South African Family Practice - latest Issue
Volume 58, Issue 5, 2016
Knowledge and practice of the prevention of mother-to-child transmission of HIV guidelines amongst doctors and nurses at Odi Hospital, Tshwane District : researchSource: South African Family Practice 58, pp 1 –5 (2016) http://dx.doi.org/10.1080/20786190.2016.1228561More Less
Background: Almost 60 million people are infected with and 25 million people have already died from HIV/AIDS. Sub-Saharan Africa is the region most affected, with 67% of all people living with HIV and 91% of all new infections amongst children and 14 million children orphaned by HIV-related deaths. HIV can be transmitted from a pregnant mother to her child during pregnancy, birth or breastfeeding. In South Africa (SA) the mother-to-child HIV transmission (MTCT) rate is under 4% at 4 to 8 weeks after birth since implementation of the most recent national prevention of MTCT (PMTCT) programme.
Aim: This study sought to investigate the level of knowledge of nurses and doctors working at Odi Hospital in Tshwane, and whether they were putting the current PMTCT programme into practice.
Methods: A descriptive cross-sectional survey was undertaken using self-administered questionnaires developed from the current PMTCT guidelines.
Results: Of the 102 participants, 12 (12%) were doctors and 90 (88%) nurses, of whom 9 (9%) were male and 93 (91%) female. Mean knowledge percentage was 60.8% and mean practice percentage was 77%. Regarding knowledge, the question on HIV counselling and testing scored an average 93.1%, while that on doses of drugs used in the PMTCT guidelines scored 17 7%. For practice questions scores ranged from 71% to 82%.
Conclusion: Nurses and doctors working at Odi Hospital knew that HIV counselling and testing is important and must be done for all mothers; however, they were unsure of the dosages of drugs used for PMTCT. More than two-thirds of the doctors and nurses reported practising the PMTCT guidelines, but as their knowledge was inadequate their practice may not be appropriate.
Self-perceived readiness of medical interns in performing basic medical procedures at the Universitas Academic Health Complex in Bloemfontein : researchSource: South African Family Practice 58, pp 1 –6 (2016) http://dx.doi.org/10.1080/20786190.2016.1228560More Less
Background: Medical internship in South Africa is a two-year period after completing the basic medical degree. Interns rotate through six different domains, where they are exposed to various clinical procedures. These skills are often not up to standard, and interns feel unprepared for future challenges. This study evaluated the self-perceived readiness of interns rotating through the Universitas Academic Health Complex in performing basic medical procedures, and the frequency of performing these procedures.
Methods: This was a descriptive quantitative study. Consenting participants completed an anonymous questionnaire regarding four pre-selected medical procedures per department.
Results: The majority of the 61 participants were second-year interns (52.5%), female (54.0%), with a median age of 25 years. Interns felt ready to perform the majority of procedures, but more than 50% reported not being ready to perform circumcisions, episiotomy and perineal repair, assisted delivery and appendectomies. Some procedures in Family Medicine, Internal Medicine, Obstetrics and Gynaecology, General Surgery and Psychiatry were rarely performed by at least half of the participants.
Conclusions: Exposure of medical students during their clinical years to practical training is inadequate. The focus in the MBChB curriculum should be increased to a more specific practical approach during both the pre-clinical and clinical years.
An evaluation of factors influencing perceptual experiences and future plans of final-year medical interns in the Free State, 2013-2014 : researchSource: South African Family Practice 58, pp 1 –7 (2016) http://dx.doi.org/10.1080/20786190.2016.1225421More Less
Background: Medical internship refers to the 24-month period of supervised training in an accredited facility, where newly qualified doctors rotate through all relevant medical domains before starting their community service as medical practitioners. The Free State province has one academic complex and three regional hospitals accredited for internship training.
Objectives: To evaluate the experience and future plans of final-year interns enrolled in a two-year medical internship programme in the Free State, and whether they felt sufficiently prepared to be medical doctors.
