South African Medical Journal - Volume 105, Issue 11, 2015
Volumes & issues
Volume 105, Issue 11, 2015
Source: South African Medical Journal 105, pp 905 –906 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10185More Less
A patent represents a right or title conferred by a government authority granting an inventor a limited period of exclusive use of a patented invention, in return for full public disclosure of the invention. The premise is to stimulate innovation by ensuring that the inventor has a limited monopoly as a reward for advancing the industry. Innovative research in the pharmaceutical industry is extremely costly and time consuming. It is generally accepted that the resulting innovations are better rewarded in countries with advanced patent systems than in countries where patent protection is still lacking. Innovation leads to innovation when other inventors have the opportunity to advance the technology disclosed in patents further, and patent their own innovations in turn. However, sometimes the working of these patents may require cross-licensing between the patentees (Patents Act, section 55).
Source: South African Medical Journal 105, pp 907 –911 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10222More Less
Adolescents and young women, particularly in South Africa, are at increased risk of HIV acquisition. To date, we have had limited primary prevention options to offer. Oral pre-exposure prophylaxis (PrEP) is an additional prevention modality that has now been proven to reduce HIV acquisition in those who take it consistently during periods of HIV infection exposure. We review the PrEP evidence in adolescents and highlight some of the research gaps. Our recommendation is to increase the number of demonstration projects and other scale-up opportunities to offer oral PrEP to at-risk adolescents, and monitor carefully to answer the outstanding questions.
School-based human papillomavirus vaccination : an opportunity to increase knowledge about cervical cancer and improve uptake of screening : researchSource: South African Medical Journal 105, pp 912 –916 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9814More Less
Background. Poor knowledge about cervical cancer plays a role in limiting screening uptake. HPV vaccination provides an untested platform to distribute information that could possibly improve knowledge and screening coverage.
Objective. To measure changes in knowledge and screening uptake when information and screening opportunities were provided tomothers of adolescent HPV vaccine recipients.
Methods. During an HPV vaccine implementation project in the Western Cape (WC) and Gauteng Province (GP), South Africa, information about cervical cancer was provided to parents during a lecture, written information was distributed, and mothers were then invited to either screen at their clinic (WC) or use a self-screening kit (GP). A structured questionnaire was used to test cervical cancer knowledge and screening practices, comparing these before and after the project and between the two screening groups.
Results. Complete data for both questionnaires were available for 777 of 906 recruited women. Initial knowledge was poor, but on retesting6 months later, knowledge about symptoms (p < 0.005), screening (p < 0.005) and vaccination (p < 0.05) improved significantly after the information session and school-based HPV vaccination. In the second questionnaire, women reported significantly more screening and the last reported screening test was more recent. This improvement was more favourable in GP than in the WC (41% v. 26% reporting screening in the past 12 months).
Conclusion. These results demonstrate how adolescent HPV vaccine programmes can help to control cervical cancer among mothers by offering information and screening. It is important not to lose this opportunity to educate mothers and their daughters and offer effective methods to prevent cervical cancer in both generations.
Source: South African Medical Journal 105, pp 917 –921 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10194More Less
Background. Childhood immunisations are a cost-effective public health intervention for prevention of infectious diseases. Immunisation coverage is still suboptimal, however, which may result in disease outbreaks. Immunisation at every contact with a health facility is a strategy developed by the World Health Organization in order to improve immunisation coverage.
Objectives. To estimate the prevalence of missed opportunities for immunisation at different levels of healthcare in the Western Cape Province, South Africa, and assess factors associated with missed opportunities.
Methods. The study included a health facility-based cross-sectional exit survey of caregivers with children up to 5 years of age, followed by a qualitative exploration of staff attitudes towards immunisation.
Results. The overall prevalence of missed opportunities for immunisation was 4.6%; 81.3% of caregivers brought Road-to-Health booklets (RTHBs) to consultations; and 56.0% of health workers asked to see the RTHBs during consultations. Children attending primary level facilities were significantly more likely to have their RTHBs requested than children attending a tertiary level facility. Lack of training and resources and heavy workloads were the main challenges reported at secondary/tertiary level facilities.
Conclusion. Missed opportunities for immunisation at health facilities in Cape Town were low, probably reflecting good immunisation coverage among children accessing health facilities. Increased health worker support, particularly at secondary/tertiary levels of care, is needed to improve the use of RTHBs to provide immunisation.
Source: South African Medical Journal 105, pp 922 –926 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9654More Less
Background. The South African Vaccination and Immunisation Centre receives many requests to explain the validity of internet-based anti-vaccination claims. Previous global studies on internet-based anti-vaccination lobbying had not identified anti-vaccination web pages originating in South Africa (SA).
