South African Family Practice - Volume 51, Issue 3, 2009
Volume 51, Issue 3, 2009
Author Gboyega A. OgunbanjoSource: South African Family Practice 51 (2009)More Less
The CPD section of this issue of the SA Family Practice journal starts with the sixth in the series on healthy lifestyle interventions in general practice. This article focuses on "Lifestyle and metabolic syndrome" by Schwellnus MP et al.They indicate upfront that there is no clarity on the precise definition of the metabolic syndrome but there is consensus that it is a cluster of inter-related risks factors namely elevated blood pressure, elevated plasma glucose and atherogenic dyslipidemia, due to mainly abdominal obesity and insulin resistance. In the article, the authors further explain that the prevalence of metabolic syndrome is increasing globally with its prevalence in developed countries about 30% in the adult population. In the South African population, the prevalence of the syndrome is not known as national prevalence surveys have not been done. But prevalence studies on obesity point in the direction of increasing numbers of men and women who are over weight or obese. In terms of management, lifestyle intervention is consistently regarded as the first line treatment and the cornerstone of management. This includes nutritional intervention, promotion of physical activity, psychosocial care and education. The article has practical strategies on how to implement the lifestyle intervention and ends with the importance of follow up assessment to re-set goals for achievable outcomes in the patient.
Source: South African Family Practice 51, pp 177 –181 (2009)More Less
Although there is no clarity on the precise definition of the metabolic syndrome, there is consensus that it is a cluster of inter-related risk factors(elevated blood pressure, elevated plasma glucose, atherogenic dyslipidaemia) that are due to mainly abdominal obesity and insulin resistance, and which appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD), and increase the risk for developing type 2 diabetes mellitus. The prevalence of the metabolic syndrome is increasing globally, including in the adolescent population. In developed countries the prevalence of the metabolic syndrome is about 30% of the adult population. The cornerstone of management of this syndrome is lifestyle intervention. Following a comprehensive initial assessment to risk-stratify patients, they are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of a lifestyle intervention programme for metabolic syndrome are nutritional intervention (mainly for weight loss and to improve the atherogenic dyslipidaemia), exercise training (minimum of 30-60 minutes at moderate intensity on most days of the week), and psychosocial interventions. Regular monitoring should be conducted and a follow-up assessment is indicated after three months to assess progress and to re-set goals. Longer-term (5-6 months) and supervised intervention programmes are associated with better long-term outcomes.
Author M.J. MpeSource: South African Family Practice 51, pp 182 –185 (2009)More Less
Smokers have an approximately 12% lifetime risk of developing a primary spontaneous pneumothorax. It is rarely life-threatening and is mainly treated by aspiration. Secondary spontaneous pneumothoraces occur mostly in patients with chronic obstructive pulmonary disease, they have a mortality rate of approximately 1% and most patients require a tube thoracostomy with instillation of a sclerosing agent. Successful prevention of recurring secondary pneumothoraces requires more invasive surgical procedures. This article provides a short overview of spontaneous pneumothorax and its treatment.
Author M.H. MotswalediSource: South African Family Practice 51, pp 186 –187 (2009)More Less
The porphyrias are a group of disorders in which excessive quantities of porphyrins or their precursors are produced. They are due to abnormalities in the control of the porphyrin-haem metabolic pathway. The porphyrias are classified into acute and chronic. The acute porphyrias are acute intermittent porphyria (AIP), porphyria variegata (PV) and hereditary coproporphyria (HCP). The chronic porphyrias are porphyria cutanea tarda (PCT), erythropoietic protoporphyria (EPP) and congenital erythropoietic porphyria (CEP). They are further classified as hepatic or erythropoietic, depending on the major site of abnormal metabolism. This article is about PCT, which is more common in South Africa than the other porphyrias and is classified as chronic and hepatic.
