In his review article in the March 2015 edition of CME, Prof. A M Meyers refers to chronic kidney disease as 'an important disease group that threatens health'. I fully concur with this observation and wish to go a step further and assert that kidney disease, together with other related non-communicable diseases (NCDs), poses not only a threat to health but also to the overall development of South Africa (SA). It is now almost 4 years since the adoption of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (September 2011), where it was emphatically stated that member States that have signed the Declaration (including SA) 'Acknowledge that the global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world, and threatens the achievement of internationally agreed development goals'.
The ethical obligations of physicians to respect and protect the human rights of all people are well articulated in international medical ethics statements. For example, the World Medical Association (WMA)'s Declaration of Geneva (1948) obligates physicians to swear that 'I will not use my medical knowledge contrary to the laws of humanity.'
Matters obstetric (and gynaecological) and neonatal
Safety versus accessibility in maternal and perinatal care
Maternal death and CS in SA
Management of obstetric haemorrhage
Intrapartum asphyxia and hypoxic ischaemic encephalopathy
Food insecurity in informal settlements in urban SA
In 2012, the Postgraduate Education Committee of the Health Professions Council of South Africa (HPCSA) supported the accreditation of Community Paediatrics and Child Health (CPCH) as a paediatric subspecialty; however, full HPCSA approval is outstanding. Consequently, by February 2015 there had been no visible progress towards implementation.
A year-old amendment to the Births and Deaths Registration Act, making the cause of death confidential to all but Statistics South Africa (Stats SA) officials, has effectively torpedoed mortality surveillance for public health planning in the Western Cape.
He may be remembered as 'the axe man' for his radical fiscal discipline, which included cutting beds in top tertiary hospitals, regulating private work and slashing commuted overtime, but Prof. Craig Househam, who retired as Western Cape health chief in March, was above all a strategist.
Just basic interventions could reduce South Africa (SA)'s neonatal death rate by up to 90%, according to a world-acclaimed innovator in cheap, child-friendly therapies, Prof. Heather Zar, chief of Paediatrics and Child Health at Red Cross War Memorial Children's Hospital in Cape Town.
Indefatigable, with a conviction to match his harshest critics, Prof. Tim Noakes took to the scientific trenches in Cape Town in February, fusing the firepower of 15 of the world's top experts on the low-carbohydrate, high-fat (LCHF) diet at a heavily subscribed R3 million, 4-day 'health convention'.
The High Court-approved recusal application by apartheid-era chemical and biological weapons expert Dr Wouter Basson to the two-person Medical and Dental Professions Board Professional Conduct Committee was turned down flat last month.
A multidisciplinary team at Tygerberg Hospital has performed the first-ever successful penile transplant, giving hope to victims of botched ritual circumcisions and penile cancer and even men with severe erectile dysfunction.
Stephen Hough and I collided for the first time when we were research fellows in the USA. That encounter in 1980 sowed in me the seed that was to become one of my closest friendships, although at the very beginning I had my doubts. Stephen had hit St Louis about a year before I did and we were to share an office. The potential difficulty lay in putting a slightly 'left of centre' Brit in with a South African, and an Afrikaans one at that. This was 1980.
Max Klein passed away suddenly on Tuesday 27 January while doing what he loved, cycling in Stellenbosch. He had made a large contribution to the development of paediatric critical care and paediatric pulmonology in South Africa and beyond.
Lochlann Jain is a cancer survivor. She is also an anthropologist living in the USA. Malignant is in part the personal story of what she aptly terms 'living in prognosis' after an ordeal of misdiagnosis and subsequent treatment for breast cancer. The book is also her detailed investigation of our profoundly diseased society.
Aim. To assess the functionality of healthcare facilities with respect to providing the signal functions of basic and comprehensive emergency obstetric care in 12 districts.
Setting. Twelve districts were selected from the 52 districts in South Africa, based on the number of maternal deaths, the institutional maternal mortality ratio and the stillbirth rate for the district.
Methods. All community health centres (CHCs) and district, regional and tertiary hospitals were visited and detailed information was obtained on the ability of the facility to perform the basic (BEmONC) and comprehensive (CEmONC) emergency obstetric and neonatal care signal functions.
