The recent public outcry over the brutal rapes and murders in New Delhi, India, and in the Western Cape, South Africa (SA), has rudely awakened civil society from apathy to shock about what is regarded as a common violent act against women and children, but is often ignored. The United Nations High Commissioner for Human Rights, Dr Navanethem Pillay, herself a South African, has made an impassioned plea to all members of civil society, including key role-players such as members of the criminal justice and healthcare systems, to be vigilant and mindful of their key responsibilities in protecting women and children against such violence.
The editorial 'No schools for medical editors' struck a personal chord. The lot of the journal editor can indeed be lonely. The challenge of dealing with the manuscripts of colleagues, friends and associates is often fraught with difficulty, especially if one is based at an academic institution where many potential contributors are likely to reside.
As a former head of the Associated Academic Hospitals (Groote Schuur, Red Cross War Memorial and Tygerberg), I would like to support the view that these hospitals should continue to be managed as an integral part of the Western Cape Provincial Health Service.
Overweight, smoking doctors 'make terrible counselors', says Dr Derek Yach, the South African former tobacco-control activist who rose to lead the World Health Organization (WHO)'s Framework Convention on Tobacco Control and its strategy on diet and physical activity.
Dr Siva Pillay, the IT-savvy, corruption-busting Nelson Mandela Bay doctor and millionaire businessman, has been edged out as Superintendent-General of the controversy-riddled Eastern Cape Health Department, after a long-standing feud with his Health MEC, Sicelo Gqobana.
The Western Cape is pioneering an independent fund-raising foundation that will help its provincial health department to reduce the regional burden of disease through wellness programmes, infrastructure upgrades and mutually beneficial public-private partnerships.
A group of well-respected South African academics and HIV experts have started a national debate by questioning the 'dangerously hasty' acceptance and implementation of lifelong antiretroviral therapy (ART) for HIV-positive pregnant women in resource-constrained settings.
Ruby died suddenly in Houston, Texas, on 25 June 2012. He had been ill for a long time and, although one never saw him without his portable oxygen supply during the past few years, the finality of his passing came as a great shock.
Polly, as he was usually called, was born in Port Elizabeth in 1925. He was the son of a PE radiologist, R Perrot. His primary schooling was at St Georges in PE. He then went on to St Andrews in Grahamstown, where he excelled in academics and became a prefect.
This book contains much useful information, although its chapters are somewhat uneven. Its title is misleading, as it covers a much broader field than 'family medicine': several excellent chapters also deal with primary care, clinics and community-based care. While the foreword welcomes 'the case studies in this book, based on real people', I found them distracting, as were some of the suggested exercises.
The Constitution and the National Health Act provide that nobody shall be refused emergency medical treatment. 'Do not resuscitate' (DNR) orders require that certain patients should not be given cardiopulmonary resuscitation to save their lives. Whether there is a conflict between these two requirements is answered by considering: (i) the meaning of emergency medical treatment; (ii) the relationship between emergency medical treatment and DNR orders; (iii) the meaning of futile medical treatment; (iv) the relationship between DNR orders and euthanasia; and (v) when DNR orders may be lawfully used.
The establishment of biobanks is gaining prominence globally. The open and evolving nature of biobanks has profound ethical, legal and social implications for individual and group autonomy, informed consent, privacy, confidentiality, secondary use of samples and data over time, return of results, data sharing, benefit sharing with communities, and premature or unplanned closure. Complexities also emerge because of increasing international collaborations, and differing national positions. Public consultation and involvement are very necessary to the success of biobanks. Implementing national laws in an internationally consistent manner is problematic.
The World Health Organization (WHO) released the Global Status Report on Road Safety 2013: Supporting a Decade of Action in March 2013, in Geneva, Switzerland. The report presents 2010 data for 182 participating countries and provides a baseline for monitoring the Decade of Action for Road Safety (2011 - 2020) declared by the United Nations General Assembly through resolution 64/255 in 2010. The goal of the Decade is to reduce the increasing trend in road traffic deaths, and to save an estimated 5 million lives over the period.
Next year marks the tenth anniversary since the rollout of antiretroviral therapy (ART) in South Africa (SA), the country with the largest number of people living with HIV in the world. SA also has the world's largest antiretroviral therapy (ART) programme, with approximately 1.8 million people estimated to have received ART by mid-2011.