Source: South African Family Practice 51, pp 188 –193 (2009)More Less
Arthritis is a common cause of pain and disability in adults. In this article, the first in a series of two articles on arthritis, a clinical approach to musculoskeletal disorders is reviewed, with emphasis on the history and examination as the basis for diagnosis of common rheumatic disorders. A simple step-by-step clinical approach is discussed and basic investigations are considered in the context of clinical findings. Some common clinical pitfalls in diagnosis are highlighted. Broad principles of management of rheumatic diseases are briefly discussed as a prelude to the second article in which an in-depth approach to the management of rheumatoid arthritis is covered.
Source: South African Family Practice 51, pp 194 –195 (2009)More Less
In the practice of medicine, the idea of confidentiality is articulated in almost all its oaths, guidelines and codes. Dating at least as far back to the Hippocratics, swearing that "... What I may see or hear in the course of the treatment, or even outside of the treatment, which of no account one must spread abroad, I will keep to myself ..." Confidentiality is not only of practical importance (who would continue to consult with a doctor who divulged personal information), but it is an ethical mandate as well. Privacy is similar in that it concerns one's person and is value-laden. The distinctions between confidentiality and privacy however are often unclear. In this article, we will articulate some of the conceptual differences, similarities and end with an example from current news which illuminates both concepts.
Author B. BromSource: South African Family Practice 51, pp 196 –197 (2009)More Less
These studies show that poor lifestyle management may be the cause of arteriosclerosis and that it is reversible; good lifestyle choices can reverse this problem. Denke has estimated that reducing meat intake, increasing intake of antioxidant-rich fruits and vegetables, eating fibre-rich complex carbohydrates, and consuming low-fat dairy products can reduce cardiovascular disease risk by as much as 90%.
Author Pierre J.T. De VilliersSource: South African Family Practice 51 (2009)More Less
There can be no doubt that denying / refusing care to patients in need, through act or omission, goes against the centuries old ethical principles of the medical profession, embodied in the Hippocratic Oath. Legislation also prohibits doctors from striking in South Africa. And yet in spite of all this a strike was mooted by the SAMA leadership, says Prof Mac Lukhele, SAMA Executive Committee member and Chairman of the Committee for Public Sector Doctors: "However, we put our patients first and organising a strike would be a last resort." Last resort? How can a strike put patients first? The fact that a strike was even contemplated is shocking to say the least. Two wrongs do not make a right, and the government's feet-dragging in the implementation of the OSD and poor working conditions do not make a strike by doctors any more legitimate or ethical. Striking public sector doctors not only add to the suffering of the poorest of the poor but also add to the tarnishing of the profession's image. In the long run the damage to the profession will be more than the gain. There are other ways to make your point.
Source: South African Family Practice 51, pp 202 –205 (2009)More Less
Randomised controlled trials form the foundation for 'evidence-based-medicine', but the results of such research can be relied upon only if it was conducted according to principles and standards collectively referred to as 'Good Clinical Practice' (GCP). The GCP was established as a basis both for the scientific and ethical integrity of research involving human subjects and for generating valid observations and sound documentation of research findings. It provides a framework for clinical investigators and pharmaceutical companies to conduct clinical trials according to similar rules and regulations, to ensure clinical research is consistently performed to high ethical and scientific standards and an assurance that the data and reported results are credible and accurate, and that the rights, integrity, and confidentiality of trial subjects are protected. Thus the GCP protects the rights, safety and well-being of subjects and ensures that investigations are scientifically sound and advance public health goals.
Person-centred counselling to ameliorate symptoms of psychological distress among South African patients living with hypertension and diabetes : results of an intervention study : original researchSource: South African Family Practice 51, pp 206 –210 (2009)More Less
Background: Previous research, internationally and in South Africa, suggests that symptoms of depression and anxiety are prevalent among patients living with a chronic illness. Very few behavioural interventions have shown to be effective in ameliorating such symptoms among patients attending public health clinics in South Africa. In this study, a five-session counselling programme was tested to ameliorate symptoms of depression and anxiety in clinic patients living with diabetes and hypertension in the Western Cape, South Africa.