Objective. To characterise SA internet-based anti-vaccination lobbying.
Methods. In 2011, searches for anti-vaccination content were performed using Google, Yahoo and MSN-Bing, limited to English-language SA web pages. Content analysis was performed on web pages expressing anti-vaccination sentiment about infant vaccination. This was repeated in 2012 and 2013 using Google, with the first 700 web pages per search being analysed.
Results. Blogs/forums, articles and e-shops constituted 40.3%, 55.2% and 4.5% of web pages, respectively. Authors were lay people (63.5%),complementary/alternative medicine (CAM) practitioners (23.1%), medical professionals practising CAM (7.7%) and medical professionals practising only allopathic medicine (5.8%). Advertisements appeared on 55.2% of web pages. Of these, 67.6% were sponsored by or linked to organisations with financial interests in discrediting vaccines, with 80.0% and 24.0% of web pages sponsored by these organisations claiming respectively that vaccines are ineffective and that vaccination is profit driven. The vast majority of web pages (92.5%) claimed that vaccines are not safe, and 77.6% of anti-vaccination claims originated from the USA.
Conclusion. South Africans are creating web pages or blogs for local anti-vaccination lobbying. Research is needed to understand what influence internet-based anti-vaccination lobbying has on the uptake of infant vaccination in SA.
Source: South African Medical Journal 105, pp 927 –929 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9576More Less
Background. The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better.
Objective. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city.
Methods. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design.
Results. Forty-eight children aged < 6 years with disabling hearing impairment (DHI) were identified in the private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (p < 0.0001; 95% confidence interval (CI) 0.99 - 2.0). The median age of diagnosis of CHL in the private healthcare sector was 3.01years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (p < 0.01; 95% CI 0.72 - 2.47). We also compared the median age of diagnosis of CHL in children from the private healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (p < 0.01; 95% CI 0.41 - 1.56).
Conclusions. Children in the Free State are diagnosed with CHL at a younger age in the private healthcare sector than in the public healthcare sector. With the social and economic benefits of early intervention in cases of DHI well established internationally, SA healthcare providers in both the public and private sectors need to develop screening, diagnostic and (re)habilitation services for children with hearing impairment.
Source: South African Medical Journal 105, pp 930 –933 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9415More Less
Background. The Department of Radiology at Groote Schuur Hospital, Cape Town, South Africa, has been performing fetal magnetic resonance imaging (MRI) since 2007. Fetal MRI findings have not previously been analysed to correlate them with antenatal and postnatal findings.
Objectives. To determine the most common indication for fetal MRI, and to correlate antenatal MRI with antenatal ultrasound (US), postnatal imaging and postmortem findings.
Methods. This was a retrospective study of imaging carried out between January 2006 and December 2011. Seventy fetal MRI cases with complete antenatal and postnatal medical records were included. Antenatal US and antenatal MRI were compared, and also compared with the postnatal imaging findings. Stata 12 was used to analyse the data, and Spearman's test to test the agreement between the results.
Results. Intracranial pathology was the most common indication for fetal MRI, with ventriculomegaly being the commonest indication determined from prenatal US. There was 72% agreement between antenatal US and fetal MRI. Postnatal findings showed 28% agreement with antenatal US and 39% agreement with fetal MRI.
Conclusions. Intracranial pathology was the major indication for fetal MRI. There was good agreement between prenatal US and fetal MRIbut poor agreement between antenatal and postnatal findings, largely as a result of resolution of ventriculomegaly.
Depressive and post-traumatic stress symptoms following termination of pregnancy in South African women : a longitudinal study measuring the effects of chronic burden, crisis support and resilience : researchSource: South African Medical Journal 105, pp 934 –938 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9394More Less
Background. Termination of pregnancy (TOP) remains a controversial issue, regardless of legislation. Access to services as well as psychological effects may vary across the world.
Objectives and methods. To better understand the psychological effects of TOP, this study describes the circumstances of 102 women who underwent a TOP from two socioeconomic sites in Johannesburg, South Africa, one serving women with few economic resources and the other serving women with adequate resources. The relationship between demographic characteristics, resilience and symptoms of post traumatic stress disorder (PTSD) and depression before, 1 month after and 3 months after the procedure was also examined.
Results. Time since TOP, age, chronic burden, resilience and the interaction of site with religion and site with chronic burden were significant. In addition, site differences were found for religion and chronic burden in predicting depression scores. Women from both sites had significant decreases in depression scores over time. The interaction of time with site was not significant. Higher chronic burden scores correlated with higher depression scores. No variables were significant in the bivariate analysis for PTSD.
