South African Medical Journal - Volume 106, Issue 7, 2016
Volumes & issues
Volume 106, Issue 7, 2016
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11157More Less
Source: South African Medical Journal 106, pp 642 –643 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11108More Less
Advances in immunisation, improvements in socioeconomic status and effective HIV prevention and treatment strategies have reduced the population burden of childhood pneumonia and severe disease. However, pneumonia remains the major single cause of death in children outside the neonatal period, causing approximately around 1 million deaths annually, or 15% of an estimated 6.3 million deaths in children aged <5 years. This burden is disproportionately high in low- and middle-income countries (LMICs) and in Africa, where almost 50% of deaths in children aged <5 years occur, despite African children comprising only 25% of live births globally. The incidence and severity of pneumonia are highest in the first year of life, especially in the first 6 months.
Source: South African Medical Journal 106, pp 644 –645 (2016) http://dx.doi.org/10.7196/SAMJ.2016v106i7.10903More Less
To the Editor: I note with interest the review entitled 'Heart failure in sub-Saharan Africa: A clinical approach'. It is very concerning that the only heart failure guideline published in Africa was not referenced in this review. The Heart Failure Society of South Africa (HeFSSA) is the only official heart failure society in Africa. The HeFSSA guideline was published as a modification of the European Society of Cardiology guideline that is quoted in the review, specifically to impart a 'sub-Saharan' perspective.
Source: South African Medical Journal 106, pp 646 –647 (2016) http://dx.doi.org/10.7196/SAMJ.2016v106i7.10906More Less
To the Editor: Den Hollander argues that 'the exclusion of severe burns from the indications for the use of colloids, as well as the exclusion of consultant surgeons and emergency specialists from those who will be allowed to prescribe HES-containing products, indicates little insight into the evidence and the clinical situation "at the coalface".'
Knowledge of multidrug-resistant tuberculosis in the Thabo Mofutsanyana District, Free State, South Africa : a Grade 10 learner's project : correspondenceSource: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016v106i7.10882More Less
To the Editor: Tuberculosis (TB) remains one of the leading causes of mortality in the world. South Africa (SA) has the third highest incidence of TB, largely fuelled by the HIV epidemic and poor TB management. The incidence of multidrug-resistant (MDR)-TB is also increasing, with SA among the five countries contributing to 60% of new cases. The reported number of deaths in SA due to MDR-TB has increased by 16.6% between 2013 and 2014.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11093More Less
The deadly cervical cancer-causing human papillomavirus (HPV) could be eliminated in South Africa (SA) within 15 years if ground-breaking new 'test-and-treat' technology for women can be successfully introduced to supplement nationwide vaccination of primary schoolgirls.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11094More Less
Source: South African Medical Journal 106, pp 652 –653 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11092More Less
Source: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11147More Less
Urgent research is needed to understand the massive potential burden of non-tobacco-related chronic obstructive pulmonary disease (COPD) in Cape Town and South Africa (SA), both of which have among the world's worst COPD burdens, Prof. Richard van Zyl, Associate Professor and Head of the Lung Clinical Research Unit at the University of Cape Town, said last month.
Source: South African Medical Journal 106, pp 655 –657 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11033More Less
The Global Report on Urban Health: Equitable, Healthier Cities for Sustainable Development, issued in March 2016 by the World Health Organization (WHO) and the United Nations Human Settlements Programme (UN-Habitat), emphasises the need for enhanced governance and leadership to achieve universal health coverage and the Sustainable Development Goals (SDGs). Noting that a healthy population forms the foundation for 'sustainable economic growth, social stability, and full realisation of human potential', the report presents 'practical, proven solutions for working across sectors to tackle these ... health challenges', and includes examples of such successes in South Africa (SA).
Colliding epidemics of communicable and non-communicable diseases during adolescence in South Africa : CME - guest editorialAuthor Quarraisha Abdool KarimSource: South African Medical Journal 106 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.11130More Less
Over the past 50 years, the improvement of health outcomes in infants and young children has received more attention than that in adolescents, primarily because adolescence is not typically associated with ill health. However, this picture is rapidly changing, with the present generation of adolescents already encountering diverse challenges, with different biosocial and neurocognitive responses compared with their parents and grandparents. These transitions are influenced by geographical, cultural, economic and genetic contexts. This issue of CME includes the final two articles on the topic of adolescent health.
Source: South African Medical Journal 106, pp 659 –661 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10945More Less
This article focuses on adolescents as a group, who are exposed to major changes in their near future, with the key transformation being the epidemiological transition from the age of infectious and nutritional problems to that of the non-communicable disorders (NCDs). The major NCDs are: obesity, diabetes, maternal, newborn and child, hypertension and mental health disorders. We also discuss allergies, exposure to pollutants, indoor open stoves, and behavioural factors, such as lack of exercise, unhealthy diet, substance abuse, injuries and violence, and sexually transmitted diseases, which contribute to a risky environment. We particularly emphasise the continuum from birth to old age, during which early events may produce lifelong diseases, and which requires serious attention with regard to preventive measures during the earliest period of susceptibility. Some indicators of disease can serve as diagnostic markers and help healthcare workers to avoid complications and manage a disorder efficiently.