Method: A convenience sample of patients (n = 37) was recruited from two public clinics. The sample was non-randomly assigned to a treatment group (n = 20) and a control group (n = 17), and assessed before and after the intervention was presented. A battery of instruments consisting of the Hopkins Symptom Checklist, the Beck Depression Inventory, and the Beck Anxiety Inventory was administered before and after the intervention.
Results: The results indicate that person-centred counselling was effective in ameliorating general psychological distress and symptoms of depression, but not symptoms of anxiety, as measured by the above instruments. The results suggest that psychological counselling may be helpful to medical patients.
Conclusions: While counselling interventions may be well placed in public health settings from the perspective of treatment efficacy, it is necessary to temper this recommendation with an understanding of the barriers to implementing such services and the resulting impact on therapeutic effectiveness.
Source: South African Family Practice 51, pp 211 –215 (2009)More Less
Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons,medical professionals, often from sub-Saharan Africa, are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally, a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has, however, been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin, than do pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions, high levels of crime and violence, political instability, lack of future prospects, HIV / AIDS and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals, source countries also face substantial monetary implications caused by the migration of doctors. Government subsidy of medical students' training could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who had emigrated from South Africa.
Methods: The investigation was conducted in 2005 as a descriptive study of participants found primarily by the snowball sampling method. The initial participants were known to the researcher. Participants had to be graduates from South African medical schools / faculties, living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information,consent letters and questionnaires were either hand-delivered or e-mailed, and completed forms and questionnaires were returned via these routes.Participation was voluntary.
Results: Twenty-nine of 43 potential participants responded, of which 79.3% were male and 20.7% female between the ages of 28 and 64 years(median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985), and the year of leaving the country ranged from 1993 to 2005(median 2002). The majority (72.4%) were in private practice before they left, 27.5% had public service appointments and 17.3% were employed by private hospitals. Seventy-nine per cent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand, United Arab Emirates, Bahrain, United Kingdom, Canada, Yemen and Australia. Forty-one per cent of respondents indicated that they would encourage South African young people to study medicine, although 75% would recommend newly graduated doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2% of the respondents, better job opportunities by 79.3%, and the high crime rate in South Africa by 75.9%. Only 50% of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9%) of the respondents indicated that they already had family abroad by the time they decided to emigrate.
Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations,followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously, the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality health care, issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders.
Health risk behaviours of high school learners and their perceptions of preventive services offered by general practitioners : original researchAuthor C. ThomasSource: South African Family Practice 51, pp 216 –223 (2009)More Less
Background: Adolescence spans nearly a decade in which young people may initiate health risk behaviours such as unsafe sexual practices and the use of alcohol, tobacco and other drugs (ATOD use). Most adolescent mortality and morbidity, attributable to such health risk behaviours, are preventable. Managing the consequences of health risk behaviours is costly and does not reduce the number of young people making these unhealthy lifestyle choices. The emphasis needs to shift towards the provision of adolescent primary and secondary preventive services. Overseas efforts involve national health risk behaviour screening, the application of national guidelines for primary health care workers in all contexts and continuing evaluation so that appropriate region-specific policies can be instituted. In spite of the completion of the second South African National Health Risk Behaviour Survey and the implementation and evaluation of the National Adolescent-Friendly Clinic Initiative (NAFCI) in government clinics, South Africa still lacks national guidelines for the primary health care worker to administer adolescent preventive services. Furthermore, the NAFCI initiative does not involve the general practitioner (GP) in the private sector. The aim of the research is to provide a profile of adolescent health risk behaviours and describe their GPs' provision of preventive services to address these health risk behaviours.
Methods: This cross-sectional descriptive study was conducted among senior high school learners (grades 10, 11 and 12) from 18 randomly selected secondary public, coeducational schools with an ordinary curriculum in the Johannesburg educational districts, during the first three school terms of 2002. A self-administered research questionnaire was used to ascertain learners' self-reported involvement in health risk behaviours and their interaction with their GP in dealing with these health risk behaviours.
