South African Medical Journal - latest Issue
Volumes & issues
Volume 106, Issue 12, 2016
Author Hannah KikayaSource: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12202More Less
That the results of medical and health research must be disseminated is one of the fundamental principles of biomedical ethics. Enshrined in the World Medical Association's 1964 Declaration of Helsinki, the requirement for publication of findings, whether positive or negative, aims to ensure that the risk accepted by participants in research studies is balanced by the benefit of knowing their data helped to advance scientific knowledge.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12186More Less
As we end 2016 - which has effectively been my first year as de facto editor of the SAMJ - I have a bit of time to reflect. It has been a steep learning curve - going from working with a highly respected academic who made most of the decisions, to taking over - with all the slings and arrows that come with this! On a run recently I chatted briefly to my old teacher and friend, Raymond Abratt, who said that he was warned, as editor of a journal, that he wouldn't have many friends left! As a professional editor, rather than an academic, I may have been somewhat immune to this, and I have certainly enjoyed my expanded role.
Source: South African Medical Journal 106, pp 1150 –1151 (2016)More Less
The dual burden of gender-based violence and HIV in adolescent girls and young women in South Africa : guest editorialSource: South African Medical Journal 106, pp 1151 –1153 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12126More Less
The 16 Days of Activism is an international awareness-raising campaign that promotes no violence against women and children. Each year the campaign runs between 25 November and 10 December and overlaps with World AIDS Day on 1 December. Adopted by South Africa (SA) in 1998, the campaign aims to raise awareness among South Africans about the negative impact of violence against women and children on all members of the community. This campaign is particularly relevant in the SA context, as young women aged 15 - 24 years, who have the least power in society, bear an enormous burden of both intimate partner violence (IPV) and HIV.
Willingness of tobacco smokers to contribute financially towards cessation resources : correspondenceSource: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12106More Less
Exposure to tobacco smoke accounts for approximately 9% (95% confidence interval 8.1 - 10.2) of all South African (SA) deaths. Seventeen percent of SA adults are self-reported active smokers and an alarming 32% of pregnant women were found to be active smokers on urine cotinine testing. Despite the publication in 2013 of the South African Tobacco Smoking Cessation Clinical Practice Guideline, tobacco smoking cessation programmes in the public health sector remain scarce.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/ SAMJ.2016.v106i12.12187More Less
The year 2016 has seen some major changes to the Health and Medical Publishing Group (HMPG) in general, and to the SAMJ in particular. From a practical perspective, one of the biggest changes has been to our online submission system for journals, which has moved from the open-source OJS (open journal system) to Editorial Manager/Production Manager, an international system used by large international publishers including The Lancet and Elsevier.
Source: South African Medical Journal 106, pp 1156 –1157 (2016)More Less
The J-curve: Blood pressure and cardiovascular disease
Treatment, not screening, cause of reduction in breast cancer deaths
Maternal and newborn mortality directly affected by quality of care at health facilities
Can we reach the 2025 WHO global tuberculosis targets?
No more cranberry juice for urinary tract infections
Little difference in outcome between treated and monitored prostate cancer
Industry-funded studies find no link between sugary drinks and diabetes and obesity
Source: South African Medical Journal 106 (2016)More Less
Author Kate JoynerSource: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12178More Less
Child abuse is disturbingly common in South Africa (SA). As such, it presents an outrageous scourge that calls for greater attention, skills, resources and political support. Also termed 'maltreatment', health professionals need to know how to deal with it better. 'Maltreatment is one of the biggest paediatric public health challenges, yet any research activity is dwarfed by work on more established childhood ills.'
Developing an understanding of fatal child abuse and neglect : results from the South African child death review pilot study : CMESource: South African Medical Journal 106, pp 1160 –1163 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12130More Less
Fatal child abuse is the severest consequence of violence against children. Yet, little is known about this phenomenon, as routine data do not describe it. Child death review (CDR) teams have been established to systematically review deaths from birth to adolescence as a public health response to better identify child abuse deaths, to develop policy and to improve the child protection response. This article describes the incidence of fatal child abuse and injury patterns associated with such deaths. CDR teams reviewed all child fatalities from 1 January to 31 December 2014 at two pilot sites in South Africa (SA). Data were collected on demographics, causes and circumstances of the death, and family social context. We assessed the feasibility of CDR teams in the SA setting to strengthen the identification of child abuse deaths and influence practice. A total of 707 cases were reviewed. Over half (52.4%) of the deaths were due to natural causes. A third were caused by murder, with nearly half (44%) of all murders attributed to fatal child abuse. The burden of fatal child abuse and neglect was found among the <1-year age group. Abandonment at birth was most common, followed by blunt force injuries and strangulation/asphyxiation deaths. CDR teams are effective in better identifying deaths due to child abuse and neglect via a multidisciplinary approach and regular case reviews.
Source: South African Medical Journal 106, pp 1164 –1167 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12129More Less
Even though maternal mental health receives low priority in healthcare, it is a vital component for the developing fetus and the raising of healthy children who are able to contribute meaningfully to society. This article explores risk factors for common mental illnesses and treatment options available in under-resourced settings.