Conclusion. Resilience, religion and chronic burden emerge as significant variables in women undergoing a first-trimester TOP, and warrant further assessment in studies of this nature.
Source: South African Medical Journal 105, pp 939 –947 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.9780More Less
Background. Childhood cancer is an emerging problem in Africa. Its extent is hazy because data are scarce, but it should be addressed. This is the first report from the South African Children's Tumour Registry (SACTR), which covers the whole of South Africa (SA). It provides minimal estimates of cancer incidence and discusses the challenges of cancer surveillance and control in a child population in a middle-income country. Only about 2% of the African population is covered by cancer registries producing comparable incidence data.
Objective. To present and interpret incidence patterns and trends of childhood cancer over a 21-year period. The results should raise awareness of the problem of childhood cancer in an African population and provide sensible data for taking this problem in hand.Methods. All eligible and validated cancer cases registered in the SACTR over the period 1987 - 2007 and classified according to the International Classification of Childhood Cancer were included. Population data were retrieved from official sources and estimated for the population subcategories. Incidence rates were standardised to the world standard and time trends were evaluated using join point models, adjusting for sex and age.
Results. Based on the 11 699 cases, the overall age-standardised average annual incidence rate was 45 per million. Threefold differences in the overall incidence rates were observed between the ethnic groups, ranging from 116 for whites to 37 for black Africans, and they differed by diagnostic group. Differences between the nine provinces of SA relate to the ethnic composition and prevailing socioeconomic status. The overall incidence rate declined by 1.2% per year for the whole country (p < 0.01). However, the decline was mainly observed during the first few years of the study period, after which rates stabilised or increased.
Conclusions. Diagnosis and notification of childhood cancer should improve. The differences in incidence between ethnic groups suggest the priorities for cancer control.
Source: South African Medical Journal 105, pp 948 –951 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10126More Less
Each year thousands of adolescent girls and young women in South Africa (SA) become pregnant and many die from complications related to pregnancy and childbirth. Although women of all ages are susceptible, girls < 15 years of age are five times as likely, and those aged 15 - 19 years twice as likely, to die from complications related to childbirth than women in their 20s. In SA, non-pregnancy-related infections (e.g. HIV), obstetric haemorrhage and hypertension contributed to almost 70% of avoidable maternal deaths. In addition to the implementation of standardised preventive interventions to reduce obstetric haemorrhage and hypertension, better reproductive health services for adolescents, access to HIV care and treatment for women infected with HIV, and improved access to and uptake of long-acting reversible contraception are important ingredients for reducing maternal mortality among adolescents.
Author Quarraisha Abdool KarimSource: South African Medical Journal 105 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10195More Less
The period of adolescence is associated with complex psychological, physical and cognitive changes as children transition to adulthood. In more recent times this transition has taken on added complexities, particularly in developing countries undergoing social and political changes, in an era of increasing globalisation and access to information through new technologies. While adolescents comprise about 25% of the global population, they constitute up to 40% of the population in sub-Saharan Africa, creating what is also referred to as the 'youth bulge' in the population pyramid. This demographic shift in sub-Saharan Africa is also associated with poorer health outcomes in adolescents as a result of a convergence of communicable and non-communicable diseases. Notably, the gender gaps in infant and childhood survival are being reversed, with secondary sexual development resulting in increasing vulnerability of young women, which perpetuates vicious cycles of inter-generational poverty, low levels of schooling, and ill health that undermine social and economic transformation in these settings.
Understanding and responding to HIV risk in young South African women : clinical perspectives : continuing medical educationSource: South African Medical Journal 105, pp 952 –955 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2015.v105i11.10099More Less
Young women (15 - 24 years) contribute a disproportionate 24% to all new HIV infections in South Africa - more than four times that of their male peers. HIV risk in young women is driven by amplifying cycles of social, behavioural and biological vulnerability. Those most likely to acquire infection are typically from socioeconomically deprived households in high HIV-prevalence communities, have limited or no schooling, engage in transactional sex or other high-risk coping behaviours, and have a history of sexually transmitted infections (STIs) and/or pregnancy. Despite the imperative to prevent HIV acquisition in young women, there is a dearth of evidence-based interventions to do so. However, there are several steps that healthcare workers can take to improve outcomes for this key population at the individual level. These include being able to identify high HIV-risk young women, ensuring that they receive the maximum social support they are eligible for, providing reliable and non-judgemental counselling on sexual and reproductive health and relationships, delivering contraceptives and screening and treating STIs in the context of accessible, youth-friendly services.