But South Africa (SA) does not cherish her children, in spite of their right to care and protection, enshrined in our Constitution's Bill of Rights. Of course this failure occurs in a milieu of social tolerance of use of force and violence in the country as a whole, with high levels of family violence in the home, violence in the community, and violence at the hands of police and in schools (with frequent resort to corporal punishment). Children from poorer households and from rural areas are particularly affected. An editorial in this issue of SAMJ informs us of the SA position in relation to other countries around the world in the Global Status Report on Violence Prevention 2014, jointly released by the World Health Organization (WHO), the United Nations Development Programme and the United Nations Office on Drugs and Crime.
Recognising and diagnosing chronic kidney disease: Part 1
Effects of methamphetamine abuse on the kidneys and blood pressure
Preventing liver fibrosis and cancer in Africa
The Vaccine and Cervical Cancer Screen project 2
Dementia in rural SA: A pressing need for epidemiological studies
TBI: The hidden pandemic
A noteworthy event for global undergraduate surgical education took place when the University of Cape Town Student Surgical Society successfully hosted the inaugural International Association of Student Surgical Societies (IASSS) Symposium.
Parrish and Blockman make excellent points about conflict of interest (COI), particularly in the context of 'medical leadership'. As key opinion leaders themselves (both are members of the National Essential Medicines List Committee (2013 - 2015), as is the second signatory to this letter - the term does not imply membership of an advisory panel to any for-profit vendor of health-related goods or services), the authors are well placed to make comments. An aspect of COI not considered in their article relates to regulatory authorities.
At least half of all known drug-resistant tuberculosis (DR-TB) patients in the Port Elizabeth area (and possibly the entire Eastern Cape) are being treated with too few drugs, fuelling the spread of extensively drug-resistant (XDR)-TB and condemning them to death.
The seasoned legal team of apartheid-era chemical warfare expert and top cardiologist Dr Wouter Basson will within a fortnight ask the Medical and Dental Professions Board (MDPB) committee that found him guilty of violating basic medical ethics to recuse itself entirely.
President Jacob Zuma's legal advisors 'led him astray', resulting in him 'irrationally' signing into existence a law that criminalised the provision of healthcare services in South Africa and flouted several provisions of the Constitution. That is the nub of the Constitutional Court's 27 January finding after Zuma, his Minister in the Presidency Jeff Radebe, Minister of Health Dr Aaron Motsoaledi and National Health Director-General (DG) Precious Malebona Matsoso applied to have the controversial Certificate of Need (CoN) provisions deproclaimed.
Of the 18.5 million children under the age of 18 in South Africa (SA), 8% have no fathers, 23% do not live with their biological parents, and 60% live in poverty - frightening figures that top local epidemiologists and clinicians agree help explain why the risk of a child dying here is ten times higher than in Europe.
Dit is met innige leedwese dat ek verneem het van Alewyn se dood. Op 27 Januarie 2015 sou hy 79 jaar oud geword. Alewyn kom vanaf Lydenburg, waar sy vader 'n gesinsdokter was. Sy moeder was 'n sjarmante dame vanaf Nederland, maar het goed hier ingeburger. Alewyn se ouer broer, Braam, was ook 'n algemene praktisyn en sy suster, Corrie, was getroud met ds. Punt Janson, wat later 'n parlementslid geword het.
Nutrition support is an evolving field, and modern clinical nutrition practice should actively incorporate strategies to enhance various clinical outcomes. In surgical patients, clinical benefits can be maximised by nutritional support protocols that minimise and manage the perioperative fasting period. This approach, which includes the perioperative provision of clear carbohydrate-containing fluids, has been shown to be safe, is evidence based, and is supported by many professional societies. Such a strategy has been shown to aid the anaesthetic process and maintain an optimal metabolic state, including improved insulin sensitivity and blunted muscle catabolic activity. Some important consequences of this improved metabolic control include shorter hospital stay and fewer postoperative complications. A proactive multidisciplinary team approach is essential to use this nutrition support strategy with success across a hospital's surgical service.
Notified malaria cases in South Africa (SA) decreased significantly over the past 14 years, from over 60 000 in the 1999/2000 malaria season to less than 13 000 in 2013/2014. However, the past two seasons have seen increases in both local and imported cases. Mozambique contributes the highest number of imported cases in SA. This update provides recommendations for malaria treatment and prevention (in travellers and residents) for 2015.
Chronic pancreatitis (CP) is a progressive and debilitating disease. A potentially important consideration is the relationship between CP, depression and substance use disorders, which seems to be circular and multiplicative. Pain management is a critical component of intervention, and it would seem that in the context of chronic illness this requires a biopsychosocial approach aiming for a tailored intervention that strikes an appropriate therapeutic balance.
