South African Family Practice - Volume 48, Issue 9, 2006
Volume 48, Issue 9, 2006
A qualitative study of the reasons why PTB patients at clinics in the Wellington area stop their treatment : original researchSource: South African Family Practice 48 (2006)More Less
<i>Background:</i> Tuberculosis (TB) remains the leading infectious cause of adult mortality, despite 60 years of effective chemotherapy. One reason for this is the problem caused by the interruption and failure of treatment, which usually are related to non-adherence. The reasons for non-adherence to TB treatment are multifaceted, ranging from the personalities of the patients to the social and economic environment. In South Africa, the most common problems have been shown to be the erratic way in which the treatment is taken, and not patients absconding from the treatment program. There is a strong suspicion that the disability grants issued to TB patients are acting as a disincentive to finish anti-tuberculosis medication. TB is a stigmatised disease and the lack of support from health workers, family and friends, as well as the length of the treatment period, all contribute to the temptation to discontinue TB therapy. This research was undertaken in Van Wyksvlei, a sub-economic area of Wellington. Wellington is part of the Drakenstein Municipality in the Western Cape, South Africa and is mainly an agricultural area. The aim of the study was to explore and describe the reasons why patients in the Wellington area do not complete their TB treatment, and then to make recommendations to improve adherence. <br><I>Methods:</I> The method used in this study was a descriptive qualitative one. Free attitude interviews were conducted with six non-adherent patients from Van Wyksvlei, a sub-economic area. The exploratory question was: "Which circumstances resulted in your interruption of your treatment?" The patients' responses were recorded and transcribed, and analysed to identify common themes. <br><I>Results:</I> The major themes that were identified were priorities, motivation and support. Priorities imply definite choices the TB patient has to make from the day the diagnosis is made. The patients are poorly equipped with decision-making and coping skills. A lack of motivation resulted from an improvement in the symptoms while on medication, group pressure, poor self-esteem, distance from clinic and lack of continuity of care. The support theme centred on lack of support from both the family and the community. <br><I>Conclusion:</I> Patients should not carry primary responsibility for their adherence, but be part of a team. If TB treatment is to be optimised, patient cooperation and information need to be addressed, as these are essential for success. Existing services need to be made more accessible and acceptable. Additional effort needs to be made to educate the community.
Guidelines for kangaroo care in district hospitals and primary healthcare maternity sections in the Free State : original researchSource: South African Family Practice 48 (2006)More Less
<I>Background:</I> Kangaroo care was introduced in Bogotá, Colombia in 1979 by Dr Edgar Ray and Dr Hector Martinez due to the shortage of resources and the large number of premature babies that needed special care. Kangaroo care implies direct skin-to-skin contact between the mother and her premature/newborn baby. The advantages of kangaroo care are well known and have been published widely. In the National District Hospital in Bloemfontein, South Africa, stable babies are admitted from 1.2 kg and above and the babies are discharged at around 1.8 kg, when they are able to drink adequately. Babies above 1.2 kg are given kangaroo care by their mothers in the day, but sleep in an incubator at night. Babies with a weight of between 1.5 kg and 1.6 kg are started with around-the-clock kangaroo care. The aim of this study was to determine predictors for good and poor outcomes in kangaroo mother care practiced at the primary healthcare level. This information was then used to compile a protocol for kangaroo care in hospitals and maternity sections at the primary care level. The aim of the protocol is to provide specific inclusion and exclusion criteria for kangaroo care, to indicate all the absolute and relative needs for such a unit, to provide guidelines for managing babies with insufficient weight gain, and to provide guidance for follow-up. <br><I>Methods:</I> In this cohort study, the patient files of premature babies that received kangaroo care in the