Results: The research questionnaires were completed by 1 139 learners.
- Learners reported a high prevalence of health risk behaviours: 65% for alcohol use, 57% for sexual activity, 39% for tobacco use and 15% for drug use.
- The predominant pattern of substance use was the experimental pattern of having tried these substances: 40% for cigarette use, 53% for alcohol use, 54% for injected drug use and 57% for other drug use. The majority of sexually active adolescents were practising unsafe sex: 55% with multiple partners, 52% without condoms and 28% without family planning.
- Learners reported a high prevalence of coexisting health risk behaviours: 44% for alcohol use and sexual activity, 36% for tobacco and alcohol use and 26% for tobacco use and sexual activity.
- Risk perception was lower for sexual activity (25% felt in danger and 5% felt affected) than for substance use (an average of 82% felt in danger and 40% felt affected).
Of the 1 139 learners, only 271 learners (24%) had a GP in private practice.
- The adolescent-GP interaction was favourable for preventive service delivery: 70% of learners had medical aid cover, 41% had been seeing their GP for more than five years, 92% had a 'family' doctor, 80% had visited their GP in the past six months and 60% had consulted their GP on their own at least once.
- Primary preventive service delivery to those not involved in health risk behaviours was poor: 28% for sexual activity, 24% for drug use, 23% for alcohol use and 19% for tobacco use.
- Uncovering of health risk behaviours occurred to varying degrees: 40% for sexual activity, 18% for alcohol use, 18% for tobacco use and 11% for drug use.
- Secondary preventive service delivery to those involved in health risk behaviours was better: averages of 89% for sexual activity, 84% for drug use, 54% for tobacco use and 38% for alcohol use. Statistically significant learner and GP demographics highlighted the complex dynamics involved in this interaction.
Conclusions: The study showed that adolescents from economically disadvantaged backgrounds have a high prevalence of health risk behaviours but utilise the GP resource to a limited degree. Despite the interaction between adolescent and GP being conducive to the receipt of primary and secondary preventive services, this is not optimal.
Author G.A. OgunbanjoSource: South African Family Practice 51, pp 224 –227 (2009)More Less
Background: Snakebites remain a source of considerable morbidity and mortality in many countries, with an estimated global true incidence of envenomation exceeding five million a year, with about 100 000 of these cases developing severe sequelae. Despite the availability of polyvalent snake antivenom, inappropriate first aid, regional effects of envenomation and inappropriate use of antivenom result in significant and at times potentially avoidable morbidity and mortality, particularly in children. The study was undertaken in Lephalale (previously Ellisras) Hospital, Limpopo Province, due to the frequency of snakebites managed at the hospital.
Methods: This was a record-based retrospective study in which patient files with the diagnosis of snakebite were reviewed. The objective of this study was to document the management of snakebites at Lephalale Hospital, a rural hospital in South Africa. The hospital files of all patients managed at the hospital for snakebites from 1 January 1998 to 31 December 2001 were reviewed.
Results: Seventy patients were treated for snakebites during the study period. The results showed a male preponderance (60%) and a mean age of 27.3 years among the reported cases. Twenty-nine patients (41.1%) were bitten between dusk and dawn (18:00 and 06:00), 43 (61.4%) were bitten on the lower limb and the mean duration of admission in the wards was 4.2 days. Twenty-one bites (30%) were attributed to known poisonous snakes, 22 (31.4%) patients received polyvalent antivenom, 42 (60%) received promethazine, which has not been shown to prevent anaphylactic reactions, 12 (17.1%) developed complications and two died (a case fatality rate of 2.9%). None of the patients was given tetanus toxoid as prophylaxis, as no previous tetanus immunisation was documented.
Conclusions: The findings of this study highlight gaps in the management of snakebites at this rural hospital where they were treated frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. Elevation of the affected limb, administration of intravenous fluids and administration of analgesia, with close monitoring of patients during and after antivenom administration, form the basis of most clinical protocols on the management of snakebites.
