In South Africa (SA), >4 000 women die annually of cervical cancer, a disease caused by the human papillomavirus (HPV). Infections caused by certain genotypes of HPV increase the risk of cervical cancer. HIV-infected women in particular are more likely to have persistent HPV infection, with higher-risk genotypes. In SA, two vaccines (HPV quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant (Gardasil) and HPV bivalent (types 16 and 18) vaccine, recombinant (Cervarix)) are currently registered for the prevention of HPV-related disease. In the past, there have been significant challenges to achieving high coverage and uptake of vaccination - contributory factors include cost and lack of awareness. An HPV demonstration project among schoolgirls in rural KwaZulu-Natal showed that high vaccine uptake is achievable. In 2014, the National Department of Health launched the national HPV vaccination programme among female learners attending public schools. Awareness of HPV vaccination among healthcare providers, education of parents, teachers and learners, and avoidance of missed opportunities for vaccination are vital to the success of the programme. Primary healthcare practitioners may play an important role in cervical cancer prevention by identifying and offering vaccination to girls who miss the opportunity to be vaccinated at school. HPV vaccination should be considered as one arm of a comprehensive programme of cervical cancer prevention and control.
Following the discovery of the human immunodeficiency virus (HIV), our knowledge of HIV infection and management has increased rapidly, but implementation of interventions has been slow in resource-limited settings. In particular, interventions such as antiretroviral treatment (ART) and prevention of mother-to-child transmission were hindered owing to lack of access to antiretroviral drugs. This resulted in ongoing HIV transmission, morbidity and mortality associated with opportunistic infections. Notwithstanding the current progress in HIV prevention and treatment, challenges remain in preventing new infections in adolescents and supporting and treating HIV-infected adolescents. Barriers to successful treatment of infection in adolescents include denial of diagnosis, poor understanding or perception of future benefits of treatment and current-orientated thinking that may contribute to non-adherence to ART. Side-effects that lead to stigmatisation, such as lipoatrophy (stavudine, zidovudine), diarrhoea and flatulence (lopinavir/ritonavir) and gynaecomastia (efavirenz), may be intolerable and prevent adherence to treatment. This article highlights common treatment issues in HIV adolescent care and provides guidance on their management in the South African setting.
This case-based discussion highlights challenges in adolescent antiretroviral management, focusing on non-disclosure of status and the subsequent impact of suboptimal treatment adherence. Despite the scale-up of antiretroviral therapy (ART) and recommendations made by the World Health Organization (WHO) for ART for all human immunodeficiency virus (HIV)-infected paediatric patients, ART coverage in adolescents lags behind that in adults. Challenges of sustaining lifelong ART in children and adolescents require consideration of specific behavioural, physiological and psychosocial complexities associated with this special group. To preserve future drug options and sustain lifelong access to therapy, addressing non-adherence to treatment is critical to minimising acquisition of ART drug resistance and treatment failure. We review the psychosocial and developmental components that influence the course of the disease in adolescents and consider the complexities arising from perinatal exposure to ART and the growing risk of transmitted ART drug resistance in high-burden resource limited settings.
Vaccines are one of the safest and most effective tools available in efforts to control and prevent many infectious diseases. When the Expanded Programme on Immunization (EPI) was established by the World Health Assembly (WHA) in 1974, only about 5% of the world's children were immunised against polio, diphtheria, tuberculosis, measles, pertussis and tetanus. In 2014, 40 years later, 83% were immunised, and the World Health Organization (WHO) estimates that this programme saves the lives of two to three million children every year. There are a number of other success stories... the complete eradication of smallpox, the near-elimination of polio, and the many countries that have reported elimination of measles (although there have been recent outbreaks in some of these).
To the Editor : In the present era of rapidly increasing medical costs, there is a need for doctors to assist in controlling these costs, in addition to providing quality care to all patients. This requires inclusion of the parameter of 'value' in medical practice. Value has been defined as 'outcome divided by costs'.
Minister of Health Dr Aaron Motsoaledi says that implementing the highly lauded new World Health Organization (WHO) HIV treatment guidelines will require careful fine-tuning to South Africa (SA)'s most vulnerable groups, with some aspects easier to implement than others.
Less than a third of medical schemes in South Africa (SA) (29.4%) use estimates of their losses to fraud, waste and abuse to decide how much they will invest in countering these practices. Most try to negotiate with offenders to mitigate their losses, making countrywide quantification almost impossible, while individual schemes fail to collaborate sufficiently, enabling crooked syndicates and individuals to move between schemes with virtual impunity. Only a minority (also 29.4%) of schemes ensure that the people they hire to counter these practices have received professional training and accreditation for their roles.
