'Circumcision reduces HIV infections 76% in South Africa, researchers find', screamed the headline in the online Bloomberg news, taking its cue from the reported findings of a randomised, controlled intervention trial (RCT) conducted at Orange Farm, Gauteng. The findings were presented by French researcher Bertran Auvert et al. in July 2011 at an AIDS conference in Rome, showing that circumcision significantly reduced the risk of female-to-male transmission of HIV. 'We are changing the social norm,' Auvert gushed at a news conference. 'It's the first time in the world that we have a successful intervention in a community to reduce the sexual transmission of HIV between adults.'
To the Editor: Dignity SA was launched on 25 September. Its stated intention is to lobby for legal doctor-assisted suicide in South Africa, to allow individuals with terminal illnesses this choice. The debate, which will follow in our profession, should be undertaken in the correct ethical framework.
To the Editor: An unsolved mystery in the history of ancient Egypt is whether or not a familial disease was present among royal members of the 18th dynasty of the New Kingdom, which ruled from the mid- 16th to the early 11th centuries BC. The notion of a genetic disorder within this royal family originates mainly from sculptures and reliefs of Akhenaten and his family, which depict an elongated head, face and extremities, and undeveloped thorax with gynaecomastia.
To the Editor: In response to Professor Max Klein's correspondence, I am flattered that he noticed the research done but take the opportunity to mention a few missed points. Most significantly, the research was approved by the ethics committees of both the UCT Health Science Faculty and the Business School. I should be most interested to hear on what grounds he infers the research to be unethical.
A deeply pragmatic approach to national health insurance that favours patient choice (not ideology) and an incentive-based relationship that 'avoids treating the private sector like a one-night stand' are vital to South Africa's success, a key architect of universal health coverage in the United Kingdom says.
Foreign doctors, the backbone of South African rural health care delivery, are being 'thrown in the deep end' with little support, supplementary training or supervision, resulting in serious miscommunication and sometimes even xenophobia from health care colleagues who treat them as professionally inferior.
Take two dedicated, efficient doctor/managers out of the mix at a deep rural district hospital and the local health care system begins to implode, leaving a nursing manager scrambling to re-assign remaining staff while the local population is left with the prospect of little more than a mediocre day hospital.
Smarter solvency legislation and urgently revisiting the creation of a risk equalisation fund would enable private medical schemes to help a budding NHI shoulder patient burdens when most needed, Discovery Health's CEO, Dr Jonathan Broomberg, says.
Whether it is ethically acceptable for doctors to require payment of fees before treatment depends on interpretation of the ethical rules of the profession, the circumstances of the doctor-patient relationship, the urgency of the patient's need for treatment, and whether refusal to treat before payment represents abandonment of a patient.
The introduction of no-fault or strict liability by the Consumer Protection Act 68 of 2008 (CPA) poses serious problems in the health care context. With a patient as a 'consumer' in terms of the CPA, health care practitioners may find themselves as 'suppliers' or 'retailers' as part of a supply chain, and potentially liable for harm and loss suffered by a patient in terms of the new no-fault liability provision. The claimant (patient) can sue anyone in the supply chain in terms of this provision, which places the health care practitioner who delivered the care in a very difficult position, as he or she is the most easily and often only identifiable person in the supply chain. Although the causal link between the harm suffered by the complainant will still need to be established on a balance of probabilities, the traditional common law obstacle requiring proof of negligence no longer applies. The article argues that this situation is unsatisfactory, as it places an increasingly onerous burden on certain health care practitioners.
Professor Bryan Kies passed away peacefully on 18 July 2011 after a long illness borne with great courage. At the time of his death, he was a Specialist Neurologist at Groote Schuur Hospital and an Associate Professor of Neurology at the University of Cape Town.
'Every book is, in an intimate sense, a circular letter to the friends of him who writes it.' This is a quote from Robert Louis Stevenson in this book, describing the transfer of 109 mission hospitals to the various governments formed under the national policy of separate development. It is especially the story of the transfer of All Saints Hospital from the Diocese of St John (Anglican) to the Transkei Department of Health, told by an active roleplayer in the process, backed by many letters, documents, minutes, circulars, memoranda and addendums. Interspersed with the wonderful photographs of Pauline, Dr Ingle's colleague and wife, the book creates a sense of what it was like to work at All Saints, build relationships with the staff and communities being served, and then to work through major organisational change with friends, colleagues, church committees and state representatives. This thoughtful documentary intends to inform especially young doctors who battle in the same hospitals today and hear: 'The government just took over the mission hospitals - and look what's happened!' Its history provides insight into the uncertainty of, and responses to, those changing times.
Child-focused health care workers are compelled to prescribe medicines that lack adequate dosage guidelines for children, as dosing is often derived from data extrapolated from adult studies. Given that the pharmacokinetics and pharmacodynamics of treatments are often unknown for children, and that effectiveness may vary according to age, developmental stage and body size, there is an urgent need to study diagnostic and therapeutic interventions in children to increase the evidence base. A 2005 report of African HIV trial activity identified 77 randomised controlled HIV/AIDS trials prior to 2004. Analysis revealed poor representation of children and adolescents. Currently there is no database dedicated to collating child-focused clinical research for the African continent. Our aim is to summarise evolving efforts for such a resource.
Of women with early breast cancer who receive chemotherapy 70 - 80% do not benefit from the treatment, but 1 - 5% with an 'excellent' prognosis experience recurrence and should have been given the benefit of the extra therapy. More accurate markers are needed to reflect the disease prognosis and predict response to treatment.
Necrotising enterocolitis (NEC) is an gastro-intestinal emergency occurring almost solely in preterm, low birth weight infants. Mortality, morbidity and the complication rate are high. An increase in NEC at the Groote Schuur Hospital nursery in 2008 prompted a change of practice, resulting in a significant decrease in the condition.
The mini-health technology assessment (HTA) tool is valuable in assessing the quality of decisions regarding health technology management in South African public hospitals. The tool demonstrates the needs for improved decision-making and for developing an appropriate, customised instrument to support decision makers regarding medical device management. Health technology in South Africa has changed rapidly over the past two decades. Current challenges include the introduction of rapidly developing diagnostic technologies such as point-of-care testing (POCT) devices and national health insurance. The mini-HTA tool can play an important role in effective and efficient management of health technology in this setting.
Background. Prisons are recognised internationally as institutions with very high tuberculosis (TB) burdens where transmission is predominantly determined by contact between infectious and susceptible prisoners. A recent South African court case described the conditions under which prisoners awaiting trial were kept. With the use of these data, a mathematical model was developed to explore the interactions between incarceration conditions and TB control measures.
Methods. Cell dimensions, cell occupancy, lock-up time, TB incidence and treatment delays were derived from court evidence and judicial reports. Using the Wells-Riley equation and probability analyses of contact between prisoners, we estimated the current TB transmission probability within prison cells, and estimated transmission probabilities of improved levels of case finding in combination with implementation of national and international minimum standards for incarceration.
Results. Levels of overcrowding (230%) in communal cells and poor TB case finding result in annual TB transmission risks of 90% per annum. Implementing current national or international cell occupancy recommendations would reduce TB transmission probabilities by 30% and 50%, respectively. Improved passive case finding, modest ventilation increase or decreased lock-up time would minimally impact on transmission if introduced individually. However, active case finding together with implementation of minimum national and international standards of incarceration could reduce transmission by 50% and 94%, respectively.
Conclusions. Current conditions of detention for awaiting trial prisoners are highly conducive for spread of drug-sensitive and drug-resistant TB. Combinations of simple well-established scientific control measures should be implemented urgently.