http://hdl.handle.net/10386/62 2026-04-11T17:46:59Z http://hdl.handle.net/10386/5397 Evaluation of nursing' antimicrobial prescribing practices and use in selected public primary health care facilities in the North-West Province, South Africa Motseatsea, Valentia Pretty Mosima Background: Antimicrobial Resistance (AMR) poses a significant threat to global health, primarily driven by inappropriate antimicrobial prescribing practices. This study aims to evaluate the effectiveness of Antimicrobial Stewardship (AMS) activities at the primary healthcare (PHC) level. The primary aim was to evaluate the appropriateness of nurses’ antimicrobial prescribing practices and determine the availability of antimicrobial stewardship activities in PHC settings. Methods: The study employed a mixed-methods approach, analysing 366 prescriptions for appropriateness in Phase 1. Descriptive data analysis was performed using SPSS. In Phase 2, fifteen (15) In-depth interviews were conducted with professional nurses, but only twelve (12) were included for analysis. These were analysed verbatim to derive themes related to their understanding of antimicrobial prescribing practices. A pilot study and cross-checking were conducted to ensure the validity and trustworthiness of the results. Results: The majority (89%, n = 326) of the prescriptions were deemed inappropriate. Identified issues included incomplete diagnoses (65%, n = 211) and unjustified use of antimicrobials (7%, n = 23). The identified matters included undocumented dose strengths (86%, n = 438), incorrect dosing (10%, n = 34), and undocumented therapy duration (85%, n = 434) among the 509 prescribed antimicrobials. Qualitative findings revealed six key themes: nurses' understanding of antimicrobial resistance, challenges in antimicrobial prescribing, health education and patient interaction, professional training and confidence, access to resources and guidelines, and awareness of antimicrobial stewardship (AMS). Additional concerns emerged, including the personal use of antimicrobials by nurses and non-adherence to the Standard Treatment Guidelines and Essential Drug List Guidelines, which suggested treatment durations. While some nurses reported clinical support and accessibility to pharmacists, this was inconsistent and often limited to stock management, with the underutilisation of pharmacists for clinical guidance noted. Conclusions: The study concludes that inappropriate antimicrobial prescribing is prevalent in PHC due to systemic and personal challenges that nurses face, potentially contributing to antimicrobial resistance.Recommendations: Key recommendations include expanding the role of Sub-District Pharmacists and infection control practitioners (ICP) to include surveillance, incorporating antimicrobial discussions in pharmaceutical and therapeutics committee meetings, initiating AMS activities at the PHC level, prioritising nurse training on antimicrobials and guidelines, and addressing staffing issues to alleviate workload pressures. Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2025 2025-01-01T00:00:00Z http://hdl.handle.net/10386/5364 Knowledge and perceptions of patients with hypertension on adverse drug reation reporting in the community of Dikgale, Mamabolo, Molepo and Mothapo health and demographic surveillance site Molepo, Molatela Rose Introduction: Both adverse drug reactions and hypertension pose a threat to global public health. Underreporting of adverse drug reactions (ADRs) by patients and healthcare professionals is still a major challenge to effective pharmacovigilance system globally. Underreporting of ADRs by patients is particularly low in Africa because of lack of knowledge and awareness. In South Africa, there are platforms for patients and healthcare professionals to report ADRs, but inadequate knowledge and awareness continue to hinder the progress of effective ADR reporting. Most patients report to healthcare professionals. Purpose: To assess the knowledge, perceptions and experiences of ADR reporting among patients on anti-hypertensives attending primary health care (PHC) facilities under the Dikgale, Mamamolo, Mothapo and Molepo Health and Demographic Surveillance Site (DIMAMO HDSS), Limpopo Province, South Africa. Methodology: This was a quantitative cross-sectional study. A questionnaire was used to collect data from 384 respondents. Data was collected from six PHC facilities under the DIMAMO HDSS. The data was analysed using the Statistical Package for Social Sciences version 29 and Microsoft Excel. Results: Majority of the respondents were female, unemployed and aged 61 years and above. The common antihypertensive medications were amlodipine, enalapril and hydrochlorothiazide with most reported side effects experienced from enalapril. The term medication side effect was more common than ADRs. There was an overall lack of knowledge among respondents with only two respondents familiar with the word ADR. The perspective was positive in that patients identified themselves as responsible for detection and reporting of ADRs. Lack of knowledge and unemployment served as barriers for ADR reporting Conclusion: The population of DIMAMO generally had lack of knowledge on side effects and ADRs. Medication side effect was a more common term to the respondents than ADR. Only a few respondents reported to have had experienced an ADR or a side effect. The respondents had a positive perspective on reporting ADRs despite having limited knowledge. Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2025 2025-01-01T00:00:00Z http://hdl.handle.net/10386/5183 The role and attitude of pharmacists in mental health management at community pharmacies in the Limpopo Provice Mphahlele, Tshwarelo Desree Introduction: Pharmacists are medication experts who play various significant roles in the provision of proper mental health care. Community pharmacists are usually either the first point of contact for the patient seeking pharmacist-initiated therapy or the last point of contact for a patient who has consulted with a doctor. Consequently, they have a huge role to perform in mental health management. Mental health patients are generally highly associated with non-compliance to treatment, mainly due to the severely uncomfortable side effects of the treatment. Most of them also tend to feel embarrassed by having these conditions mainly due to the stigma and misconception built around mental health conditions. This usually leads to a relatively high mortality rate. This suggests that patients may not have enough information