Results. Fifty-three CHCs, 63 district hospitals (DHs), 13 regional hospitals and 4 tertiary hospitals were assessed. None of the CHCs could perform all seven BEmONC signal functions; the majority could not give parenteral antibiotics (68%), perform manual removal of the placenta (58%), do an assisted delivery (98%) or perform manual vacuum aspiration of the uterus in a woman with an uncomplicated incomplete miscarriage (96%). Seventeen per cent of CHCs could not bag-and-mask ventilate a neonate. Less than half (48%) of the DHs could perform all nine CEmONC signal functions (81% could perform eight of the nine functions), 24% could not perform caesarean sections, and 30% could not perform assisted deliveries.
Conclusions. The ability of the CHCs and district hospitals to perform the signal functions (lifesaving services) of basic and comprehensive emergency obstetric care was poor in many of the districts studied. This implies that safe maternity care was not consistently available at many facilities conducting births.
This article adds to the debate on appropriate staffing in maternity units. My starting point for assessing staffing norms is the staff required to provide a safe maternity unit. A survey in 12 districts showed that their health facilities were not adequately prepared to perform all the essential emergency services required. Lack of staff was often cited as a reason. To test this notion, two norms (World Health Organization (WHO) and Greenfield) giving the minimum staff required for the provision of safe maternity services were applied to the 12 districts. Assuming the appropriate equipment is available and the facility is open 24 hours a day 7 days a week, at a minimum there need to be ten professional nurses with midwifery/advanced midwives to ensure safety for mother and baby in every maternity unit. The norms indicate that the units should do a minimum of 500 - 1 200 deliveries per year to be cost-effective. All 12 districts had sufficient staff according to the WHO. When the numbers of facilities with maternity units were compared with Council for Scientific and Industrial Research and WHO norms for number of health facilities per population, a large excess of facilities was found. Per district there were sufficient personnel to perform the number of deliveries for that district using the WHO or Greenfield formulas, but per site there were insufficient personnel. In my view there are sufficient personnel to provide safe maternity services, but too many units are performing deliveries, leading to dilution of staff and unsafe services. A realignment of maternity units must be undertaken to provide safe services, even at the expense of accessibility.
Access to emergency contraception (EC) has little restriction in South Africa. EC is a contraceptive method that can be used by women up to 7 days after unprotected intercourse. It can be used in the following situations: when no contraceptive has been used; for condom accidents; after intrauterine contraceptive device expulsion; when a contraceptive method has been incorrectly used, or contraceptive pills missed; if there has been a >3-hour delay in taking the progestogen-only pill, a >2-week delay for intramuscular depot medroxyprogesterone acetate or a >1-week delay for intramuscular norethisterone enanthate; or after delayed placement or early removal or dislodgement of a contraceptive transdermal patch or vaginal ring.
Food insecurity in the urban poor is a major public health challenge. The Health, Environment and Development study assessed trends in food insecurity and food consumption over a period of 7 years in an informal settlement in Johannesburg, South Africa (SA). Annual cross-sectional surveys were conducted in the informal settlement (Hospital Hill). The degree of household food insecurity decreased significantly from 2006 (85%) to 2012 (70%). There was a spike in 2009 (91%), possibly owing to global food price increases. Childhood food insecurity followed the same trend as household food insecurity. During the first 3 study years, consumption of protein, vegetables and fruit decreased by 10 - 20%, but had returned to previous levels by 2012. In this study, although declining, food insecurity remains unacceptably high. Hunger relief and poverty alleviation need to be more aggressively implemented in order to improve the quality of life in poor urban communities in SA.
Maternal deaths due to haemorrhage continue to increase in South Africa (SA). It appears that oxytocin and other uterotonics are not being used optimally, even though they are an essential part of managing maternal haemorrhage. Oxytocin should be administered to every mother delivering in SA. Awareness is required of the side-effects that can occur and the appropriate measures to avoid harm from these. Second-line uterotonics should also be available and utilised in conjunction with mechanical and surgical means to arrest haemorrhage in women who continue to bleed after the appropriate administration of oxytocin.