Source: South African Family Practice 51, pp 228 –236 (2009)More Less
Background: Disability grants in South Africa increased from 600 000 in 2000 to almost 1.3 million in 2004. This rise can be attributed to the HIV / AIDS epidemic, South Africa's high rate of unemployment and possibly an increased awareness of constitutional rights. The Western Cape, which has a disability prevalence of 3.8%, has also experienced an influx of applications. The study was conducted at Bishop Lavis Community Health Centre (BLCHC) in the Cape Town Metropole, Western Cape. The primary aim of this study was to establish the profile of adults applying for disability grants at Bishop Lavis. The secondary aim was the determination of the degree of activity limitation and participation restriction by means of the International Classification of Functioning, Disability and Health (ICF) shortlist of activity and participation domains.
Methods: A descriptive study was conducted with emphasis on identifying and quantifying the relevant factors. The population studied included all prospective adult (18-59-year-old females and 18-64-year-old males) disability grant applicants in Bishop Lavis over a two-month period (April-May 2007). A structured, self-compiled questionnaire was administered during face-to-face interviews with applicants. The questionnaire included the demographic details of the applicants, disability/chronic illness/condition, educational level and social/living conditions. The second part of the questionnaire was based on the ICF shortlist of activity and participation.
Results: There were 69 respondents over the period of data collection. Of the 69 applicants who participated in the study, 45 (65%) received a temporary disability grant, 6 (8%) received a permanent grant and 18 (26%) applications were rejected. The results demonstrated that most applicants were females over the age of 50, were poorly educated with chronic medical conditions and were living in formal accommodation with good basic services but with minimal or no disposable income. The ICF questionnaire responses showed that the majority of respondents had no difficulty in most domains, except for the general tasks and demands (multiple tasks), mobility (lifting and carrying, fine hand use and walking) and domestic tasks domains, which showed high percentages of severe to complete difficulty. However, further statistical analysis showed no association between degree of difficulty in the above domains and eventual outcome of type of grant received.
Conclusions: This study confirmed that unemployment and a lack of income are the factors influencing patients to seek assistance in the form of disability grants. Most applicants had a chronic medical condition and reported functional restrictions but only received a temporary grant. This may be an indication that most patients require further evaluation before a final decision can be made. There is a need for a standardised, objective assessment tool for disability grant applications. A campaign to educate patients about disability grants could save patients and hospital medical services time and money.
Immigrants' and refugees' unmet reproductive health demands in Botswana : perceptions of public healthcare providers : original researchSource: South African Family Practice 51, pp 237 –243 (2009)More Less
Background: The healthcare of Batswana (citizens of Botswana) as indicated in the country's Vision 2016 is one of the top priorities of the government of Botswana, yet Botswana's National Health Policy, the Immigration Policy and the National Sexual and Reproductive Health Programme Framework all are silent on the obligations of the government to provide health services to the immigrant and refugee population. In view of the high prevalence of HIV / AIDS in Botswana, South Africa and other sub-Saharan countries, it is critical that reproductive health services be as affordable and accessible for the immigrants and refugees as they are for other residents in Botswana.
This study measured the views of the primary healthcare providers in Botswana on the perceived reproductive health needs of immigrants and refugees and the availability and accessibility of reproductive healthcare services to the immigrant and refugee populations in the country. This information will be important for policy makers, the government of Botswana and the private sector to shape intervention measures to assist immigrants and refugees in seeking and accessing the desired reproductive health services.
Methods: The study targeted all 4 667 medical doctors and nurses who were serving in various hospitals and clinics in 23 health districts of Botswana as at June 2005 when this study was conducted. Using NCS Pearson statistical software, the sample size for the study was determined to be 851. This estimated sample size was allocated to the 23 health districts (strata) using probability proportional to size (PPS). Having obtained the sample size for each district, the healthcare providers to be interviewed from each health district were selected randomly and in proportion to the number of doctors and nurses in each district.