A new regulatory framework will in January 2016 enable medical schemes to offer low-cost, limited-benefit primary care medical aid, expanding private healthcare coverage by an extra 12.7 million people (from the current decade-long-stagnant 8.7 million higher-income members).
A renowned global authority on national healthcare systems says the South African (SA) government should shift its focus from only supporting public hospitals to leveraging the skills and expertise of their private counterparts to turbo-boost state reform in preparation for a universal healthcare system.
There is no doubt that a book that clearly sets out the principles of malpractice law would be helpful to the medical profession. The question is - is this the book? In the second sentence of his introduction the author states that the book, by virtue of the subject material, is primarily a legal work, and he is correct. He is obviously an expert in the field, and the subject of litigation is extensively and well covered.
'Cochrane Corner' in the November SAMJ highlights a Cochrane review that evaluated the effects of interventions for improving childhood vaccination coverage in low- and middle-income countries.
Question: Which interventions increase the uptake of childhood vaccines in low- and middle-income countries?
Bottom line: Health education, home visits and reminders probably increase the uptake of childhood vaccines in low- and middle-income countries.
Individualised patient treatment approaches demand precise determination of initial disease extent combined with early, accurate assessment of response to treatment, which is made possible by positron emission tomography/computed tomography (PET/CT). PET is a non-invasive tool that provides tomographic images and quantitative parameters of perfusion, cell viability, proliferation and/or metabolic activity of tissues. Fusion of the functional information with the morphological detail provided by CT as PET/CT can provide clinicians with a sensitive and accurate one-step whole-body diagnostic and prognostic tool, which directs and changes patient management. Three large-scale national studies published by the National Oncologic PET Registry in the USA have shown that imaging with PET changes the intended patient management strategy in 36.5% to 49% of cases, with consistent results across all cancer types. The proven clinical effectiveness and growing importance of PET/CT have prompted the College of Nuclear Physicians of South Africa, in collaboration with university hospitals, to develop a list of recommendations on the appropriate use of fluorine-18-fluorodeoxyglucose (18F-FDG) and non-18F-FDG PET/CT in oncology, cardiology, neurology and infection/inflammation. It is expected that other clinical situations will be added to these recommendations, provided that they are based upon solid clinical evidence. These recommendations are intended to offer advice regarding contemporary applications of PET/CT, as well as indicating novel developments and potential future indications. The CNP believes that these recommendations will serve an important and relevant role in advising referring physicians on the appropriate use of 18F-FDG and non-18F-FDG PET/CT. More promising clinical applications will be possible in the future, as newer PET tracers become more readily available.
Acute ataxia in childhood is often caused by toxin ingestion. With the increasing number of paediatric patients on antiretroviral medication, we are seeing more side-effects of these drugs. We report two cases of efavirenz toxicity causing ataxia.
Child research is governed by legal norms in the National Health Act (2003) and the Regulations. There is increasing harmony between the two on many issues, including the conditions under which children should be enrolled in research. The most striking disjuncture in the ethical-legal framework remains the allowable consent strategy for child research, where the law requires mandatory parental or legal guardian consent for all child research, while ethical guidelines afford research stakeholders the discretion to implement exceptions to this approach in specific justifiable circumstances.
Hearing impairment is viewed as the silent epidemic, because of its invisible nature and because routine clinical examinations often fail to detect it. It is the most prevalent sensory disorder in developed countries such as the USA and UK, with at least 1 in every 500 newborns having bilateral permanent hearing impairment. Data on the prevalence of childhood hearing impairment in developing countries are scarce. However, estimates based on pilot studies suggest that childhood hearing impairment may be more prevalent in developing than developed countries. For instance, the prevalence of hearing impairment among neonates was found to be 5.3 - 28/1 000 in Nigeria and 5.0 - 5.6/1 000 in India. In South Africa (SA) it is estimated that at least 6 116 babies are born with permanent bilateral hearing impairment every year. Up to 75% of prelingual hearing impairment has some genetic origin.
Antenatal care is a unique preventive public health intervention, offered routinely to healthy pregnant women. The overall objectives include health education, routine dietary supplementation, and, most importantly, to improve pregnancy outcomes for mother and child by detecting complications, particularly those without obvious symptoms, early.
In common with most developing countries, South Africa (SA) has a rapidly expanding population. Family planning has a central role in slowing population growth. Successful use of birth control relies on many factors, including economic, medical and social. One of the many difficulties faced in supplying adequate birth control is the growing lack of availability of a number of birth control options. Some of these options are vital for ensuring optimal contraception for all who need and want it, while others are useful alternative options for those who experience problems with their current method(s).