South African Family Practice - latest Issue
Volume 59, Issue 1, 2017
Source: South African Family Practice 59, pp 1 –8 (2017) http://dx.doi.org/10.1080/20786190.2016.1248142More Less
Background: Successful Family Medicine practices and academic programmes are found in western countries, Australia, Singapore, Cuba and among other non-western countries. Documenting the enablers and challenges of different contexts would, it is hoped, inform current and future process of developing academic and practice programmes in Family Medicine in countries where the discipline is starting.
Methods: A qualitative study was undertaken that conducted a focused literature review and in-depth interviews of key informants on the early development of the Family Medicine in Kenya. All interviews were audio recorded. Pattern matching, explanation building, time-series analysis and logic models were used in analysis.
Results: Representatives of Kenyan and foreign organisations worked well as a team to write and implement the first curriculum of Family Medicine. The challenges include lack of teachers; starting a graduate programme in medical schools that did not have one and starting these health services delivery departments in a system that did not have any.
Conclusions: The main enablers of the evolution of Family Medicine in Kenya include committed partnerships and teamwork among Kenyan and non-Kenyan stakeholders. The challenges include the lack of Kenyan teachers of the programme and the introduction of a new discipline.
The eventual outcome of patients who had lower limb amputations due to peripheral vascular disease at Pelonomi Hospital, BloemfonteinSource: South African Family Practice 59, pp 1 –4 (2017) http://dx.doi.org/10.1080/20786190.2016.1248145More Less
Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011.
Methods: Prospective data collection of a retrospective cohort study group was performed. Included were patients with PVDinduced LLAs. Demographic and contact information was collected from Meditech. Living status (alive or dead) was determined using the Department of Home Affairs database and interviews with relatives.
Results: Of the study population (n = 224), 119 had contact information. Data of 158 people were available to determine living status: 71.5% had died by follow-up in 2014. Forty-nine interviews were possible, 31 patients had died, with cause of death reported to be primarily vascular related. The cumulative mortality showed that 16.1% died within a month and 48.4% within one year post-amputation. Among the 18 living amputees, 50.0% became unemployed, 77.8% used wheelchairs, 11.1% used crutches and 11.1% a prosthesis.
Conclusion: Lower limb amputation due to PVD is indicative of a poor prognosis. In our study only 28.5% of patients survived 3–6 years post-amputation. Restoration to ideal mobility was achieved in a minority of cases.
Nutritional status and metabolic risk in HIV-infected university students : challenges in their monitoring and managementSource: South African Family Practice 59, pp 9 –13 (2017) http://dx.doi.org/10.1080/20786190.2016.1248143More Less
Objective: This study aims to describe challenges in the management of HIV-infected university students focusing on their nutritional status and metabolic risk.
Methods: A cross-sectional, descriptive study design was used to assess the anthropometry, food intake and clinical status of a cohort of known HIV-infected registered students at a South African university.
Results: Participants (n = 63) had a mean CD4 cell count of 411 (SD = 219.9) cells/mm3, a mean body mass index (BMI) of 28.05 (SD = 7.9) kg/m2 and only half of the participants (n = 31) were on antiretroviral therapy (ART). A higher BMI (> 25 kg/m2) was significantly (p < 0.05; V = 0.32) associated with higher CD4 cell counts of > 350 cells/mm3. Some 40% (n = 25) of students were at risk for metabolic complications based on their waist circumference and 11% (n = 7) had clinical signs of lipodystrophy. The ‘obese’ group consumed a mean energy intake of 24 kcal/kg bodyweight which was lower than the ‘overweight’ and normal weight groups.
Conclusions: In total 51% of HIV-positive students in the sample presented with signs of metabolic complications. Side effects of ART can be prevented and/or treated by regular physical activity, adequate nutritional intake, monitoring of side effects and BMI, combined with optimal care and support.
A new health care profession in rural district hospitals : a case study of the introduction of Clinical Associates in Shongwe hospitalSource: South African Family Practice 59, pp 14 –17 (2017) http://dx.doi.org/10.1080/20786190.2016.1248144More Less
Background: One of the reasons to develop training courses for medical mid-level workers in South Africa is a shortage of doctors. The introduction of this new profession has led to task sharing and redefining of professional boundaries. The primary aim of this study is to evaluate the introduction of new healthcare professionals in a rural hospital district.