Source: South African Medical Journal 106, pp 1168 –1172 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12128More Less
Violence against children is widespread in South Africa. Much of it remains hidden, and social services are thinly stretched. This article therefore focuses on children's rights to protection and considers the implications for healthcare practice. Children's rights can be considered both a 'language of critique' and a 'language of possibility' - encouraging us to evaluate current practice from a child-centred perspective and to re-imagine ways in which we deliver healthcare services. The article outlines the nature, extent and long-term effects of violence against children, introduces a framework for conceptualising violence prevention, and considers ways in which health professionals can better respond to cases of abuse and neglect, and prevent violence against children from taking place.
Addressing legal and policy barriers to male circumcision for adolescent boys in South Africa : in practice - medicine and the lawSource: South African Medical Journal 106, pp 1173 –1176 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11215More Less
With millions of adolescents becoming infected with HIV globally, it is essential that barriers to much-needed interventions are reduced for at-risk adolescents. In this article we review the legal and policy framework in South Africa for adolescent access to male circumcision. We are of the view that the framework does confer protection for adolescent boys while enabling access to male circumcision; however, we identify ambiguities and tensions that exist between the Children's Act, regulations and national guidelines. We recommend reform to further enable access by this vulnerable group to this prevention modality.
South African Guidelines Excellence (SAGE) : adopt, adapt, or contextualise? : in practice - Cochrane cornerSource: South African Medical Journal 106, pp 1177 –1178 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11374More Less
Clinical practice guideline (CPG) activities must be planned carefully for efficient use of available resources and evidence-based implementation. De novo development of CPGs may sometimes 'recreate the wheel' and delay implementation. Three innovative alternatives to de novo CPG development (adopt, contextualise or adapt) are outlined, which have greater potential than de novo development to best use the limited available resources, personnel and time in settings such as South Africa.
The universities of Stellenbosch/Cape Town low-carbohydrate diet review : mistake or mischief? : in practice - issues in public healthSource: South African Medical Journal 106, pp 1179 –1182 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12072More Less
A 2014 meta-analysis from the universities of Stellenbosch and Cape Town reported that diets with a lower-carbohydrate (CHO) content are no more effective for producing weight loss than are high-CHO diets, so-called isoenergetic 'balanced' diets. We have re-examined the article and found numerous errors, many material in nature. Studies were included that failed the authors' own inclusion criteria; invalid and subjective meta-analysis sub-grouping was used; and data extraction was repeatedly inaccurate. All but one error favoured the balanced diet. The article was widely publicised, highly impactful and inaccurate. This begs the question: mistake or mischief?
Source: South African Medical Journal 106, pp 1183 –1185 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11217More Less
The requirement of 'research completion' as necessary for specialist registration with the Health Professions Council of South Africa (HPCSA) has recently been subject to legal action, with a court order potentially shifting requirements beyond those envisaged by the HPCSA. The research requirement is congruent with National Department of Health strategy in this regard, i.e. the strengthening of research as a stated priority. While the expectation of research competency is not in itself contentious, the capacity of institutions and the ability of registrars to facilitate and complete, respectively, have brought the issue into focus. Specifically, the apparent discrepancy between a court order and a regulation needs to be resolved to ensure that specialist registration is not unduly hampered, while ensuring that a potentially important contributor to a national priority is not prejudiced.
Source: South African Medical Journal 106, pp 1186 –1187 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11446More Less
Author L. SmitSource: South African Medical Journal 106, pp 1188 –1189 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11417More Less
A hypertensive patient presented with complaints of headache and fluctuating double vision and deterioration in vision from 2010. She displayed symptoms associated with convergence spasms, which could be confused with sixth cranial nerve palsies. A few pointers are given to prevent clinicians from being caught off-guard when encountering this clinical condition.
Diabetic cachectic neuropathy : an uncommon neurological complication of diabetes : in practice - case reportSource: South African Medical Journal 106, pp 1190 –1191 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.11198More Less
A 40-year-old female patient with diabetes of 12 years' duration, with poor drug compliance, presented with a 4-month history of rapid progressive weight loss, burning sensations in the feet, abdominal swelling, and constipation with occasional episodes of epigastric pain. On examination, she was chronically ill-looking with a body mass index of 17.1 kg/m2, grossly distended abdomen (initially mistaken for gravid abdomen). Blood pressure measurements in the supine and standing positions were 200/130 mmHg and 180/100 mmHg, respectively. Neurological examination revealed stocking-pattern loss of pain, temperature, and light touch modalities. Vibration sensation was impaired up to the malleoli bilaterally, with impairment of joint position sense of both big toes. Random blood sugar level was 16.4 mmol/L; glycosylated haemoglobin was 13.2% with a haematocrit of 33.0%. Renal indices, uric acid, liver function tests and fasting lipid profile were all within normal limits. An abdominal ultrasound scan showed distended bowel loops. The vibration perception threshold average using biothesiometry was 27.3 mV.
Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth : design lessons from pregnancy support programmes in 27 countries : researchSource: South African Medical Journal 106, pp 1192 –1210 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i12.12011More Less
Background. Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants.
Objectives. To review design and operational features of pregnancy support programmes, highlighting features that promote their effectiveness and efficiency, and implications thereof for SA.
Methods. Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries.
Results. Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support.
Conclusions. Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.