, identified priorities for investment in a resource-scarce environment. I found that the 147 most valuable PAs (6.8% of PAs) collectively accounted for 50% of the network's aggregated value, illustrating the need for targeted investment strategies that prioritise high-value areas. Based on these analyses, I conclude that Africa's PA network is in a severely compromised state that is likely to degrade in the future if strategic investment is not provided. I argue that Africa's contribution to global PA targets will only be achieved if funding for PAs is increased considerably, PAs are aligned with human development goals, and the most valuable PAs are secured before they collapse.
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Open Access
Validity of electrocardiogram for detecting left ventricular hypertrophy in younger South African patients
(2026) Robertson, Gordon; Jones, Erika; Cupido, Blanche
Aim
The aim of this study is to compare ECG criteria for LVH on ECG to transthoracic echocardiographic (TTE) defined-LVH in patients with hypertension between the ages of 18 and 45 years.
Methods
This study was a retrospective cross-sectional analysis of patients (ages 18 to 45 years old) with hypertension attending the Hypertension Clinic in a tertiary medical center in Cape Town, South Africa. Patients who had electrocardiograms (ECG) and transthoracic echocardiograms (TTE) data were collected. TTE was used as the gold standard for left ventricular hypertrophy (LVH) and various common ECG criteria for LVH were compared: Sokolow-Lyon, Obesity-adjusted Sokolow Lyon, Cornel Index, Cornell Product, R in aVL >11mm and R in V4-V6 >25mm. The data were analysed in two subgroups: younger (age 18 to 30 years) and older (31 to 45 years). Results This study included 71 participants with a median age of 30.8 years (54% male), the younger subgroup had 33 participants and the older sub-group had 38 participants. LVH was present on TTE in 51% of participants. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for any ECG criteria being positive in a patient aged 18 to 45 years with TTEdefined LVH was 67%, 46%, 56% and 57% respectively. The following ECG criteria had very good specificity: R in aVL (97%), Cornell index (97%), Cornell Product (89%), R in V4-V6 (86%) and Sokolow-Lyon (77%). The sensitivities were poor with Cornell product (25%), R in aVL >11mm (14%) and R in V4-V6 >25mm (19%). The criteria with better sensitivities were Sokolow-Lyon (50%) and Obesity-adjusted Sokolow-Lyon (58%). The criterion R in V4-V6 >25mm had an exceptionally poor PPV of 17% in the younger age group.
Conclusion
The commonly used ECG criteria have poor sensitivities and therefore are not useful for screening for LVH. The obesity adjusted Sokolow-Lyon criteria did improve sensitivity slightly (50 to 58%) with a significant reduction in specificity (77% to 54%). The R in V4-V6 >25mm criterion performed poorly in the younger age group due to a large number of false positives and cannot be used for assessing presence of LVH in younger patients. This study showed that patients aged 18 to 45 years with a positive Cornell Index, Cornell product or R in aVL>11mm was very specific for LVH. In a resource constrained setting this could save cost by reducing the number of TTEs required to assess for hypertension mediated target organ damage (HMOD) in patients who do not have another indication for TTE.