Worldwide there has been a growing awareness of the disability, suffering and economic costs associated with mental disorders, and of the availability of cost-efficient treatments. A range of authors, as well as key institutions such as the World Health Organization (WHO), have played an important role in producing data and reports which emphasise these points. After an extensive consultative process, in May 2013, a further step forwards was taken when the World Health Assembly adopted the Comprehensive Mental Health Action Plan 2013 - 2020, committing all United Nations member states to take specified actions to help reach agreed targets. Four key objectives are: 'to strengthen effective leadership and governance for mental health; provide comprehensive, integrated and responsive mental health and social care services in community-based settings; implement strategies for promotion and prevention in mental health; and strengthen information systems, evidence and research for mental health'.
Africa, especially sub-Saharan Africa, carries a significant burden of communicable and noncommunicable diseases. The relative distribution of these is projected to shift by 2030. By 2012, 25 million people in the sub-region were living with HIV/AIDS, comprising 70.8% of the global disease burden. Regionally, cancer is an emerging public health problem. In 2008 there were 715 000 new cases and 542 000 cancer-related deaths in Africa. This is projected to nearly double by 2030 due to population growth and ageing, with 36% of cancers infection-related, twice the global average.
Background: Physical and psychological symptom burden among people with HIV infection is associated with poor quality of life, poorer treatment adherence, viral rebound and risk behaviour. Symptomatology has not been investigated among outpatients in sub-Saharan Africa.
Objective: To measure the seven-day period prevalence, burden and correlates of pain and other physical and psychological symptoms among HIV patients receiving antiretroviral therapy (ART).
Methods: This was a cross-sectional self-report study. A total of 378 patients were interviewed using validated tools in three South African public sector clinics.
Results: The most prevalent symptoms were feeling sad (64%), feeling irritable (61.6%), worry (60.8%), numbness and tingling in hands/ feet (59.8%), and sexual problems (51%). In multivariate analysis, later disease stage was associated with worse psychological symptom burden (β=0.359; 95% confidence interval (CI) 0.202 - 0.516; p≤0.001), global symptom burden (β=0.365; 95% CI 0.204 - 0.526; p<0.001) and number of symptoms (β=0.308; 95% CI 0.150 - 0.465; p<0.001). Those receiving treatment for a greater number of years also reported higher burden for physical (β=0.083; 95% CI 0.037 - 0.129; p≤0.001), psychological (β=0.068; 95% CI 0.019 - 0.117; p<=0.007) and global symptoms (β=0.065; 95% CI 0.016 - 0.115; p<=0.010), and a greater number of symptoms (β=0.081; 95% CI 0.032 - 0.130; p<=0.001).
Conclusions: The data reveal a high symptom burden despite treatment. Detailed symptom assessment and control continues to be required in the era of treatment.
Background: A helicopter emergency medical service (HEMS) was established in 2005 in Richards Bay, KwaZulu-Natal, South Africa, to provide primary response and inter-facility transfers to a largely rural area with a population of 3.4 million people.
Objective: To describe the first 5 years of operation of the HEMS.
Methods: A chart review of all flights from 1 January 2006 to 31 December 2010 was conducted.
Results: A total of 1 429 flights were undertaken; 3 were excluded from analysis (missing folders). Most flights (88.4%) were inter-facility transfers (IFTs). Almost 10% were cancelled after takeoff. The breakdown by age was 61.9% adult, 15.1% paediatric and 21.6% neonate. The main indications for IFTs were obstetrics (34.5%), paediatrics (27.9%) and trauma (15.9%). For primary response most cases were trauma (72.9%) and obstetrics (11.3%). The median on-scene time for neonates was significantly longer (48 min, interquartile range (IQR) 35 - 64 min) than that for adults (36 min, IQR 26 - 48; p<0.001) and paediatrics (36 min, IQR 25 - 51; p<0.02). On-scene times for doctor-paramedic crews (45 min, IQR 27 - 50) were significantly longer than for paramedic-only crews (38 min, IQR 27 - 57; p<0.001).
Conclusion: The low flight-to-population ratio and primary response rate may indicate under-utilisation of the air medical service in an area with a shortage of advanced life support crews and long transport distances. Further studies on HEMSs in rural Africa are needed, particularly with regard to cost-benefit analyses, optimal activation criteria and triage systems.
Background: The economic, social and health costs associated with alcohol-related harms are important measures with which to inform alcohol management policies and laws. This analysis builds on previous cost estimates for South Africa.
Methods: We reviewed existing international best-practice costing frameworks to provide the costing definitions and dimensions. We sourced data from South African costing literature or, if unavailable, estimated costs using socio-economic and health data from secondary sources. Care was taken to avoid possible causes of cost overestimation, in particular double counting and, as far as possible, second-round effects of alcohol abuse.