National District Hospital were evaluated in order to establish indicators for good and poor outcomes. Patient files were selected consecutively from the last entry in the admissions register from May 2005 backwards until June 2003. Data was collected on a standard data-collection form. Reasons for not gaining weight and the need for special investigations were investigated and noted. Poor weight gain was regarded as weight gain of less than 17 g/kg/day. <br><I>Results:</I> A total of 200 files were audited. In 62% of the cases (95% CI 55.1%; 68.4%), the babies gained weight satisfactorily, while weight gain was unsatisfactory in 38% of the cases. The mean admission weight of the babies was 1 545 g (range 1 100 g to 2 100 g) and the mean discharge weight was 1 800 g (range 1 700 g to 2 100 g). The chance of weight gain was reduced if one of the following occurred: anaemia, low body temperature, inappropriate amount and route of milk administered, sepsis, transport, procedures and other medical conditions. The reinsertion of nasogastric tubes (53%), improved temperature control with improved kangaroo care technique (79%), the correction of anaemia with blood transfusion (12%) and the correction of the volume of milk (5%) were the major corrective steps taken to address the problem. In 29% of the cases, extra energy in the form of FM 85 was added to the breast milk. The type of milk that the babies received, namely breast milk (n=113), premature milk formula (n=40) and a combination of breast milk and formula milk (n=46), did not significantly influence weight gain. Gender, birth weight and gestational age at birth also did not have a significant influence on weight gain. If the problem was properly addressed, the babies started gaining weight within an average of four days. <br><I>Conclusion:</I> It is possible to render safe kangaroo care to all stable premature babies in a primary healthcare setting, provided that the set guidelines are adhered to.
A comparison of cervical smear adequacy using either the cytobrush or the Ayre spatula : a practice audit : original researchSource: South African Family Practice 48 (2006)More Less
<I>Background:</I> To obtain an adequate cervical (Papanicolaou) smear, the transformation zone, including the squamo-columnar junction, should be sampled as carcinoma develops preferentially in this transformation zone. The Ayre spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency, including the cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre spatula as opposed to the cytobrush. <br><I>Methods:</I> This was a retrospective analytical study. One sampler, an experienced general practitioner, took the smears in the period 1990 to 2004. Initially, the Ayre spatula was used to consecutively sample the cervix and thereafter, a cytobrush alone was used. Two groups were thus formed for comparison. The presence of endocervical cells was accepted as an indicator of an adequate smear. A Cusco speculum was used to visualize the cervix. The sample was smeared onto a slide and fixated with an alcohol aerosol spray. <br><I>Results:</I> A total of 4561 smears were taken and 247 had no endocervical cells. A further 34 smears were classified as unsatisfactory due to the presence of degeneration (19), insufficient squamous cells (7), inflammatory exudate (4), excess blood (3) and/or a thick slide (1).The cytobrush group was similar demographically to the Ayre spatula group: 1981 (99%) and 2490 (98%) respectively were non pregnant; 67 (3%) and 110 (4%) were nulliparous, 1008 (50%) and 1370 (54%) were para 1 - 5, and 931 (46%) and 1075 (42%) were para 6 or more; 0 (0%) and 2 (0.1%) were aged between 10 - 19 years, 1496 (75%) and 2012 (78%) between 20 - 49, and 510 (25%) and 541 (21%) were aged 50 years or more. Of 2006 smears taken with a cytobrush, 1955 (97.5%) contained endocervical cells compared with 2325 (91%) of 2555 smears taken with an Ayre spatula. The difference was significant with an Odds Ratio of 4.56 (95% Confidence Interval 3.42-6.42). <br><I>Conclusion:</I> The cytobrush is significantly more efficacious than the Ayre spatula in obtaining adequate cervical smears. Use of the cytobrush will ensure less repeat smears with a consequent reduction in workload for samplers and laboratories. Although very few smears lacked sufficient squamous cells (an indicator of adequate ectocervical sampling), current best practice is that the cytobrush be used together with a wooden spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone.