Source: South African Medical Journal 106, pp 662 –665 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10946More Less
Overweight and obesity are common in South African boys (18.8%) and girls (26.3%). Considering the potential serious consequences of these conditions, clinicians need to identify overweight and obese adolescents to enable early diagnosis and treatment. The key contributor in adolescents is increased intake of unhealthy foods and lower levels of physical activity. The consequences of overweight and obesity in adolescence are multisystemic and include cardiometabolic (type 2 diabetes mellitus, high blood pressure, dyslipidaemia), respiratory (obstructive sleep apnoea), gastrointestinal (non-alcoholic fatty liver disease), musculoskeletal, psychological (depression) and social (stigmatisation) effects. Body mass index (BMI) is calculated to determine overweight and obesity in adolescents. Numerous expert committees, despite using different methods, classify overweight and obesity in children by age- and gender-specific cut points for BMI. After a diagnosis of overweight and obesity, secondary causes must be excluded, and a history of dietary intake, physical activity and sedentary behaviour obtained. This will identify modifiable behaviours that promote energy imbalance. All obese adolescents should undergo cardiometabolic assessments comprising fasting glucose, lipid and blood pressure measurements every 2 years. Interventions should focus on creating healthier home environments that provide easy access to healthy foods, encourage physical activity and discourage sedentary behaviour. Medication for weight loss or bariatric surgery may be considered for severely obese adolescents who do not respond to other strategies.
The impact of HIV infection on the presentation of lung cancer in South Africa : in practice - clinical practiceSource: South African Medical Journal 106, pp 666 –668 (2016) http://dx.doi.org/10.7196/SAMJ.2016v106i7.10737More Less
Background. Despite the very high background prevalence of HIV and smoking-related diseases in sub-Saharan Africa, very little is known about the presentation of lung cancer in HIV-infected individuals.
Methods. We prospectively compared HIV-positive (n=44) and HIV-negative lung cancer patients (n=425) with regard to demographics, cell type, performance status and tumour node metastasis staging at initial presentation.
Results. HIV-positive patients were found to be younger than HIV-negative (mean 54.1 (standard deviation 8.4) years v. 60.5 (10) years, p<0.01), more likely to have squamous cell carcinoma (43.2% v. 30.1%, p=0.07) and significantly more likely to have a poor Eastern Cooperative Oncology Group (ECOG) performance status of ≥3 (47.7% v. 29.4%, p=0.02). In the case of non-small cell-lung cancer, they were also significantly less likely to have early stage lung cancer (0% v. 10.3%, p=0.02) compared with HIV-negative patients.
Conclusions. HIV-positive lung cancer patients were younger, significantly more likely to have a poor performance status at presentation and significantly less likely to have early stage lung cancer when compared with HIV-negative patients.
Review of the 2015 Guidelines for Maternity Care with relevance to congenital disorders : in practice - issues in public healthSource: South African Medical Journal 106, pp 669 –671 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10813More Less
The 4th edition of the Guidelines for Maternal Care in South Africa published by the National Department of Health in 2015 was evaluated with relevance to the care and prevention of congenital disorders (CDs). Disparate terminology is used for CDs throughout the guidelines, and overall less detail is included on CDs compared with the previous edition. This demonstrates a lack of awareness around the growing health need and contribution of CDs to the disease burden in South Africa (SA). Referrals to medical genetic services in the guidelines for mothers of advanced maternal age and other high-risk categories do not take into account the insufficient capacity available for screening and diagnosis of CDs. This highlights the lack of consultation with the medical genetics sector during the development of the guidelines. To respond to the Sustainable Development Goals by 2030, CDs must be integrated comprehensively at all levels of healthcare in SA.
Ending preventable child deaths in South Africa : what role can ward-based outreach teams play? : in practice - issues in public healthSource: South African Medical Journal 106, pp 672 –674 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10790More Less
South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more.
The Expanded Programme on Immunisation in South Africa : a story yet to be told : in practice - healthcare deliverySource: South African Medical Journal 106, pp 675 –677 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10956More Less
During the past two decades, immunisation has saved millions of lives and prevented countless illnesses and disabilities in South Africa (SA). However, vaccine-preventable diseases are still a threat. A vaccine-preventable disease that might lead to a 1- or 2-week illness in an adult, could prove deadly for infants, children or elderly people. Vaccination protects oneself and one's family. For example, adults are the most common source of pertussis (whooping cough) infection in infants, which can be deadly for the latter. This article demonstrates the commitment of the SA government to immunisation, highlights key milestones of the Expanded Programme on Immunisation (EPI) and dispels the myth that the EPI in SA is in shambles.
Social justice and research using human biological material : a response to Mahomed, Nöthling-Slabbert and Pepper : in practice - medicine and the lawAuthor D.W. JordaanSource: South African Medical Journal 106, pp 678 –680 (2016) http://dx.doi.org/10.7196/SAMJ.2016.v106i7.10552More Less
Social justice in the context of research using human biological material is an important contemporary legal-ethical issue. A question at the heart of this issue is the following: Is it fair to expect a research participant (a person who participates in such research by, among others, making available biological material from his or her body) to participate on an altruistic basis, while the researchers and the investors in the research can gain commercially from the research? In a recent article, Mahomed, Nöthling-Slabbert and Pepper proposed that research participants should be entitled to share in the profits emanating from such research via a proposed new statutory right to the intellectual property emanating from such research. In order to stimulate debate on this important issue of social justice, this article responds to the position of Mahomed et al. by focusing on two main points: Firstly, I contend that Mahomed et al. fail to make a convincing argument in favour of shifting away from altruism; secondly, I caution against framing the debate in terms of the binary poles of altruism v. profitsharing, and suggest that should healthcare public policy ever move away from altruism, various non-monetary forms of benefit-sharing by research participants should be considered.