South African Medical Journal - Volume 104, Issue 5, 2014
Volumes & issues
Volume 104, Issue 5, 2014
Author Jenny EdgeSource: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8300More Less
Parents' perceptions of HIV counselling and testing in schools : study methodology deeply flawed : correspondenceSource: South African Medical Journal 104, pp 323 –324 (2014) http://dx.doi.org/10.7196/SAMJ.8001More Less
I am responding to the article by Gwandure et al. that appeared in the January SAMJ. The article claims to explore parents' views on the HIV counselling and testing campaign to be conducted in high schools, within an interpretative qualitative paradigm. This is an interesting and important topic. However, the methodology of the study is deeply flawed and unfortunately gives qualitative research a bad name. While the authors' sampling for a qualitative study was acceptable, it is unclear what their 'snowballing' means. Since there are so many parents of children in high school (and it is not a sensitive issue to be such a parent), it is unclear why snowballing was necessary; in fact, it creates an unnecessary clustering of possibly like-minded people. This, however, is not my main objection (nor is their description of 'black' people as one ethnic group). My main problem with the methodology is that all the data that are presented are quantitative. If this was a quantitative study, then of course the sample of 20 and the sampling process would be woefully inadequate. Presenting the numbers in this context has no meaning and is irrelevant. Had this study been a quantitative one with an adequate sample, it might have had some validity. However, it fails on both qualitative and quantative fronts.
Source: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.7897More Less
The evaluation of the surgical outreach programme to district hospitals in Sisonke Health District (SHD), KwaZulu-Natal, South Africa (SA), recently published in the SAMJ demonstrates an admirable commitment to improving district health services. While the authors documented a large number of flying hours and kilometres travelled and 2 160 operations performed over a 6-month period in the four district hospitals, it is difficult to determine what the impact of the surgical outreach was on the number and range of operations performed.
Rapid, minimally invasive adult voluntary male circumcision with the Unicirc, a novel disposable device : correspondenceSource: South African Medical Journal 104, pp 324 –325 (2014) http://dx.doi.org/10.7196/SAMJ.7993More Less
I congratulate Millard et al. on their publication. My co-workers and I have studied the PrePex male circumcision device in three clinical trials, and I would like to share our opinions.
The Unicirc is intended to be used exclusively with glue. We therefore consider that any suturing that is necessary with the device should be defined as an adverse event and should have been documented as such, as in the authors' previous reported study.
Source: South African Medical Journal 104, pp 325 –326 (2014) http://dx.doi.org/10.7196/SAMJ.8178More Less
The facilities available in southern Gauteng for severely ill patients with diseases related to internal medicine are currently under severe pressure. Central and regional hospitals in this region have frequently had to close to admissions because their bed occupancies have exceeded 100%. This problem started in 2013 and has become progressively worse. The reasons for this crisis are not difficult to understand: (i) there is a very high burden of illness in the population served by these public hospitals, including communicable (HIV/AIDS, tuberculosis) and non-communicable (cardiac, pulmonary, metabolic, oncological) diseases; (ii) Gauteng is the most populous province of South Africa, with just over 12 million people; and (iii) despite this ever-increasing burden of illness, a decision was taken some years ago to close a number of public health facilities such as Hillbrow and Kempton Park hospitals. In addition, a significant number of public healthcare beds were privatised for use by patients with medical aids - Folateng private wards. It is no wonder that our existing public hospitals are overwhelmed.
Source: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8216More Less
'Go ka bo go ne go le botoka go nna le HIV gona le bolwetse jwa sukiri' ('It would have been better if I had HIV instead of diabetes'). This flippant comment was overheard in a diabetes clinic waiting room in southern Botswana earlier this year. Although a new diagnosis of diabetes does not carry the stigma of a new HIV diagnosis, for many patients it nonetheless feels like a life sentence. While there are no local data to support the suggestion that type 2 diabetes mellitus (T2DM) confers a worse prognosis than HIV, patients with T2DM in Botswana face at least as many obstacles to high-quality care as do patients with HIV.
