Developing an implementation model to address food shortages in Matabeleland South Province, Zimbabwe.

Doctoral Degree. University of KwaZulu-Natal, Durban.Matabeleland South Province has since 1980 to date been experiencing acute food shortages. Currently, it is the province with the highest number of food insecure people. The study recommends a bottom up approach, that is beyond ZimASSET, that addresses food shortages in Matabeleland South Province. The purpose of this study is to develop an Implementation Model to address food shortages in the Matabeleland South Province of Zimbabwe. The study employed the Grounded Theory approach utilizing a purely qualitative design. Purposive sampling of 200 stakeholders, that is expert and typical case sampling was the primary method of research. As the study was unfolding, a theoretical sampling was later employed. A confirmatory retrospective document review of food security documents from the Zimbabwe Vulnerability Assessment Committee and the Famine Early Warning systems Network was done. The Entitlement Theory by Sen Amartya, and the Systems Theory by Von Bertalanffy were utilised as the theoretical point of departure for the study. The study utilised Key Informant Interviews, Focus Group Discussion and Document Analysis to mine data. Data was analysed using the thematic approach. Major findings and results showed a disjuncture and dissonance within the Provincial Food and Nutrition Security Task Force approaches used to address the food insecurity situation in the province of Matabeleland South. The findings showed that, there is an implementation gap in need to be filled, and all stakeholders must apply a bottom up approach in addressing the problem of food shortages. The developed Implementation Model was validated by the stakeholders who participated in the data collection phase and endorsed the bottom up approach, which as intended, conveyed the community’s views. The Food Security Implementation Model is forwarding the community development aspirations to a new level that leaves footprints on the development terrain with a pragmatist component of coming up with home grown solutions to the problem of food insecurity

Improving the management of Parkinson's disease: the experience of hospitalisation and a novel mri-based diagnostic tool

Parkinson's disease (PD) motor and non-motor symptoms progress relentlessly leading to frequent hospitalisations and an increase in the economic and societal burden of the disease. A major challenge in assessing treatments which can potentially reduce neurodegeneration, is the lack of tools that can be used to identify individuals with early PD with high sensitivity and specificity. There were several facets to this thesis, which were aimed at addressing these issues. Firstly a retrospective analysis of PD hospital admissions was conducted to provide background data on hospitalisation and clinical coding accuracy. A systematic review of literature for interventions to reduce hospital admissions was performed. Effect of treatments for PD motor symptoms on hospitalisation was also evaluated. Lastly, screening of potential lanthanide and 19 Fluorine based MRI probes for future use as diagnostic tools in PD was conducted. Results of these studies highlight significant underreporting of PD hospitalisation which has a negative effect on PD resource allocation. A lack of robust evidence for measures which reduce PD admissions was demonstrated. Although the initial attempts to develop a novel MRI sensitive tool for use in PD were negative, the study refined a protocol that has potential for use in screening future probes

Impacts of climate change on household food security in Matande communal lands, Mwenezi district in Zimbabwe

Mwenezi district is a drought prone area characterised by high temperatures, droughts, rainfall deficit, crop failures and chronic food deficiencies. Rainfed agriculture can no longer be sustained without any innovations. The study explored the impacts of climate change on household food security among the vulnerable populations of Matande communal lands, Mwenezi district in Zimbabwe. The study is guided by the Sustainable Livelihoods Framework (SLF). An exploratory sequential research design was adopted, and a total of 78 respondents were selected from the population of 371 households using purposive and cluster sampling techniques. Data collection was triangulated through the use of household survey, focus group discussions, key informant interviews and observations. The thematic approach and SPSS software were used to analyse qualitative and quantitative data, respectively. Results demonstrated that climate change propelled increases of pests and diseases for both livestock and crops, reduction of meals uptake per day, biodiversity loss and dwindled crop production. Livestock increases were recorded despite the changing climate shows a nexus with food insecurity. The research called for the adoption of drought-tolerant crops, capacity building through climate change resilience programmes, livestock centric in diversification, improved formal markets for livestock and tapping of underground water for irrigation and other purposes to complement existing water bodies to prevent them drying up early. Contribution: There is deepening aridification in Mwenezi district because of climate change resulting in the continuous obliteration for the worst of agro-ecological regions iv and v reclassified into a and b. This confirmed the heterogeneity of various climatic conditions and variability within the same geographical context. However, vulnerability continues to be generalised into regions. The study investigates the impacts of climate change typical to Matande communal lands with the view to generate knowledge relevant to review adaptation practices specific to the researched area in order to escalate community resilience

Coding accuracy for Parkinson's disease hospital admissions:implications for healthcare planning in the UK

ObjectivesHospital Episode Statistics data are used for healthcare planning and hospital reimbursements. Reliability of these data is dependent on the accuracy of individual hospitals reporting Secondary Uses Service (SUS) which includes hospitalisation. The number and coding accuracy for Parkinson's disease hospital admissions at a tertiary centre in Birmingham was assessed.Study designRetrospective, routine-data–based study.MethodsA retrospective electronic database search for all Parkinson's disease patients admitted to the tertiary hospital over a 4-year period (2009–2013) was performed on the SUS database using International Classification of Disease codes, and on the local inpatient electronic prescription database, Prescription and Information Communications System, using medication prescriptions. Capture-recapture methods were used to estimate the number of patients and admissions missed by both databases.ResultsFrom the two databases, between July 2009 and June 2013, 1068 patients with Parkinson's disease accounted for 1999 admissions. During these admissions, the Parkinson's disease was coded as a primary or secondary diagnosis. Ninety-one percent of these admissions were recorded on the SUS database. Capture-recapture methods estimated that the number of Parkinson's disease patients admitted during this period was 1127 patients (95% confidence interval: 1107–1146). A supplementary search of both SUS and Prescription and Information Communications System was undertaken using the hospital numbers of these 1068 patients. This identified another 479 admissions. SUS database under-estimated Parkinson's disease admissions by 27% during the study period.ConclusionThe accuracy of disease coding is critical for healthcare policy planning and must be improved. If the under-reporting of Parkinson's disease admissions on the SUS database is repeated nationally, expenditure on Parkinson's disease admissions in England is under-estimated by approximately £61 million per year

A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson’s disease: a study protocol for a randomised controlled trial

Abstract: Background: Parkinson’s disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals’ needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. Methods/design: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. Primary outcome: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson’s Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. Discussion: The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. Trial registration: International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016

A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson’s disease: a study protocol for a randomised controlled trial

Abstract: Background: Parkinson’s disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals’ needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. Methods/design: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. Primary outcome: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson’s Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. Discussion: The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. Trial registration: International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016

Gold-sulphide mineralisation in the Giyani Grrenstone Belt case studies at Black Mountain and West-59 targets, Limpopo Province, South Africa

Department of Mining and Environmental GeologyMESME