Methods: This study was a cross-sectional study. A questionnaire was distributed to all consenting interns from the Free State completing their second year of internship during 2013 and 2014.
Results: A total of 80 second-year internship doctors from four healthcare facilities completed the questionnaire. The majority (87.2%) indicated that they believe internship prepared them well for community service and 65.0% were positive about the supervision they received. However, only 52.5% felt that they were properly orientated.
Conclusion: Medical interns felt positive about their experiences at their allocated Free State healthcare facilities and acknowledged they were better prepared for their careers. In some domains, insufficient supervision and lack of orientation impacted on the internship experience. Workload, lack of resources, insufficient staff and work environment at institutions are the main push factors.
Evaluation of a two-question screening tool in the detection of intimate partner violence in a primary healthcare setting in South Africa : researchSource: South African Family Practice 58, pp 1 –7 (2016)More Less
Introduction: Intimate partner violence has been recognised globally as a human rights violation. It is universally under-diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool-short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool).
Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool-short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool.
Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool-short was shown to have a sensitivity of 45.2% and specificity of 98%.
Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants' understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence. Improvement in the sensitivity of the Women Abuse Screening Tool-short in this setting may be achieved by lowering the threshold for a positive result.
Author Gboyega A. OgunbanjoSource: South African Family Practice 58 (2016)More Less
The World Health Organization estimates that Non-communicable diseases (NCDs) kill 38 million people each year, with almost three quarters of NCD deaths, occurring in low- and middle-income countries. In terms of mortality, sixteen million NCD deaths occur globally before the age of 70 years, and 82% of these "premature" deaths occurred in low- and middle-income countries. In addition, cardiovascular diseases account for most NCD deaths or 17.5 million people annually, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). Tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets all increase the risk of dying from an NCD.
Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection : reviewSource: South African Family Practice 58, pp 6 –17 (2016)More Less
The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.
Author Haley SmithSource: South African Family Practice 58, pp 44 –48 (2016)More Less
Reflux is a normal process that occurs in healthy infants, children and adults. Most episodes are short-lived and do not cause bothersome symptoms of complications. Gastro-oesophageal reflux disease (GORD) develops when the reflux of stomach acid causes troublesome reflux-associated symptoms and/or complications. The most common symptom of GORD is heartburn. Depending on how severe the symptoms of GORD are, treatment may involve one or more of the following: lifestyle changes, medications, or surgery. Acid suppressive medications include, in increasing order of potency, over-the-counter antacids, alginates and H2 antagonists at non-prescription strength, prescription strength H2 antagonists and proton pump inhibitors. In patients with mild to moderate GORD, symptom severity and previous treatments can guide the selection of an initial acid suppressive regimen. The most common and effective treatment of oesophagitis and GORD is to reduce gastric acid secretion with a proton pump inhibitor.
Author K. OuthoffSource: South African Family Practice 58, pp 50 –56 (2016)More Less
The anxiety disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common and debilitating, often coexist with medical and psychiatric conditions, and usually require long-term treatment. Effective anxiolytic drugs include the selective serotonin reuptake inhibitors (SSRIs) and the serotonin and noradrenaline reuptake inhibitors (SNRIs), which are the preferred agents in primary care. Patients who fail to respond adequately to these may benefit from second-line tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs). Alternative antidepressants include agomelatine and mirtazapine. Benzodiazepines, the anti-epileptic agent, pregabalin, and atypical antipsychotics are generally reserved for specialist use. The 5-HT1A agonist, buspirone, and the antihistamine, hydroxyzine, may also be useful, although the evidence for their efficacy covers a very narrow spectrum. This review describes the pharmacology of these anxiolytics and provides updated evidence for their use in the anxiety and related disorders.
