South African Family Practice - Volume 49, Issue 6, 2007
Volume 49, Issue 6, 2007
Prevalence of anaemia in pregnancy in the Uthungulu health district of KwaZulu-Natal, South Africa : original researchSource: South African Family Practice 49 (2007)More Less
Background: An estimated 30% of the world's population is affected with anaemia. Anaemia in pregnancy is a leading cause of maternal and perinatal deaths in developing countries. In developing countries, anaemia affects almost two thirds of the pregnant population. It is also estimated that anaemia is responsible for as much as 20% of all maternal deaths in sub-Saharan Africa. Maternal anaemia is a risk factor for infant iron deficiency anaemia and, if left uncorrected, can be associated with adverse behavioural and cognitive development in children. The prevalence of anaemia in pregnancy is estimated at between 35% and 75% in sub-Saharan Africa, however, the area-specific health problems during pregnancy are not known. In order to improve maternal health and the health of the foetus during pregnancy, knowledge of the prevalence or incidence of pregnancy-related conditions would be useful for district management teams, as well as for provincial and national maternal, child and women's health programme development. The objectives of this study were to describe haemoglobin levels and estimate the prevalence of anaemia among pregnant women at their booking visit.
Methods: A retrospective cross-sectional descriptive study was conducted using the antenatal clinic registers of primary healthcare (PHC) clinics in the Empangeni subdistrict of the Uthungulu Health District from July to December 2003. Data were gathered from 1 214 consecutive pregnant women who attended for antenatal care at three randomly selected primary healthcare clinics during the study period. We examined the distribution of Hb values to determine the percentages of women with anaemia (Hb < 10 gm/dL) and severe anaemia (Hb < 7 gm/dL), and compared this with the prevalence of anaemia according to the WHO definition (Hb < 11 gm/dL).
Results: In terms of the South African National Department of Health definition of anaemia in pregnancy, (haemoglobin < 10 gm/dL), 30.1% of the attendees were anaemic. According to the World Health Organisation (WHO) criteria (Hb < 11 gm/dL), the prevalence of anaemia was 57.3%. The difference in the prevalence of anaemia on the basis of the two different criteria was significant (p = 0.000). This finding was comparable to studies conducted in other Sub-Saharan African countries.
Conclusion: The prevalence of anaemia in pregnancy in this community is high. The prevalence of anaemia varied greatly when the WHO definition was used. The pregnant women of this community attend the healthcare facility very late for their booking visit, in spite of free maternity services at public health facilities. There is an urgent need for health education and health promotion programmes in this population for early booking for antenatal care. Further investigations are needed to establish the risk factors for, causes of and preventive interventions for anaemia in pregnancy.
Effect of the use of insecticide-treated bed nets on birth outcomes among primigravidae in a peri-urban slum settlement in South-East Nigeria : original researchSource: South African Family Practice 49 (2007)More Less
Introduction: Each year in sub-Saharan Africa, where 80 to 90% of the world's malaria cases occur, approximately 19 to 24 million women are at risk for malaria and its adverse consequences during pregnancy. The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent, predominantly low-grade, sometimes sub-patent, parasitaemia. In Nigeria, malaria has severe negative effects on maternal health and birth outcomes, resulting in maternal anaemia, a high incidence of miscarriages and low birth weight. Primigravidae and secundigravidae are most at risk.
Resistance to first-line antimalarials has increased in sub-Saharan Africa, and the available arsenal of alternative tools for malaria control in pregnancy is very limited. One of the most promising of these tools is insecticide-treated bed nets (ITNs), which have been shown to reduce the number of infective mosquito bites by 70 to 90% in a variety of ecologic settings. In Nigeria, the current use of ITNs by the at-risk groups, pregnant women and children under five years, is just 1%, according to the latest report of the Nigeria Demographic and Health Survey (NDHS).
Aim: This study aimed at examining the effects of the use of ITNs on pregnancy outcomes among 208 primigravidae.
Methodology: The study design was an analytical case control. One hundred and four subjects, the intervention group, received ITNs between August 2003 and January 2004. The other 104 subjects were the control. Data were obtained using the new World Health Organization antenatal care classifying form and the basic component checklist, and a self-structured, 30-item pre-tested questionnaire. The Apgar scores of the babies and their birth weights were observed and recorded for both the intervention and the control groups.
Results: The results showed that 83% of babies of mothers in the intervention group had a good condition at birth, while 87% of babies of mothers in the control group had a good condition at birth (p>0.07; X2=1.69). A small increase in mean birth weight (0.001kg) of the babies of mothers in the intervention group was observed over those of mothers in the control group (p>0.90). This showed that there were no significant beneficial impacts of the use of ITNs on foetal condition at birth, mean birth weight and low birth weight.
Conclusion: The use of ITNs by primigravidae in Okpoko, a peri-urban slum in south-eastern Nigeria, showed no significant impact on pregnancy outcome.
Involuntary admission of psychiatric patients in the Northern Cape Province and the accuracy of the initial psychiatric assessment done by the referring general practitioners : original researchSource: South African Family Practice 49 (2007)More Less
Background: Admission to a mental healthcare facility is not always based on the voluntary consent of the patient. Sometimes a patient is unable or unwilling to consent to admission because of his mental status and lack of insight into his mental illness. If a mentally ill person needs admission because of a threat to himself and other people, the law prescribes procedures to admit such a person into an appropriate facility for care, treatment and rehabilitation. Such admissions are called involuntary admissions. Involuntary admissions in a psychiatric hospital have financial, legal and ethical implications. In order to avoid unnecessary involuntary admissions, there is a need to determine and understand the factors causing involuntary admissions. Many previous studies have focused on the differences between patients admitted voluntarily and involuntarily. The goal of this study was to analyse the conditions responsible for the involuntary admission of psychiatric patients in the Northern Cape Province and the accuracy of the initial psychiatric assessment done by the referring general practitioners.