Source: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.7611More Less
Access to high-quality, safe and appropriate priority medical devices is becoming the bedrock of delivery of effective and efficient healthcare across the world. The use of medical devices impacts on the continuum of care under the universal health coverage strategy. However, the decision-making process relating to commissioning, maintenance and decommissioning of medical devices, often taken without evidence, results in poor service delivery, particularly in developing countries. The World Health Organization baseline country survey provides a global reference on health technologies, and particularly on the availability of specific medical devices, policies, guidelines, standards and services. It is necessary to develop country-specific case studies to elaborate on these reports and to share road maps from the progress made in different countries.
Source: South African Medical Journal 104, pp 327 –328 (2014) http://dx.doi.org/10.7196/SAMJ.8085More Less
Source: South African Medical Journal 104, pp 329 –330 (2014) http://dx.doi.org/10.7196/SAMJ.8172More Less
A 'static, outdated and inflexible' population-based funding formula for public health is putting huge pressure on well-run and well-equipped hospitals in the Western Cape, KwaZulu-Natal and Gauteng as people from other provinces migrate there in their tens of thousands to seek a better life.
Source: South African Medical Journal 104, pp 330 –331 (2014)More Less
Breast Care: A Health Professional's Guide to Diagnosis and Management of Common Breast Conditions, Jenny Edge and Dave Woods : izindaba - book reviewAuthor Bridget FarhamSource: South African Medical Journal 104 (2014)More Less
This practical book on the management of breast cancer is part of the Bettercare series of books, aimed at addressing the need for continuing education of healthcare workers. The book was inspired by the Breast Course for Nurses, run by Dr Jenny Edge, a general surgeon with a particular interest in breast surgery, at the Christiaan Barnard Hospital in Cape Town, South Africa. Her co-author, Professor David Woods, is the founder of the Bettercare series and is a retired neonatologist living in Cape Town.
Health and fracking : should the medical profession be concerned? : forum - medicine and the environmentAuthor B. MashSource: South African Medical Journal 104, pp 332 –335 (2014) http://dx.doi.org/10.7196/SAMJ.7860More Less
The use of natural gas that is obtained from high-volume hydraulic fracturing (fracking) may reduce carbon emissions relative to the use of coal and have substantial economic benefits for South Africa. However, concerns have been raised regarding the health and environmental impacts. The drilling and fracking processes use hundreds of chemicals as well as silica sand. Additional elements are either released from or formed in the shale during drilling. These substances can enter the environment in various ways: through failures in the well casing; via alternative underground pathways; as wastewater, spills and leaks on the wellpad; through transportation accidents; and as air pollution. Although many of these chemicals and elements have known adverse health effects, there is little evidence available on the health impacts of fracking. These health concerns have not yet been fully addressed in policy making, and the authors recommend that the voice of health professionals should be part of the public debate on fracking and that a full health impact assessment be required before companies are given the go-ahead to drill.
Odyssean malaria outbreaks in Gauteng Province, South Africa, 2007 - 2013 : forum - clinical practiceSource: South African Medical Journal 104, pp 335 –338 (2014) http://dx.doi.org/10.7196/SAMJ.7684More Less
Background. Odyssean malaria refers to malaria transmitted by translocated mosquitoes and is a diagnosis of exclusion, as the probability of finding the responsible vector is miniscule. We believe that road traffic from endemic areas in and around South Africa is the source of most of the infected mosquitoes. Because of the unexpected nature of the disease, diagnosis is often delayed and severe and complicated malaria is common.
Objectives. To describe outbreaks of odyssean malaria during the period 2007 through 2013 in Gauteng Province, South Africa, and to educate healthcare workers about this form of malaria.
Methods. Site visits, environmental hygiene inspections, patient interviews, and entomological investigations for adult mosquitoes and larvae in potential breeding sites were done in each identified outbreak.
Results. Over the period, 14 laboratory-proven and 7 probable cases of odyssean malaria were investigated. There were 2 deaths (9.5% case fatality rate, approximately 10 times higher than the national fatality rate for malaria). We describe two recent clusters of cases in detail, and emphasise the importance of clinician awareness of this rare but frequently severe form of malaria.
Conclusion. Odyssean malaria cases are inevitable in South Africa, given the volume of road, rail and air traffic from malaria risk areas into Gauteng and other non-endemic provinces. It is likely that many cases are missed, owing to the rare and sporadic nature of the condition. Malaria should always be kept in mind as a cause of unexplained fever and thrombocytopenia, even in the absence of a travel history.
Tuberculosis preventive therapy : an underutilised strategy to reduce individual risk of TB and contribute to TB control : forum - reviewSource: South African Medical Journal 104, pp 339 –343 (2014) http://dx.doi.org/10.7196/SAMJ.8290More Less
Tuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88% of HIV-uninfected young adults (31 - 35 years) are latently infected with TB. In the most recent meta-analysis, 6 - 12 months of isoniazid preventive therapy (IPT) was associated with a lower incidence of active TB than placebo (relative risk (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85), with the greatest benefit among individuals with a positive tuberculin skin test (TST) (RR 0.38; 95% CI 0.25 - 0.57). A clinical trial of IPT given with antiretroviral therapy (ART) for 12 months reduced TB incidence by 37% compared with ART alone (hazard ratio (HR) 0.63; 95% CI 0.41 - 0.94). The effect of IPT is limited in high-burden countries. IPT for 36 months v. 6 months reduced TB incidence among HIV-positive, TST-positive participants by 74% (HR 0.26; 95% CI 0.09 - 0.80). A study of more than 24 000 goldminers confirmed that IPT is safe, with only 0.5% experiencing adverse events. A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control.
Author S.K. DlaminiSource: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8306More Less
Malaria has long been regarded as a major public health burden in South Africa (SA), affecting vast regions of the country. However, SA is now one of eight countries in Africa that is close to malaria elimination. This was documented in a supplement to the October 2013 SAMJ. Even though SA is on the threshold of malaria elimination, many countries in Africa continue to experience high morbidity and mortality related to the disease. Malaria may also be encountered in parts of SA not known to have malaria, in ways not typical of how it is usually transmitted or acquired. In this issue of SAMJ two articles discuss two forms of malaria seen in nonendemic areas, imported malaria and odyssean malaria.
Source: South African Medical Journal 104, pp 345 –346 (2014) http://dx.doi.org/10.7196/SAMJ.8215More Less
Faced by an explosion in available evidence for multiple new treatments, busy clinicians value guidelines that are clear, reliable, unbiased and locally applicable. Finding them can be difficult, however. The science of guideline development has moved rapidly in the past decade, resulting in a more robust and systematic process. However, just as the language of evidence-based medicine can be subverted to sound convincing while hiding errors and biases, so too guidelines may look convincing but lack many of the elements needed to ensure quality of care. In particular, the pharmaceutical and health technology industries are intensely aware of the marketing potential offered by widely disseminated and ostensibly neutral documents that ultimately influence medical practice.
Source: South African Medical Journal 104, pp 347 –349 (2014) http://dx.doi.org/10.7196/SAMJ.7904More Less
Background. The Western Cape Province of South Africa (SA) is not malaria endemic; however, a considerable number of patients present with malaria to our healthcare services.
Objectives. To establish the frequency of patients presenting with malaria at Groote Schuur Hospital (GSH), Cape Town, SA, and to describe their demographics, clinical outcomes and laboratory findings.
Methods. An observational, retrospective, descriptive study was conducted, which included all patients presenting with smear-positive malaria to GSH over a 4-year period between 1 April 2008 and 31 March 2012.