Results: The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 - 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP.
Discussion: The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy.
Conclusions: Existing frameworks that guide the regulation and distribution of alcohol frequently focus on maximising the contribution of the alcohol sector to the economy, but should also take into account the associated economic, social and health costs. Current interventions do not systematically address the most important causes of harm from alcohol, and need to be informed by reliable evidence of the ongoing costs of alcohol-related harms.
Background: A 1993 paper in the SAMJ suggested that public attitudes to organ donation in South Africa were positive. However, statistics reveal a decline in the annual number of transplants in this country.
Objective: To repeat the 1993 survey as far as possible and determine whether public attitudes to organ donation in some South African populations have changed over the past 20 years.
Methods: The 1993 study was replicated in 2012 to generate a current data set. This was compared with the raw data from the 1993 study, and an analysis of percentages was used to determine variations.
Results: Generally attitudes to organ donation have not changed since 1993, remaining positive among the study population. However, individuals are significantly more hesitant to consider donating the organs of a relative without being aware of that person's donation preference. Individuals in the black African study population are currently more willing to donate kidneys than in 1993 (66% v. 81%; p<0.0001), but less willing to donate a heart (64% v. 38%; p<0.0001), a liver (40% v. 34%; p<0.036) and corneas (22% v. 15%, p<0.0059).
Conclusions: Publicity campaigns aimed at raising awareness of organ donation should emphasise the importance of sharing donation preferences with one's family in order to mitigate discomfort about making a decision on behalf of another. These campaigns should be culturally and linguistically sensitive. The study should be repeated in all populations over time to continually gauge attitudes.
Objectives: To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole.
Methods: A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients.
Results: The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted.
Conclusions: This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes.
There has been a significant rise in the burden of non-communicable diseases (NCDs) in the past 20 years. Atherosclerotic peripheral arterial disease (PAD) is one of the most prevalent, morbid and mortal of all the NCDs, with more than 202 million people, conservatively estimated, affected by PAD. This is about six times the 34 million people estimated to be living with HIV at the end of 2011. PAD does not only affect high-income countries. As population demographics change in low- and middle-income countries, patients are exposed to the sustained effects of exposure to the risk factors of smoking, hypertension, diabetes and dyslipidaemia. PAD also affects both young and old individuals in low- and high-income countries. Globally, there has been an increase of about 24% in PAD from 2000 to 2010. This rise in prevalence comes at a significant cost, as many low- and middle-income countries are combating the scourges of numerous debilitating communicable diseases.
Warfarin, one of the vitamin K antagonists, has been used since 1940, when it was first approved for the treatment of venous thromboembolism.It is currently the most commonly used anticoagulant, although alternative drugs are available, such as aspirin, clopidogrel and dipyridamol,which have been studied in a number of scenarios. The newest agents available to clinicians are the broad group of novel anticoagulants, such as direct thrombin and direct factor Xa inhibitors, including molecules such as dabigatran, rivaroxaban, apixaban and edoxaban.
Chronic venous disorders encompass a spectrum of venous diseases, ranging from simple telangiectases (spider veins), reticular veins, varicose veins, and leg oedema to more severe advanced forms of disorders, including hyperpigmented skin changes, dermal sclerosis, and ulcer formation. Part of the spectrum of chronic venous disorders includes varicose veins, oedema, skin changes and ulcers affecting the lower limb, which are categorised as chronic venous disease (CVD). Chronic venous disorders with manifestations specific to abnormal venous function are grouped under the term chronic venous insufficiency (CVI). A distinguishing feature between CVD and CVI is that the latter indicates more advanced forms of chronic venous disorders. Accordingly, CVI includes manifestations such as skin pigmentation, venous eczema, lipodermatosclerosis, atrophie blanche, and healed or active ulcers.
Atherosclerosis is the leading cause of coronary, cerebrovascular and peripheral arterial disease (PAD) worldwide. Sedentary lifestyle, stress and high-fat/carbohydrate diets have contributed significantly to the rising prevalence of atherosclerosis in most populations. Preventive strategies are currently aimed at curbing the socio-economic burden of atherosclerotic disease and its consequences in healthcare systems. While myocardial infarction and cerebrovascular accidents are the two leading causes of mortality and long-term morbidity, atherosclerotic PAD remains an accurate marker of more generalised disease. Screening programmes for at-risk individuals with undiagnosed PAD should therefore be beneficial in preventing future cardiovascular and cerebrovascular events. This article reviews the evidence and benefits of selective screening for PAD.