Questionnaires were administered to these healthcare providers by research assistants, who explained the purpose of the study and obtained informed consent. The questionnaires were coded to ensure the anonymity of the respondents. It contained questions about the healthcare providers' demographic characteristics, their opinions on the reproductive health needs of immigrants and refugees, and their views on factors that influence the accessibility of these services to immigrants and refugees. Data were collected from 678 doctors and nurses (about 80% of the targeted sample).
Results: The majority of the healthcare providers indicated that the most important reproductive health needs of the immigrants and refugees, namely pregnancy-related services (prenatal, obstetrics, postnatal conditions), treatment for sexually transmitted infections (STIs), HIV / AIDS treatment and counselling and family planning were not different from those of the locals. However, some major differences noted between the local population and the foreigners were (i) that antiretroviral (ARV) treatment and prevention of mother-to-child-transmission (PMTCT) programmes were never accessible to the non-citizens; and (ii) that while treatments and other health services were free to Batswana, a fee was charged to non-citizens. Although 86% of the 21 studied reproductive health services were available in the healthcare system more than 50% of the time, only 62% of them were accessible to the immigrants and refugees 50% of the time. The major reasons for inability to access these services were: (i) The immigrants and refugees have to pay higher fees to access the reproductive health services; (ii) Once an immigrant or refugee is identified as HIV positive, there are no further follow-ups on the patient such as detecting the immune status using a CD4 count or testing the viral load; (iii) The immigrants and refugees do not have referral rights to referral clinics / hospitals for follow-ups in case of certain health conditions; and (iv) The immigrants and refugees are required to join a medical aid scheme to help offset part of the costs for the desired services.
Conclusions: The study recommended that the government of Botswana should improve the availability of reproductive health services to immigrants and refugees, and expunge those laws and practices that make it difficult for immigrants and refugees to access the available reproductive health services.
Epidemiological profile of non-daily smokers in South Africa : implications for practice : original researchAuthor O.A. Ayo-YusufSource: South African Family Practice 51, pp 244 –248 (2009)More Less
Background: This study sought to provide an epidemiological profile of non-daily (ND) smokers in South Africa.
Methods: Using data obtained from the 1998 South African demographic and health survey (SADHS) - the largest nationally representative dataset available - smokers were classified as non-daily (ND) smokers or daily smokers. NDS were defined as persons aged 18 and over who had ever smoked 100 cigarettes, but did not currently smoke daily.
Results: In 1998, an estimated 10% of current smokers were ND smokers (n = 255). Of the ND smokers, 69.7% had smoked daily in the past and currently smoked significantly fewer cigarettes per day (CPD) than current daily smokers (5.4 vs. 9.8). ND smokers were also significantly more likely to have made at least one attempt to quit smoking, live in smoke-free homes, have more than 12 years of schooling and live in urban areas. Compared to past daily ND smokers, those ND smokers who had never smoked daily smoked fewer CPD and were more likely to be younger than 25 years old.
Conclusions: The findings of this study suggest that the majority of ND smokers in South Africa are those trying to quit smoking rather than those initiating smoking. Smoking rates among ND smokers are still at a level that has been shown to pose significant health risks, therefore health practitioners should also prioritise non-daily smokers for interventions regarding smoking cessation.
The retention of community service officers for an additional year at district hospitals in KwaZulu-Natal and the Eastern Cape and Limpopo provinces : original researchSource: South African Family Practice 51, pp 249 –253 (2009)More Less
Background: Community service (CS) is an effective recruitment strategy for underserved areas, using legislation as the driver; however, it is not a retention strategy. By the end of each year, most CS officers working in district hospitals (DHs) are skilled, valued and valuable members of the health team, able to cope with the demands of working in the public health service within the resources available at DHs. Their exodus at the end of each annual cycle represents a net loss of valuable skills and experience by the public service, measured by the time and effort required to orientate and induct the following cohort of CS officers. This in turn has a negative effect on the level of service delivery and the quality of patient care.