Methods: This multi-method qualitative research study used a semi-structured questionnaire to assess the effectiveness of Clinical Associates. A review of documents from 2012 to 2015 was done including a longitudinal study of the development of the Bachelor in Clinical Medical Practice (BCMP) programme at Shongwe hospital.
Results: Three Clinical Associates in 2011 and six Clinical Associates in 2014 completed questionnaires. Student satisfaction increased as measured with the Med IQ tool. At the end of 2013 Shongwe Clinical Learning Centre (CLC) had improved from last position out of 17 CLCs in 2011 to position number eight in 2014. Casualty was run by Clinical Associates and during observations it became clear that Clinical Associates were able to take responsibility for outpatient departments (OPDs), the emergency unit and some wards with supervision by a doctor.
Conclusion: The introduction of the BCMP programme and the establishment of a Clinical Learning Centre in Shongwe hospital have led to improved patient care and a more conducive environment for teaching and learning. With the availability of more Clinical Associates vacant medical officer posts can be converted to employ Clinical Associates to serve patients without an increase in the cost of total human resources.
Knowledge, attitude and practices of South African healthcare professionals towards complementary and alternative medicine use for atopic eczema – a descriptive surveySource: South African Family Practice 59, pp 22 –28 (2017) http://dx.doi.org/10.1080/20786190.2016.1248146More Less
Background: Complementary and alternative medicines (CAM) are used widely for treating atopic eczema (AE), commonly in conjunction with conventional medicines prescribed by mainstream healthcare professionals (HCPs). This cross-sectional survey evaluated the knowledge, general attitudes and practices regarding CAM among dermatologists, paediatricians, general practitioners (GPs) and pharmacists treating patients with AE in Durban, KwaZulu-Natal.Methods: Questionnaires were sent via email or hand-delivered to HCPs nearby.
Results: Of the 330 respondents, 220 (67%) were males and 110 (33%) females. Most (40%) were > 50 years. GPs and pharmacists were significantly more embracing of CAM compared with dermatologists and paediatricians. The majority were not familiar with most CAMs for AE. More GPs (29%) and pharmacists (43%) recommend CAM compared with dermatologists (8%) and paediatricians (5%). GPs and pharmacists were also amenable to referring patients to CAM practitioners. The majority do not initiate discussions with their patients regarding CAM use nor enquire when taking a history. Many dermatologists (65%) and pharmacists (51%) reported that their patients ask about CAM. All dermatologists, 95% of paediatricians, 87% of GPs and 55% of pharmacists reported having no training in CAM but believed it should be included in their curriculum. Most are interested in learning about CAM and agreed that it would better prepare them in managing patients.
Conclusion: This study demonstrated poor CAM knowledge and communication between HCPs and patients but a strong interest amongst HCPs to learn more. There is an urgent need for continuing education programmes and inclusion in undergraduate curriculums, which will assist HCPs in influencing better patient outcomes.
Optimal management of children on antiretroviral therapy (ART) in primary care : a quality improvement projectSource: South African Family Practice 59, pp 29 –34 (2017) http://dx.doi.org/10.1080/20786190.2016.1254928More Less
Introduction: With the large volumes of human immunodeficiency virus (HIV) positive patients in South Africa, one clinical management strategy has been to task shift. This means that previously hospi-centric HIV services have devolved to primary health care (PHC) clinics. The referral pattern is true for paediatric patients as well. With the added complexity of managing children, there was a concern in the research district that children were not being optimally managed at PHC level.
Method: A quality improvement project was initiated to assess HIV-positive children’s management at PHC clinics and to implement an intervention to improve this care.
Results: The initial audits of 624 children in the district revealed that only 66.6% of children had undetectable viral loads (VLs). Other poor indicators were lack of regular blood results, omission of prophylactic isoniazide (INH) and cotrimoxazole etc. Documents were disorganised and not standard across the district. The intervention sought to place the local clinic doctor as the champion in each clinic. A reorganised file was planned where all the care elements would be clearly present.
Conclusion: Post intervention, it was clear that where individual doctors took on the challenge of quality improvement there were significant process changes. Results are discussed in detail.
