South African Medical Journal
The South African Medical Journal (SAMJ) is published under the auspices of the South African Medical Association, though it enjoys full editorial autonomy. The SAMJ :
- Provides a premier vehicle for the publication of medical research in South Africa and beyond;
- Provides high quality educational material for doctors;
- Informs the medical profession and the public on relevant health issues;
- Provides a forum for members of the profession to voice their opinions;
- Influences opinion and policy through the authority, relevance and quality of its contents;
- Is an important source for advertising and obtaining information about professional appointments.
This journal continues CME : Your SA Journal of CPD
|Publisher||Health and Medical Publishing Group (HMPG)|
|Coverage||Vol 93 Issue 1 2003 - current|
Department of Higher Education and Training (DHET)
ScieLO SA (2016)
The Sciences Citation Index of the Institute of Scientific Information (ISI)
Problematic alcohol and other substance use among patients presenting to emergency services in South Africa : who is ready for change?
Background. Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources.
Objective. To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs).
Methods. Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients’ age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention.
Results. Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores.
Conclusions. Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.
Prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses, and evaluation of risk factors for transmission : report of a population screening in Nigeria
Background. Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV are common blood-borne infections unevenly distributed across regions in Nigeria. Few population-based prevalence studies have been done in Nigeria.
Objective. To determine the prevalence of HBV, HCV and HIV and risk factors for infection with these viruses in a Nigerian population.
Methods. Hepatitis B surface antigen, anti-HCV and HIV were assayed in 1 498 healthy adult participants. A structured questionnaire was used to assess risk factors for viral acquisition. Bivariate analysis was used to compare differences in sociodemographic characteristics. Significant risk factors were identified by stepwise logistic regression. A p-value <0.05 was considered significant.
Results. The prevalences of HBV, HCV and HIV were 8.8%, 10.0% and 12.9%, respectively, with urban/rural disparity. HBV/HCV positivity was higher among males than females. The reverse was true for HIV. Age was significantly associated with being HBV-, HCV- or HIVpositive. Communal use of a toothbrush was significantly associated with HBV positivity in the final model (odds ratio 2.46, 95% confidence interval 1.45 - 4.18).
Conclusions. The prevalence of HBV, HCV and HIV infection is high in Nigeria, with urban/rural disparity. HCV may be more of a public health concern than HBV in some communities. Population-based studies are required to provide vital data to inform optimal national control strategies.
Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children : a move to reduce antibiotics
Background. Despite evidence of limited benefit of antibiotics in acute bronchitis, most paediatric patients are prescribed them.
Objectives. To assess the validity of the Bronchitis Severity Score (BSS) in assessing the clinical response to treatment of acute bronchitis, and determine whether clinical data and basic laboratory measurements can be used to guide antibiotic prescription.
Methods. We enrolled 200 patients (age range 6 months - 12 years) with clinically diagnosed acute bronchitis. They were divided into three groups according to age. All patients were evaluated three times during the bronchitis episode (days 0, 5 and 7). The primary outcome measurement was the change in the BSS from day 0 to day 7.
Results. On the initial visit, the mean (standard deviation (SD)) BSS was 8.36 (2.6), indicating moderate severity of bronchitis. The mean BSS decreased to 4.03 (2.3) on day 5 and to 2.36 (1.45) on day 7. Initial blood tests showed anaemia (80%), leucocytosis (6%), bandaemia (3%) and lymphocytosis (52%). Only four patients were positive for C-reactive protein, while the erythrocyte sedimentation rate was elevated in 98% of cases. There were significant correlations between bandaemia, fever grade (p<0.001) and white blood cell count with clinical variables such as the presence of secretions on chest auscultation (p<0.05) and toxic facies on general examination (p<0.05).
Conclusions. Acute bronchitis in children is a self-limiting disease that does not require routine administration of antibiotics. The BSS is a simple and practical clinical scoring system that is useful in evaluating disease severity and monitoring disease resolution in acute bronchitis.
Perceptions of healthcare professionals regarding their own body weight in selected public hospitals in Mpumalanga Province, South Africa
Background. Obesity has been cited as a public health problem in both developing and developed countries. There is evidence that rates of obesity have increased among healthcare workers (HCWs) in South Africa (SA), especially those who do night shifts, with a negative effect on health. Perceptions of body weight contribute significantly to the desire to lose weight or not to do so.
Objective. To determine perceptions of HCWs regarding their own body weight in selected public hospitals in Mpumalanga Province, SA.
Methods. The study design was a cross-sectional survey. A total of 210 HCWs were sampled. Data were collected using self-administered questionnaires. Anthropometric measurements such as weight and height were objectively measured and body mass indices (BMIs) were calculated.
Results. Of the sample of HCWs 82.4% were females, with a mean age of 37.8 years. About half (51.9%) were obese and 21.4% were overweight. They tended to misperceive their body weight compared with actual BMI classification, with the majority of obese and overweight individuals considering themselves to be of normal weight.
Conclusions. The results indicate that HCWs misclassify their own body weight, which is a risk factor for obesity. It is important to focus on the health of this group of workers, on whom the health of South Africans depends and who should be the drivers of healthy living for all. Correct classification of their own body weight will encourage people to take action in a bid to combat their own and others’ obesity.
Available data sources for monitoring non-communicable diseases and their risk factors in South Africa
Background. Health information systems for monitoring chronic non-communicable diseases (NCDs) in South Africa (SA) are relatively less advanced than those for infectious diseases (particularly tuberculosis and HIV) and for maternal and child health. NCDs are now the largest cause of premature mortality owing to exposure to risk factors arising from obesity that include physical inactivity and accessible, cheap but unhealthy diets. The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013 - 17 developed by the SA National Department of Health outlines targets and monitoring priorities.
Objectives. To assess data sources relevant for monitoring NCDs and their risk factors by identifying the strengths and weaknesses, including usability and availability, of surveys and routine systems focusing at national and certain sub-national levels.
Methods. Publicly available survey and routine data sources were assessed for variables collected, their characteristics, frequency of data collection, geographical coverage and data availability.
Results. Survey data sources were found to be quite different in the way data variables are collected, their geographical coverage and also availability, while the main weakness of routine data sources was poor quality of data.
Conclusions. To provide a sound basis for monitoring progress of NCDs and related risk factors, we recommend harmonising and strengthening available SA data sources in terms of data quality, definitions, categories used, timeliness, disease coverage and biomarker measurement.