Source: South African Family Practice 58, pp 57 –59 (2016)More Less
Stevens-Johnson syndrome (SJS) is a form of toxic epidermal necrolysis (TEN) a rare but life-threatening hypersensitivity reactions that affect the skin and mucous membranes. The most common triggers are drugs, but they can also be triggered by infections. Granulysin has been recently identified as the major molecule responsible for the widespread keratinocyte necrosis. Early identification and removal of causative agent is crucial in preventing progression of condition and reducing patient mortality. Supportive care is often recommended over immunomodulating treatments as it helps improve patient outcome.
Source: South African Family Practice 58, pp 60 –63 (2016)More Less
Heart failure is a clinical syndrome responsible for at least one-third of hospitalisations amongst cardiac patients, with escalating mortality and healthcare costs on both public and private health care. Both prevalence and incidence of heart failure increase steeply with advancing age, making it a growing public health problem. Pathophysiologically, heart failure clinically presents in two common forms: heart failure with preserved ejection fraction and heart failure with reduced ejection fraction The cornerstone of heart failure management includes the use of angiotensin-converting enzyme inhibitors A recently developed pharmacotherapy that inhibits both the angiotensin receptor and the enzyme neprilysin has shown promise in the management of heart failure with reduced ejection fraction This article will highlight the impact of this new therapy and its potential use in heart failure with reduced ejection fraction.
Source: South African Family Practice 58, pp 64 –67 (2016)More Less
Long-acting reversible hormonal contraceptives are effective methods of birth control that provide contraception for an extended period without requiring user action. Long-acting reversible hormonal contraceptives include progesterone only injectables, subdermal implants and the levonorgestrel intrauterine system. These methods have several advantages over other reversible contraceptive methods. More importantly, once in place, they require minimal maintenance and their duration of action ranges from 8 weeks to 5 years. Despite the advantages of long-acting reversible hormonal contraceptive methods, they are infrequently used in South Africa. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rates of unintended pregnancies in South Africa. In this review of long-acting reversible hormonal contraceptive methods, we discuss the long-acting progesterone injectables, the etonogestrel implant and the levonorgestrel intrauterine system available in South Africa, the side effects of each of these preparations and the non-contraceptive benefits. It is imperative that health professionals and educators inform women of reproductive age about the benefits, risks, and common side effects of long-acting reversible hormonal contraception to improve consideration and recognition of these methods.
Author R.L. Van ZylSource: South African Family Practice 58, pp 68 –72 (2016)More Less
The arrival of our summer rains brings with it Anopheles mosquitos buzzing around our ankles with the prospect of a nutritious meal. Unbeknownst to the female Anopheles mosquito, she has increased the risk of our becoming an annual statistic by being infected with malaria. Malaria is endemic in the Limpopo, Mpumalanga and Northern KwaZulu-Natal provinces, but the unpredictable occurrence of Odyssean or airport/suitcase malaria anywhere in South Africa highlights the fact that we should remain vigilant for the possibility of a rogue infection. Unfortunately for those living in sub-Saharan Africa, the likelihood of being infected with potentially lethal Plasmodium falciparum is high; necessitating the need to be informed of the initial symptoms of malaria and to ask the right questions about effective measures to prevent mosquito bites and being infected with malaria. The recommendation of taking chemoprophylaxis (mefloquine, atovaquone-proguanil, doxycycline) along with the correct clothing, DEET repellents and insecticidal treated bed nets should be considered when entering these areas during September to May. The definitive diagnosis of malaria warrants the immediate administration of artemether-lumefantrine to clear the parasite; whilst the addition of primaquine is required to eradicate the extra-erythrocytic stages of P. ovale, P. malariae or P. vivax in a mixed infection.
Source: South African Family Practice 58, pp 76 –82 (2016)More Less
The series, "Mastering your Fellowship", provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.
Author Chris EllisSource: South African Family Practice 58 (2016)More Less
Over the years I have lent books to patients to read in order for them to understand more about what they are experiencing with their illnesses. I tell them that if they do not return the books, I will hunt them down and kill them, but I notice, despite my threats, that my library has quite a few gaps on the selves. I can never remember to whom I have lent them and I usually lose the slip of paper on which I have written their name and the book title.