Method: This descriptive study included 199 patients admitted to West End Hospital in Kimberley for involuntary treatment during 2003. The data were extracted from clinical records and legal documentation relating to these patients. The patients' final diagnoses were extracted from the discharge summary and were based on the text revision of the fourth edition of DSM (DSM-IV-TR). Only diagnoses on axis I (clinical disorders and other conditions that may be a focus 1 clinical attention), axis II (personality disorders and mental retardation) and axis III (physical disorder or general medical condition that is present in addition to the mental disorder) were included in this study.
Results: Most patients were male (65.8%) and the patients' ages ranged from 16 to 67 years (mean 32 years). Patients were mostly diagnosed with schizophrenia (57.8%), while 26.6% had substance-related disorders. Few patients (5.0%) were diagnosed with mental retardation and personality disorders. A quarter (24.1%) of the patients had a general medical condition. The majority (81.4%) of patients were found "certifiable" and 77.4% were known psychiatric patients. Two-thirds of the patients were referred by general practitioners doing session for the state hospitals. The overall accuracy of psychiatric diagnosis by the referring doctors was considered correct if any of the provisional diagnoses listed by the referring (certifying) doctor matched with the final diagnosis at discharge from the hospital. Approximately half (49.5%) of the patients were diagnosed correctly by the referring doctors.
Conclusion: Schizophrenia and psychoactive substance-related disorders were the most important conditions leading to involuntary care in the Northern Cape. General practitioners play a major role in involuntary admission, but only made correct psychiatric diagnoses in approximately half of the patients.
An integrated approach to the prevention and promotion of health in the workplace : a review from international experience : open forumSource: South African Family Practice 49, pp 6 –9 (2007)More Less
This paper reports the results of a review of health promotion programmes in the workplace. The aim of this review was to ascertain evidence of success in health promotion in the workplace. Workplace health promotion (WHP) programmes help to improve employee health by optimising an organisation's overall economic, structural and cultural environment. It also tends to reach the healthy workers at the best companies, which are employing the healthier individuals in the formal sectors of the economy.
The workplace is viewed as an effective setting for health promotion in order to achieve the goal of "Health for All", and for other benefits such as reducing and controlling healthcare costs as a result of the growing epidemics of communicable and non-communicable diseases. Strategies to facilitate workplace health promotion include health education, behaviour-directed prevention, and incorporating the organisationâ??s development strategy into human resources policies to make prevention the essential part of the entire corporate strategy. A healthy, motivated and contented workforce is fundamental to the future social and economic wellbeing of any nation. The protection of employees against exposure to various occupational hazards can be achieved through implementing integrated programmes to improve employees' wellness and promoting a health- and safety-oriented culture in the workplace.
Author P.M. JoubertSource: South African Family Practice 49, pp 20 –24 (2007)More Less
Anxiety disorders represent some of the most common mental disorders. The lifetime prevalence rates for the different disorders are between 1% and 13%. Most anxiety disorders have a chronic, waxing and waning course. The impairment patients suffer due to the anxiety disorders ranges from mild to incapacitating. It is important that general practitioners understand the diagnostic and treatment concepts of the anxiety disorders to ensure early diagnosis and intervention in order to prevent undue suffering and impairment.
Author L. ScribanteSource: South African Family Practice 49, pp 26 –27 (2007)More Less
Nightmares are common in childhood and concern regarding underlying psychological or physical causes should only be investigated when nightmares become frequent, are present for a prolonged period of time or are associated with day-time behavioural or performance dysfunction. Sleep terrors may be provoked by a number of factors, such as: fever, sleep deprivation, urinary bladder distension, a noisy environment and central nervous system depressants. This article discusses the differences between nightmares and sleep terrors and provides a management approach for the family practitioner.
Author H.F. JordaanSource: South African Family Practice 49, pp 28 –29 (2007)More Less
Perniosis (chilblains) is an abnormal reaction to cold that occurs most frequently in women, children, and the elderly. Chilblains may be idiopathic and self-limited, or associated with systemic diseases. This article discusses the approach to the diagnosis and treatment perniosis and explains the concepts of acrocyanosis and erythrocyanosis.
Source: South African Family Practice 49, pp 30 –32 (2007)More Less
An underlying component of stress that manifests in physical symptoms is present in a high percentage of patients visiting the family practitioner, who is expected to help them cope with stress. In this article the transactional model of stress is briefly explained. Guidelines are given for assessing the role of stress in physical symptoms and for consulting with stressed patients. Subsequently, some stress moderators are discussed and guidelines are given for implementing these in practice. Lastly, primary, secondary and tertiary stress interventions in primary health care are briefly discussed.
Author Z. AbdoolSource: South African Family Practice 49, pp 34 –39 (2007)More Less
Urinary incontinence affects approximately a quarter of a billion people worldwide. It is associated with high economic costs, psychological morbidity and adverse effects on the quality of life. Despite this, few women seek help for this condition either due to embarrassment and unwillingness to discuss the symptom with their family member or friend or, acceptance of the disorder as a natural part of aging or being unaware that treatment exists. More resources are utilised in maintaining patients with chronic incontinence rather than for diagnosis and treatment of the condition. Urinary incontinence is a complex problem resulting from many different causes and for which many different approaches to treatment exist. The commonest types of incontinence include stress urinary incontinence, urge urinary incontinence and mixed incontinence.
Recently, better understanding of the pathophysiology of urinary incontinence has led to the development of numerous non-pharmacological, pharmacological and surgical interventions.