Thrombosis is the biggest killer internationally. Lack of appropriate education means that this fact is little known, and it is also eclipsed in the public eye by the much wider awareness of malignant tumours. While cancer is indeed a justly feared killer, the true prevalence of thrombosis and the devastation that it causes deserve to be far better recognised. heart attacks and strokes are responsible for most deaths worldwide. Venous thromboembolism (VTE) is the most important preventable cause of deaths in hospital. There is strong evidence that prophylaxis remains underprescribed.
Introduction. South Africa has made remarkable progress in rolling out antiretroviral therapy (ART), with the largest number of people (more than 1.4 million) enrolled on antiretrovirals in the world. Decentralisation of services to primary health centres (PHCs) has strengthened retention of patients on ART and reduced the burden of managing uncomplicated cases at referral hospitals.
Methods. This was a ten-step Nurse Initiated Management of Antiretroviral Treatment (NIMART) rollout intervention in which nurses from 17 primary healthcare facilities of Region F, City of Johannesburg, South Africa, were trained and mentored in NIMART by the Wits Reproductive Health and HIV Research Institute (WRHI) to commence patients on ART in their PHCs. A total of 20 535 patients initiated ART during the 30-month study period. Monthly initiations at both PHCs and referral clinics were monitored. To test the statistical significance of the impact of NIMART rollout on the referral hospital initiations and Region F monthly initiations, interrupted time series analysis was applied.
Findings. Ten-step NIMART rollout was applied, with the first step being establishment of NIMART as a priority in order to obtain primary buy-in by the Department of Health (DoH) and City of Johannesburg (CoJ). Forty-five professional nurses were trained in NIMART by WRHI quality improvement mentors. By the end of September 2011, all 17 PHCs in Region F were initiating patients on ART. Total initiations significantly increased by 99 patients immediately after NIMART rollout (p=0.013) and continued to increase by an average of 9 every month (p=0.013), while referral facility initiations decreased by 12 (p=0.791) immediately after NIMART and then decreased by an average of 18 every month (p=0.01).
Conclusion. In this study, decentralisation of ART initiation by professional nurses was shown to increase ART uptake and reduce workload at referral facilities, enabling them to concentrate on complicated cases. However, it is important to ensure capacity building, training and mentoring of nurses to integrate HIV services in order to reduce workload and provide a comprehensive package of care to patients. Engaging and having buy-in from DoH/CoJ partners in rolling out NIMART was crucial in increasing outputs as well as for sustainability of the NIMART programme.
Background. Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testing could be preferable for them and ensure timely HIV treatment initiation and optimal TB care.
Objectives. To investigate factors, including uptake of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal.
Methods. Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC) sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status.
Results. Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis.
Conclusion. We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate management of HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district management teams for PHC re-engineering on areas needing improvement.
Background. Dabigatran is an oral anticoagulant direct thrombin inhibitor recently registered in South Africa (SA) to reduce the risk of stroke and systemic embolism in patients with atrial fibrillation (AF). Owing to the price disparity between warfarin (the current gold standard for treatment of patients with AF) and dabigatran, we conducted an economic appraisal of the use of dabigatran compared with warfarin from a payer perspective in the South African private healthcare setting.
Objectives. To estimate the cost-effectiveness (CE) and budget impact of dabigatran compared with warfarin for the prevention of stroke in AF patients.
Methods. A previously published Markov model was populated with SA cost and mortality data to estimate the CE and budget impact analysis of dabigatran over a lifetime horizon. The model population consisted of a cohort of patients of whom those aged younger than 80 years used dabigatran 150 mg twice daily and those older than 80 years 110 mg twice daily. Modelled outcomes included total cost, quality-adjusted life years (QALYs) and incremental CE ratio (ICER), with the effectiveness measured by QALYs gained.
Results. Dabigatran compared with warfarin as first-line treatment was estimated to have an ICER of R93 290 and an average incremental cost per beneficiary per month of R0.39 over a 5-year period. Conservative assumptions were made regarding the number of international normalised ratio monitoring tests for patients on warfarin, and the ICER is estimated to decrease by as much as 15.7% under less stringent assumptions. A robust sensitivity analysis was also performed.
Conclusion. Dabigatran as first-line treatment compared with warfarin for the use of stroke prevention in patients with AF is deemed cost-effective when used in accordance with its registered indication in the SA private sector.