The smoking habits, attitudes towards smoking and knowledge regarding anti-smoking legislation of students in institutions of higher learning in the Eastern Cape Province of South Africa : original researchSource: South African Family Practice 48 (2006)More Less
<I>Background:</I> The study aimed to i) investigate the smoking habits of students attending tertiary institutions of learning in the Eastern Cape Province (ECP) and ii) determine the knowledge of the students about the health hazards of smoking and their attitude towards current government anti-smoking legislation. <br><I>Methods:</I> This was a questionnaire-based study involving all seven tertiary institutions of learning in the ECP, viz. the Universities of Transkei, Fort Hare, Port Elizabeth and Rhodes University, and the Border, Eastern Cape and Port Elizabeth technikons. A total of 1 728 students were interviewed out of a student population of 30, 080. Stratified random sampling was used to select the students. Two-way tables were used to test the independence of the variables and chi-square tests were applied. A 'p' value of below 5% was used as a test of significance. <br><I>Results:</I> A total of 1 480 students completed the questionnaires (86%). The racial classification of the respondents was 79% Black, 13% White, 7% Coloured and 2% Indian. Twenty-six per cent of the students were smokers, of which 37% were male and 15% were female. Forty-five per cent of the Coloured students smoked, while the figures for Whites and Blacks were 26% and 25% respectively. Seventy per cent of the students smoked less than 10 cigarettes a day. Fifty-two per cent of the smokers said they wanted to stop smoking. Sixty-one per cent had been influenced to start smoking by their friends and only 13% were influenced by advertisements. Ninety-four percent agreed that smoking was dangerous to the smoker's health, while 73% responded that there was a relationship between mothers who smoke and low birth weight. Thirteen per cent thought the legislation was too tough, while 30% said it was good as it was. On measures to reduce smoking, 86% favoured restricting smoking in public places. <br><I>Conclusion:</I> This study has demonstrated that smoking is prevalent in tertiary institutions of learning in the Eastern Cape Province. The demographic profile of the smokers reflects the national picture. The knowledge of the harmful effects of smoking is generally good.
Source: South African Family Practice 48, pp 20 –28 (2006)More Less
Worry is a normal response to uncertainty. Education, empathetic support, reassurance, and passage of time usually ameliorate ordinary worries. However, these common-sense strategies for dealing with transient worries often prove ineffective for patients with excessive worry, many of whom meet the criteria for disorders in the <I>Diagnostic and Statistical Manual of Mental Disorders, </I> 4th ed. Evidence-based treatments for such disorders can assist family physicians in management of persistent worry as a self-perpetuating habit across diagnostic categories. Antidepressants and cognitive behavioural therapy are effective treatments for various disorders characterised by excessive worry. Cognitive behavioural strategies that may be adapted to primary care contacts include education about the worry process, repeated challenge of cognitive distortions and beliefs that underpin worry, behavioural exposure assignments (e.g., scheduled worry periods, worry journals), and learning mindfulness meditation.
Source: South African Family Practice 48, pp 30 –36 (2006)More Less
Chronic plaque psoriasis, the most common form of psoriasis, is a papulosquamous disease defined by erythematous plaques with a silvery scale. The diagnosis usually is clinical, but occasionally a biopsy is necessary. Psoriasis affects 0.6 to 4.8 percent of the U.S. population, and about 30 percent of affected patients have a first-degree relative with the disease. Psoriasis is a T-cell-mediated autoimmune disease, but certain medications and infections are well-known risk factors. Management of psoriasis includes education about chronicity, realistic expectations, and use of medication. Steroids and vitamin D derivatives (e.g., calcipotriene) are the mainstays of topical therapy. Topical steroids and calcipotriene together may work better than either agent alone. Patients with psoriasis involving more than 20 percent of their skin or those not responding to topical therapy are candidates for light therapy; traditional systemic therapy; or systemic treatment with immunomodulatory drugs such as alefacept, efalizumab, and etanercept.
Author A. JamiesonSource: South African Family Practice 48, pp 38 –41 (2006)More Less
Family practitioners play an important role in educating patients about the prevention of malaria. Many patients still believe that malaria prophylaxis is negotiable and it is the family practitioner's duty to fully inform patients about the deadly complications of malaria and the rationale behind chemoprophylaxis. This article is patient orientated and will provide the family practitioner with useful information for this important task.