Caregiver satisfaction with a multidisciplinary community-based rehabilitation programme for children with cerebral palsy in South AfricaSource: South African Family Practice 59, pp 35 –40 (2017) http://dx.doi.org/10.1080/20786190.2016.1254929More Less
This study sought to determine the levels of satisfaction and experiences of caregivers with a multidisciplinary rehabilitation programme. A total of 26 caregivers were recruited at 3 health settings in South Africa. A survey based on the Multidimensional Assessment of Parental Satisfaction for Children with Special Needs and focus-group discussions were conducted at the end of programme. The majority of the respondents were mothers and unemployed. The participants were generally satisfied with the rehabilitation. However, participants held on to myths, stereotypes, and beliefs about the cause of disability and explained the impact of stigma on having a disabled child in their communities. Caregivers perceived the benefit of rehabilitation but believed that lack of communication and consultation with health professionals limited the care.
Perceptions of students regarding the effects of the implementation of the tobacco control act of 1999 on a South African University campusSource: South African Family Practice 59, pp 41 –45 (2017) http://dx.doi.org/10.1080/20786190.2016.1254930More Less
Background: Smoking among adolescents is high. In order to curb the habit, restrictions on use of tobacco products in public places were implemented in South Africa. This study aimed to explore students’ perceptions of whether the implementation of smoking restrictions and no-smoking signs have had any effects on smoking behaviours on campus.
Methods: A quantitative cross-sectional study was conducted amongst university students, who completed a self-administered questionnaire.
Results: Students were aware that smoking causes disease and that second-hand smoke is dangerous. The majority were pleased that there was a smoking regulation in effect, but disagreed that it created a healthier atmosphere. Many would like a total ban enforced in restaurants, clubs, bars and university campuses. They felt that there were insufficient non-smoking signs in public areas. Many smokers stated that they ignored regulations and only a minority stated that the policy encouraged smokers to quit.
Conclusion: Smoking among students has decreased over the years. This has been accompanied by an increase in knowledge of the harmful effects of smoking. Regulations have thus had a positive effect; however, additional efforts are required to motivate more people to quit smoking altogether and to prevent young people from taking up the habit.
Fertility intention and use of contraception among women living with the human immunodeficiency virus in Oromia Region, EthiopiaSource: South African Family Practice 59, pp 46 –51 (2017) http://dx.doi.org/10.1080/20786190.2016.1254931More Less
Background: The human immunodeficiency virus (HIV) epidemic resulted in decreased fertility among HIV-positive women, who did not want to transmit the virus to their unborn children. With the availability of antiretroviral therapy that suppresses viral load, HIV-infected women live normal lives and even acknowledge the desire and intention to have children, a factor that is rarely acknowledged in antiretroviral therapy (ART) clinic services. This study examined fertility intentions and contraception use among a sample of women attending an ART clinic in Oromia Region, Ethiopia.
Methods: A quantitative, cross-sectional and descriptive design was used on a sample of 362 HIV-positive women. Data were collected using a researcher-administered questionnaire.
Results: The ages of the participants ranged from 18 to 49 years and most were between the ages of 23 and 32. A desire and intention to fall pregnant was reported by 46.6% (n = 158) of the participants. A total of 114 (35.5%) had given birth after they were diagnosed with HIV and 4% were pregnant at the time of the study. Of the study participants who wanted to have children, 60.7% (n = 82) planned to have a child within two years. In the period before they were diagnosed with HIV, most participants used injectable contraceptives but this changed to using the condom after they were diagnosed with HIV.
Conclusion: The high number of women who have both the desire and intention to have children among this sample of HIV positive women requires that reproductive health services need to include family planning as an essential component of reproductive health services. The change to using the condom as a contraceptive method indicates the positive impact of health promotion received at ART clinic.
Illegible handwriting and other prescription errors on prescriptions at National District Hospital, BloemfonteinSource: South African Family Practice 59, pp 52 –55 (2017) http://dx.doi.org/10.1080/20786190.2016.1254932More Less
Background: It is generally accepted that doctors have illegible handwriting. The writer usually knows what is written, but other parties often have problems with reading and interpreting.
Aim: The aim of the study was to determine whether illegible doctors’ handwriting and other factors that can lead to dispensing errors occur on prescriptions at National District Hospital.
Method: In part one the prescriptions of 20 doctors were read by five doctors, nurses and pharmacists to detect who could read it most accurately. In part two, these doctors were asked to write a prescription with an IntelliPen®.
Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.
Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions.