Background. Each year, ~89 000 (180/100 000) new cases of head injury are reported in South Africa (SA), with the majority of patients being in the economically active population. Hypotension and hypoxaemia significantly increase the morbidity and mortality in patients who have suffered a traumatic brain injury (TBI). Cerebral tissue is particularly vulnerable to these secondary insults in the period immediately following a TBI, emphasising the importance of prehospital care in TBI.
Objective. To establish the prevalence of prehospital hypotension and hypoxaemia in moderate to severe blunt TBI in greater Johannesburg, Gauteng, SA.
Methods. The records of adult patients who sustained a moderate to severe TBI between 1 January and 31 December 2011 were retrospectively reviewed for hypotension (systolic blood pressure < 90 mmHg) and hypoxaemia (oxygen saturation < 90%) during their prehospital phase of care. These results were subject to descriptive analysis.
Results. A total of 299 records were identified, 66 of which met the inclusion criteria. The prevalence of prehospital hypotension and hypoxaemia were 33.3% (n=22) and 37.9% (n=25), respectively, while 21.2% (n=14) of patients suffered double insults of hypotension and hypoxaemia. Hypotension and hypoxaemia were associated with haemorrhage (p=0.011) and chest injuries (p=0.001), respectively.
Conclusion. The prevalence of hypotension in this study was similar to that observed in international studies, but the prevalence of hypoxaemia was much higher. There is a need for local guidelines to be developed to inform the quality of TBI care in the context of the developing world.
Background. Target setting is useful in planning, assessing and improving antiretroviral treatment (ART) programmes. In the past 4 years, the ART initiation environment has been transformed due to the change in eligibility criteria (starting ART at a CD4+ count < 350 cells/µl v. < 200 cells/µl) and the roll-out of nurse-initiated management of ART.
Objective. To describe and illustrate the use of a target-setting model for estimating district-based targets in the era of an expanding ART programme and changing CD4+ count thresholds for ART initiation.
Method. Using previously described models and data for annual new HIV infections, we estimated both steady-state need for ART initiation and backlog in a North West Province district, accounting for the shift in eligibility. Comparison of actual v. targeted ART initiations was undertaken. The change in CD4+ count threshold adds a once-off group of newly eligible patients to the pool requiring ART - the backlog. The steady-state remains unchanged as it is determined by the annual rate of new HIV infections in previous years.
Results. The steady-state need for the district was 639 initiations/month, and the backlog was ~15 388 patients. After the shift in eligibility in September 2011, the steady-state target was exceeded over several months with some backlog addressed. Of the total backlog for this district, 72% remains to be cleared.
Conclusion. South Africa has two pools of patients who need ART: the steady-state of HIV-infected patients entering the programme each year, determined by historical infection rates; and the backlog created by the shift in eligibility. The healthcare system needs to build long-term capacity to meet the steady-state need for ART and additional capacity to address the backlog.
Background. No published studies on the prevalence of paediatric otitis media at primary healthcare clinics (PHCs) in South Africa (SA) are available.
Objective. To examine the point prevalence of otitis media in a paediatric population in a PHC in Johannesburg, SA, using otomicroscopy.
Methods. A sample of 140 children aged 2 - 16 years (mean 6.4; 44.1% females) were recruited from patients attending the PHC. Otomicroscopy was completed for each of the participants' ears by a specialist otologist using a surgical microscope.
Results. Cerumen removal was necessary in 36.0% of participants (23.5% of ears). Otitis media with effusion was the most frequent diagnosis (16.5%). Chronic suppurative otitis media (CSOM) was diagnosed in 6.6% of children and was the most common type of otitis media in participants aged 6 - 15 years. Acute otitis media was only diagnosed in the younger 2 - 5-year age group (1.7%). Otitis media was significantly more prevalent among younger (31.4%) than older children (16.7%).
Conclusion. CSOM prevalence, as classified by the World Health Organization, was high. Consequently diagnosis, treatment and subsequent referral protocols may need to be reviewed to prevent CSOM complications.
Introduction. We used modern error theory to develop a tick-box admission form for emergency surgical patients. The tick boxes were designed to actively direct care down appropriate clinical algorithms by encouraging staff to make decisions based on recorded clinical data.
Objective. To audit the effect of these tick-box forms on the quality of documentation and the resuscitation process.
Methods. We designed and implemented a standardised tick-box admission form, and audited its impact by comparing 100 emergency surgical admissions before the intervention with 100 thereafter. We assessed the quality of the documentation in both groups and analysed the effect of use of the tick-box admission form and the decision nodes on the clinical behaviour of the admitting clinicians.
Results. The introduction of standardised tick-box admission forms dramatically improved the quality of documentation of acute surgical admissions. However, the impact of the decision nodes on clinical behaviour was less obvious. We demonstrated a tendency to cognitive dissonance in that, even though clinicians recorded abnormal physiological data, they did not consistently interpret this information correctly.
Conclusions. Although the use of tick-box admission forms improves the quality of documentation, the impact on clinical behaviour is less certain. Quality improvement is a multifactorial endeavour, and without a pervasive culture of patient safety, tick-boxes alone may well be ineffective.
Sexual health is a major area of relevance to global public health. The World Health Organization (WHO) has stipulated that every person has the right to sexual health. The United Nations Educational, Scientific and Cultural Organization (UNESCO) has identified sexual rights and sexual health education and training as a global priority. There is also growing interest in human rights and lesbian, gay, bisexual, transgender and intersex (LGBTI) issues internationally. However, there are few centres of excellence for sexual health in lowand middle-income countries, where the vast majority of the world's population live, and there is a real need to establish such resources.
Background. The World Health Organization is in the process of revising the International Classification of Diseases and Related Health Problems (ICD). Sexual dysfunction disorders (F52) have been identified as having poor clinical utility. South Africa (SA) has been selected as one of five low- and middle-income countries in which studies will be developed to assess the clinical utility of the proposed ICD-11 revisions for sexual dysfunction disorders.
Objective. To identify scientific research generated in SA on sexual dysfunction disorders to guide these studies.
Methods. A systematic review of SA research on sexual dysfunction disorders published in peer-reviewed journals.
Results. Despite the high prevalence of ejaculatory and erectile dysfunctions, only five SA articles have addressed male sexual dysfunction since 1970. Lack of sexual interest and inability to reach orgasm are the most commonly reported complaints for women, yet only four SA articles have been published on the topic of female sexual dysfunction. Diabetes mellitus, cardiovascular disease, genitourinary disease and psychiatric or psychological disorders are common comorbid conditions associated with sexual dysfunction in both sexes, but only nine articles address sexual dysfunction as the main topic with respect to comorbid conditions.
Conclusion. Despite growing awareness of the importance of sexual health, SA-based scientific research on sexual dysfunction is limited. Further work is needed to inform recommendations for ICD-11 revisions drawn from the SA context.
Sexuality is recognised as a fundamental and natural need, regardless of age or physical state. Sexual dysfunctions (SDs) are prevalent in the general population and can have a major impact on quality of life and psychosocial and emotional well-being. A high standard of sexual health is regarded as a fundamental right. However, these are self-reported conditions and patients may be reluctant to seek medical help because they are embarrassed. Surveys suggest that men appear to believe that the doctor should initiate questions about sexual health. In addition, SDs such as erectile dysfunction may be markers for comorbid conditions. Hence, a multidisciplinary approach to SDs is required.
Patients want to discuss concerns about their sexual health, but these discussions can be difficult to initiate. Most patients wait for their healthcare provider to enquire about their sexual health. Female sexual problems are highly prevalent, affecting up to 43% of women. Between a third and half of these women describe their problem/s as distressing, causing a major impact on their quality of life and interpersonal relationships. Addressing sexual health issues with patients can enhance medical practice and improve patient well-being. This article provides healthcare providers with an approach to addressing female sexual dysfunction, along with an overview of diagnosis and treatment options.
Approximately 31% of men suffer from a sexual dysfunction in their lifetime. This review aims to provide the family practitioner with an approach to managing common cases of male sexual dysfunction, such as erectile dysfunction, using consensus guidelines.
Hypersexual disorder is also termed compulsive sexual disorder, sexual addiction and non-paraphilic sexual disorder, reflecting different approaches to conceptualising its aetiology. Increased frequency of sexual behaviour alone does not indicate pathology. Research suggests that within the population with markedly increased frequency of sexual behaviour, there is a group in whom such behaviour leads to distress and impairment. Patients who experience increased frequency and intensity of sexual behaviour, with accompanying distress and impaired life functioning, may seek medical treatment.
This article gives an overview of transgender issues in South Africa, with a particular focus on the work of the Transgender Unit, Groote Schuur Hospital, Cape Town, South Africa. The article presents current definitions, diagnostic considerations and healthcare options in the area of gender dysphoria, and then outlines the history, mandate and role of the Transgender Unit. It concludes with some of the current challenges in the field of transgender healthcare and makes recommendations for the way forward.
The development of medications for the treatment of erectile dysfunction in men has, on one level, medicalised the notion of sexual dysfunction. However, it has also allowed researchers to explore many other aspects of sexual function in older persons. Health and wellbeing are positively affected by sexual activity. Older persons engaging in regular consensual sex have shown improved well-being in both physical and psychological health, associated with fewer health problems as they age. Engaging in intercourse has been correlated with improved intimate relationships, improved cardiovascular health and lower rates of depression.