This study sought to gain understanding of the motivations of CS officers to continue working at the same DH for a subsequent year after their obligatory year was over. The objectives were to determine the number of CS officers who actually remained at the same DH after completing their CS in 2002, the major factors that influenced them to remain and factors that would encourage the 2003 cohort of CS officers to remain at the same DH for an additional year.
Methods: A descriptive cross-sectional study design was employed using qualitative methods with the cohort of CS officers who had completed their compulsory CS year in 2002 and who were still working at the same DH in July 2003. This was followed by a quantitative survey of CS officers doing their CS at DHs in KwaZulu-Natal (KZN), the Eastern Cape (EC) and Limpopo Province (LP) in November 2003.
Results: Twenty-two out of 278 (8%) of the 2002 cohort of CS officers in KZN, EC and LP remained at the same DH in the year following their CS. The reasons given, in order of decreasing priority, were that they were close to home, had been allocated as part of their CS, had been personally recruited, had bursary commitments, had heard about the hospital from friends, had visited the hospital prior to starting CS and had visited as a medical student. Four CS officers did not specify reasons.
In the larger quantitative study 150 out of 221 questionnaires were returned. More than 80% of the respondents felt that there had been opportunities to develop confidence in their own ability to make independent decisions, that they had had good relations with the hospital staff and that they had been able to make a difference in health care delivery. Between 67% and 76% of respondents felt that they were providing a good standard of care, that there were learning opportunities, that they were doing worthwhile work and that CS provided excellent work experience. However, only 52% of respondents felt that there had been opportunities for personal growth, 38% felt that appropriate equipment was available, 37% had a supportive mentor figure and 29% felt that there were adequate levels of staffing at the hospital.
In total 24 (16%) of the 150 officers who responded to the questionnaire indicated a willingness to remain at the same DH after completion of their year of CS. The intention to continue for a further year was statistically significantly associated with the following factors: ethnic group, province, rural origin, allocation priority and bursary commitment.
Conclusions: The retention in the same DH of only 8% of the CS officer cohort in three rural provinces indicates a serious loss of skills on a recurrent annual basis. Local hospital management can do much to strengthen the factors that would attract CS officers to stay on by improving orientation, mentoring, teamwork, professional development opportunities, medical equipment and accommodation.
Rising rates of Caesarean sections : an audit of Caesarean sections in a specialist private practice : original researchSource: South African Family Practice 51, pp 254 –258 (2009)More Less
Background: Caesarean section (CS) rates are increasing worldwide; rates in the private sector in South Africa are reported to be particularly high. To the best of our knowledge there has been no recent audit of Caesarean sections performed by the private health sector in KwaZulu-Natal. The aim of this study was to carry out an audit of CS in a private practice.
Methods: An audit of the patient records over a period of one year was done. No personal identifiers were noted or reported on. All relevant clinical data were pooled and used to analyse the clinical information.
Results: There were 364 deliveries in the study period and 209 of these were CS, giving a rate of 60.4%. Most of the caesarean sections were carried out because of a previous CS; maternal request and HIV status also contributed to the high rate.
Conclusion: The high CS rate in private practice is probably a window to the increased rates of Caesarean section being performed worldwide. This high rate is in keeping with trends in countries such as South America, and is considerably higher than the ideal rate of 10 to 15% in low-risk obstetric populations suggested by the WHO.
Source: South African Family Practice 51, pp 259 –260 (2009)More Less
We conducted a study of death notification form (DNF) completion relating to 844 deceased Cape Town residents, and evaluated the completeness of information on the forms. The DNFs frequently lacked important data on both the deceased and the health professional who completed the DNF (completing health professional). Urgent intervention is needed to improve the usefulness of the DNF as a source data on health statistics in South Africa.
Source: South African Family Practice 51, pp 261 –262 (2009)More Less
Disseminated histoplasmosis can be the initial clue to the presence of AIDS. In HIV infected patients, histoplasmosis can present with unusual manifestations, without a positive exposure history or outside the typical endemic area. Untreated histoplasmosis can be potentially life-threatening and clues to diagnose it effectively and efficiently are essential.