Results. During the study period, 134 malaria patients presented to GSH for management; 85% (n=114) were male, median age was 27 years. Of the total smear-positive tests, 96% (n=128) were Plasmodium falciparum, 3% (n=4) P. ovale, and in 1% (n=2) the species was not identified. The number of malaria patients increased markedly, from 6 cases in 2008 to 50 cases in 2012. Of the patients, 48.3% (n=57) were from Somalia, 8.5% (n=10) from SA and 29% (n=30) from other African countries. One SA patient acquired transfusion-transmitted malaria from a pooled platelet product, and the other SA patients had travelled to malaria-endemic areas. The remaining cases were from countries outside of Africa, including 13% (n=15) from Bangladesh. Almost two-thirds (62%; n=72) were admitted to hospital with a median length of stay of 3 days (range 1 - 32). Clinical outcomes were good with only one death and the remaining patients being discharged.
Conclusion. Imported malaria is imposing a significant burden on health resources. The costs of medical care for the emergency treatment of foreign nationals needs to be recognised, and adequately budgeted for.
Source: South African Medical Journal 104, pp 350 –352 (2014) http://dx.doi.org/10.7196/SAMJ.7863More Less
Background. Mental health literacy on the part of medical practitioners is an important component of mental healthcare. General practitioners (GPs) are typically the first doctors consulted by a person who is ill. Exploration of their perceptions regarding mental illness, aetiological issues and treatment is important.
Objective. To investigate perceptions of mental illness in a sample of 10 South African Muslim GPs (five male, five female) in the Lenasia area (Johannesburg, South Africa).
Methods. Using a qualitative approach, semi-structured interviews were conducted with each GP. The questionnaire encompassed 37 questions relating to the context in which the GPs practised, perceptions of mental illness, understanding of religion and culture, and treatment of mental illness (including aspects of spiritual illness). Thematic content analysis was used to analyse the data.
Results. Six dominant themes were identified, namely GPs' understanding of mental illness and its causation; stigma, secrecy and somatisation; the beneficial effects of religion in mental illnesses; perceptions of spiritual illnesses; collaboration with traditional healers; and collaboration with psychiatrists and psychologists.
Conclusion. Greater awareness regarding the stigmatisation of mental illness is needed. Furthermore, it is important that healthcare professionals have an understanding of religious and cultural taxonomies of illness and the use of traditional healing as a mode of treatment. Participants identified a need for increased collaboration between healthcare professionals, including traditional healers.
Evaluation of the visual prostate symptom score in a male population with great language diversity and limited education : a study from Namibia : researchSource: South African Medical Journal 104, pp 353 –357 (2014) http://dx.doi.org/10.7196/SAMJ.7917More Less
Background. A visual prostate symptom score (VPSS) using pictograms was developed to assess the force of the urinary stream, urinary frequency, nocturia and quality of life (QoL).
Objective. To compare the VPSS with the international prostate symptom score (IPSS) and maximum (Qmax) and average (Qave) urinary flow rates in men from diverse language groups with limited schooling.
Methods. Men with lower urinary tract symptoms admitted to the urology ward at Windhoek Central Hospital, Namibia, were evaluated. Patients who were unable to complete the questionnaires alone were assisted by a doctor or nurse. Local ethics committee approval was obtained. Statistical analysis was performed using Student's t-test and Spearman's rank correlation test.
Results. One hundred men (mean age 56.3 years, range 20.1 - 95.4) were evaluated over a period of one year. All the men understood one or more of 15 languages, and 30 were illiterate; 32 had <5 years of schooling, 34 had 5 - 9 years and 34 had >9 years. The VPSS took significantly less time to complete than the IPSS. There were statistically significant correlations between the total VPSS and IPSS scores, between the four VPSS questions and the corresponding IPSS questions, and between Qmax and Qave and the VPSS total and VPSS questions on the force of the urinary stream and QoL.
Conclusion. The VPSS pictograms depicting the force of the urinary stream and QoL correlated significantly with Qmax and Qave, indicating that they can be used as single-item questions to rapidly assess bladder outflow obstruction in men with limited education.