regarding their mental health. Past studies have shown that lower levels of mental health stigma have also been revealed to be associated with community pharmacists’ preparedness to offer professional pharmacy services to patients with schizophrenia and other mental health conditions. This means the attitude affects the service. No studies have been found regarding the roles of community pharmacists and their attitudes towards mental health patients in South Africa, thereby necessitating this study. Objectives: The objectives of this study were to identify the role, to determine the attitude of community pharmacists, and to identify the obstacles that community pharmacists practising in Limpopo Province are faced with in the management of mental health conditions. Method: 145 community pharmacists in Limpopo Province were recruited into the study using stratified random sampling. Data was collected using a questionnaire comprising of a consent form, demographics, and questions related to the roles of community pharmacists in mental health management, and their attitude towards mental health patients. All the data obtained was analysed using Statistics Package for Social Sciences (SPSS version 27, 2021) to obtain descriptive and inferential statistics. Results: This study has found that community pharmacists in Limpopo Province perform their roles in mental health management. The results revealed that the attitude of these community pharmacists is neutral. Furthermore, the participants indicated that they are comfortable dealing with mental health patients.Lack of training in pharmaceutical care practice, lack of patient history and lack of cooperation from mental health patients are the main obstacles faced by community pharmacists practising in Limpopo Province. Conclusion: The increasing concern over mental illness calls for an urgent need for community pharmacists countrywide to stick to their commitment in offering mental health management services. Community pharmacists in Limpopo Province are comfortably fulfilling their roles in the management of mental illnesses. However, their attitude towards mental health patients could be improved. Recommendations: Further training and education should be provided to community pharmacists. Community pharmacists in Limpopo Province should be encouraged to build and maintain relationships with other healthcare practitioners. Mental health awareness campaigns should be arranged for community pharmacies in Limpopo Province. Furthermore, screening resources/tools should be provided to community pharmacists in Limpopo Province. It would be beneficial to develop policies and resources should be developed to motivate community pharmacists in Limpopo to increase their participation in mental health care service provision Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2025 2025-01-01T00:00:00Z http://hdl.handle.net/10386/5088 Determination of the association of minimum inhibitory concentrations of antituberculosis drugs and resistance mutations of clinical isolates of mycobacterium tuberculosis from Limpopo, Province, South Africa Malope, Pleasure Background: Tuberculosis (TB) maintains its position as the leading global infectious disease, and South Africa is among the countries most affected by drug-resistant strains. The situation of tuberculosis is exacerbated by the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), which presents significant challenges to TB control efforts, especially in regions such as Limpopo Province, where high transmission rates and limited resources worsen the problem. Genetic mutations are the primary drivers of drug resistance, altering the effectiveness of both first-line and second-line antituberculosis drugs. Despite the revolution in TB detection and treatment brought about by molecular diagnostics, it remains necessary to deepen our understanding of how these genetic mutations impact the level of drug resistance. The minimum inhibitory concentration (MIC) of anti-TB drugs, which indicates the lowest concentration needed to inhibit bacterial growth, plays a crucial role in clinical decision making. However, current diagnostic tools often do not account for the correlation between MIC levels and specific resistance mutations, especially for newer drugs like Bedaquiline. This study aimed to address the gap by examining the relationship between MICs and resistance mutations in Mycobacterium tuberculosis clinical isolates from Limpopo province. By utilizing advanced molecular techniques such as whole genome sequencing (WGS) and phenotypic drug susceptibility testing. Methods: This cross-sectional, quantitative study analyzed 281 clinical isolates from the tuberculosis repository of the Polokwane National Health Laboratory Service (NHLS). The MICs for levofloxacin (LVX), moxifloxacin(MXF), and bedaquiline (BDQ) were determined using the BD BACTEC MGIT 960 system. Whole genome sequencing (WGS) was performed on phenotypically resistant clinical isolates to identify mutations associated with drug resistance. Statistical analyses, including T-tests and logistic regression, were performed to correlate MICs with specific resistance mutations.Results: A total of 147 drug-resistant tuberculosis clinical isolates met the study inclusion criteria and were tested for MIC. Seventy-seven (52.4%) isolates were from men in the age group of 26-45 years with a mean age of 39 (IQR 18 to 46) years. A total of 139 (94.6%) were susceptible to LVX while 144 (98.0%) and 128 (87.1%) were susceptible to MXF and BDQ, respectively. Of the eight fluoroquinolone (FLQ)-Not resistant clinical isolates, most were associated with mutations in the gyrA gene. The most common mutations were substitutions in Condon 94 of 6 (75.5%), leading to low-level resistance. In bedaquiline-resistant clinical isolates, mutations were identified in the Rv0678, Rv1979c, and atpE genes, with most mutations linked to increased levels of resistance. Conclusions In conclusion, this study identified key mutations in Mycobacterium tuberculosis clinical isolates from Limpopo province that are associated with resistance to LVX, MXF, and BDQ. These findings highlight the need for continuous monitoring of resistance mutations and MIC levels to inform clinical decision-making and optimize treatment regimens for DR-TB (drug resistant tuberculosis). Understanding the genetic drivers of drug resistance is crucial for developing effective diagnostic tools and therapeutic strategies. Thesis (M.Sc. (Medical Sciences)) -- University of Limpopo, 2025 2025-01-01T00:00:00Z