The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account.
The World Health Organization (WHO), the United Nations Development Programme and the United Nations Office on Drugs and Crime jointly released the first Global Status Report on Violence Prevention on 10 December 2014. The report reviews how governments around the world, including in South Africa (SA), are attempting to curb interpersonal violence.
Hepatitis B virus (HBV) infection causes a spectrum of acute and chronic liver disease ranging from inactive chronic carrier status to progressive chronic hepatitis, culminating in end-stage cirrhosis and liver cancer. In SSA, HBV infection is endemic and the HBV-related disease burden is high. The lifetime risk of HBV infection is over 60%, and more than 8% of the population remain chronic HBV carriers who are at risk of progressive liver disease and HBV-related hepatocellular carcinoma (HCC). SSA has one of the highest HBV-related liver cancer rates in the world, and it is the most common cancer among males and third most common among females. Unfortunately, HCC is usually a highly aggressive tumour with limited treatment options, particularly in resource-poor settings such as SSA. Furthermore, HBV-related HCC affects patients in their working and reproductive years. HBV therefore represents a threat to health on the African continent.
The lack of prioritisation of congenital disorders (CDs) in healthcare, and the limited resources allocated to prevention and to the care of those affected, is an issue of global concern. This is especially true in low- and middle-income countries (LMICs), where over 90% of CDs currently occur, resulting in 95% of CD deaths worldwide.
Dementia is a growing public health concern globally, with total estimated worldwide costs per year at USD604 billion in 2010. With older age being a major risk factor for dementia, the increasing numbers of older adults worldwide will increase demand for services to diagnose, treat and care for people with dementia (PWD). Little is known about the prevalence of dementia or its impact on older adults living in low- and middle-income countries (LMICs) in Africa, including South Africa (SA). Furthermore, there has been little research into the aetiology and risk factors in LMICs. The need for studies to investigate these factors in SA is therefore critical.
Background. Cervical cancer is a preventable disease with a high prevalence in South Africa (SA), where screening is opportunistic. Primary prevention is now possible through HPV vaccination. In VACCS 1 the feasibility of linking cervical cancer with HPV vaccination was demonstrated.
Objectives. To investigate the feasibility of linking HPV self-testing with a two-dose HPV vaccination schedule and to compare results with VACCS 1.
Methods. The project was conducted in five schools in the South-West District of Tshwane, Gauteng, SA. Leaflet information on cervical cancer and screening was provided, with requests for consent and assent for a two-dose HPV vaccination of schoolgirls. Female caregivers were invited to take part in HPV self-screening.
Results. Of 965 girls invited for vaccination, 519 (53.7%) had full consent and 518 (99.8%) received at least one vaccine dose. The invited uptake rate was 53.7% and 495 girls received both doses, giving a completion rate of 95.4% v. 82.6% in VACCS 1. Of 1 135 self-screen kits handed out, 560 (49.3%) were not returned. The mean age (standard deviation) of the 160 women who participated in self-screening was 38.7 (7.7) years. HPV testing was negative in 116 women (72.5%), 15 women (9.4%) tested positive for HPV 16 and/or 18, and 27 (16.9%) were positive for non-16/18 oncogenic HPV.
Conclusion. Data from the VACCS projects suggest that school-based vaccine programmes can be successfully implemented. A two-dose schedule allowed for higher completion rates. Linking self-collected HPV screening to HPV vaccination is feasible, is a promising and viable screening strategy, and reached the appropriate age group for screening.
Introduction. Traumatic brain injury (TBI) has many potential cognitive, behavioural and psychological consequences, and contributes significantly to the national burden of disease and to ongoing violent behaviour. Few resources are available for the rehabilitation of patients with TBI in South Africa, and access to rehabilitation facilities in the public sector is limited. Consequently, it is the families impacted on by TBI that ultimately carry the care and rehabilitation burden once survivors are discharged from hospital. Families are generally ill equipped to cope with the complex and potentially long-term disabilities that accompany brain injury.
Methods. Reviewing interviews with 175 family members and 354 patients recovering from TBI helped identify the key challenges that the survivors of TBI and their families face.
Results. Nine problem areas were identified that formed the basis for development of a discharge resource, the S-Plan, which serves to inform patients and carers and provide practical solutions for the problems they face.
Conclusion. The experiences of TBI survivors and their family members served to inform the development of simple, integrated coping strategies, namely two S-Plan tools, one for survivors and their families/caregivers and the other for care workers, in conjunction with counselling and support group processes. The S-Plan constitutes a discharge resource to inform patients and carers and provide practical solutions for the problems they face in caring for family members who have suffered TBI.