South African Family Practice - Volume 52, Issue 6, 2010
Volume 52, Issue 6, 2010
Author Gboyega A. OgunbanjoSource: South African Family Practice 52 (2010)More Less
The year 2010 has been a momentous one, especially with the FIFA World Cup which took place for the first time on African soil. As the year winds down, I present the last issue of SA Family Practice, with five CPD articles. In addition, a new supplement of six ethics articles, for those struggling to meet their HPCSA continuing educational ethics requirements, form part of the package of this issue.
Source: South African Family Practice 52, pp 489 –491 (2010)More Less
Infants frequently present with oral lesions and conditions that may lead to anxiety among parents. The most common lesions and conditions include natal and neonatal teeth, the different oral mucosal cysts of the newborn, ankyloglossia and congenital epulis of the gingiva. The diagnostic features and management principles of these lesions are discussed in order for healthcare workers to provide proper care and counselling to patients and parents.
Author M.J. LabuschagneSource: South African Family Practice 52, pp 493 –497 (2010)More Less
Glaucoma is a sight-threatening condition. A general practitioner (GP) should be able to diagnose glaucoma, know about the different management options, and refer appropriately. The aim of this paper is to provide a background to glaucoma, and describe the assessment and management of glaucoma patients. The role of the GP in the management of glaucoma and in creating awareness of glaucoma is put into perspective.
Source: South African Family Practice 52, pp 499 –504 (2010)More Less
Contraception remains one of the most cost-effective public health measures to reduce rates of maternal and infant mortality. General practitioners (GPs) who provide contraceptive counselling should be able to discuss every eligible contraceptive method for the specific woman. In addition to contraceptive counselling, the GP can address other sexual and reproductive health issues, including the prevention of sexually transmitted infections at the same visit, providing a holistic approach. The World Health Organization (WHO) has online tools available to aid in contraceptive choice. The WHO Medical Eligibility Criteria for Contraceptive Use (WHO MEC) provides evidence-based recommendations to ensure that patients are medically fit to use a particular method and can safely select the most appropriate method of contraception. The Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Clinical Effectiveness (NICE) also provide extensive guidelines on the use of various contraceptives. This article guides product choice available in South Africa.
SEMDSA guidelines for the diagnosis and management of type 2 diabetes mellitus for primary health care : CPD articleSource: South African Family Practice 52, pp 507 –511 (2010)More Less
Author C. RogersSource: South African Family Practice 52, pp 514 –517 (2010)More Less
Diagnosis of disorders of balance is challenging, as there are broad differentials and patients may present to a variety of healthcare practitioners, ranging from an audiologist to a psychiatrist. In addition, investigations, both at the bedside and laboratory, are often non-contributory, expensive and unpleasant. The adult dizzy patient is regarded with dread by many in the healthcare community: the patient is difficult to diagnose and challenging to treat, and the situation is frequently complicated by the presence of anxiety, panic and depression. When symptoms arise in childhood they cause alarm in the parents and the treating healthcare professional. Diagnosis and management of balance disorders in childhood, is even more demanding when patients are frequently unable to communicate the nature of the complaint. Furthermore, the aetiology and presentation of vestibular disturbance is markedly different between adults and children. Symptoms of vestibular disorders in children may easily be mistaken for behavioural or other medical problems, leading to underdiagnosis and inappropriate investigations and treatment. Detrimental effects of childhood vestibular disorders may include delayed gross motor development, learning and spatial problems, and time off school. This review summarises the most common causes of childhood vestibular disorders and suggests the need for a multidisciplinary approach to assessment.
Author A. AdefolaluSource: South African Family Practice 52, pp 518 –520 (2010)More Less
The response to the HIV/AIDS epidemic by the various health systems in sub-Saharan Africa, that has the highest prevalence of the disease, has been quite significant in recent years. Millions of people are now benefiting from the services rendered for people living with HIV/AIDS. Considering the state of health systems in these countries that are not only plagued with HIV/AIDS, but have to contend with poor funding, inadequate facilities and shortage of health personnel, there is a need for a comprehensive approach in HIV/ AIDS services for it to be sustainable and meaningful in the context of developing nations.
Author J.A. KerSource: South African Family Practice 52, pp 523 –524 (2010)More Less
Statins are the most powerful cholesterol lowering drugs currently available. Statins inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase, which leads to reduced cholesterol synthesis. In addition, low-density cholesterol receptors on the hepatocyte surface are upregulated, leading to increased clearance of cholesterol. The end result is a significant reduction in cholesterol levels, and a consequent significant reduction in mortality and cardiovascular events in the appropriate individual.
Source: South African Family Practice 52, pp 527 –528 (2010)More Less
This review is based on a case study of a clinical presentation of schizophrenia with somatic and olfactory delusions and obsessive-compulsive symptoms (OCS). The patient was seen at the surgical out-patient department of the Dr George Mukhari Academic Hospital, Ga-Rankuwa, complaining of a dilated anus and requesting its reduction by the doctor on duty. The patient was later referred to the psychiatry department of the same hospital and diagnosed with schizophrenia with somatic delusions and OCS according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. He was screened for schizophrenia, OCS and olfactory and somatic delusions by means of a systematic psychiatric interview and the administration of specific assessment scales. The diagnosis was then confirmed to be schizophrenia with olfactory and somatic delusions and obsessive-compulsive disorder (OCD) features. This presentation suggests unique ways in which schizophrenia could present, including somatic and olfactory delusions and features of OCD, which may significantly influence the functional outcome of patients. This case study highlights the importance of identification and treatment of OCD in schizophrenia.
The President's Report of the 27th Annual General Meeting of the South African Academy of Family Physicians : editorialAuthor Shadrick MazazaSource: South African Family Practice 52 (2010)More Less
Members of the South African Academy of Family Physicians, colleagues, ladies and gentlemen. It is a great honour and privilege for me to deliver my report to the 27th annual general meeting (AGM) of the academy. Let me begin by offering my apology to you for the delay in convening this AGM because of our auditor's inability to complete and provide us with the financials in time for the last planned AGM. This resulted in a postponement not only of the AGM, but also of the elections for the new council of the academy.
Source: South African Family Practice 52, pp 531 –533 (2010)More Less
The Department of Family Medicine in the George Complex shares in the healthcare of about 600 000 people in the Eden and Central-Karoo districts. One of the roles of the department is to provide clinical backup to our colleagues working in the community. To this end, we regularly join the home-based carers on a weekly morning round. A recent visit provided a fascinating insight into the challenges facing home-based carers, and community care more broadly, but also highlighted the excellent opportunities for intervention when providing care to people in their own homes. Based on these insights and interviews with home-based carers and the group partly funding their work, we lay out some suggestions on how these challenges could be met.
Source: South African Family Practice 52 (2010)More Less
A successful meeting of diverse members of the palliative care community around the world was held at the University of Cape Town, under the auspices of the Division of Family Medicine, on 13 and 14 September 2010. The belief that palliative care is a primary care discipline, and that research in this area is especially needed to encourage evidence-based practice, is the main motivation behind the group which organised the gathering, the International Primary Palliative Care Research Group.
Author Steve ReidSource: South African Family Practice 52 (2010)More Less
To the editor: It was a short distance, no more than 50 yards or so, between the front door of our house and the entrance to the Outpatients and Casualty Department. But it was a huge distance psychologically between home and work, between family and the distress of sick patients. In early years it was unpaved, a dirt road that turned to sticky mud in the summer storms, through which we had to pick our way, step by step, through each one of those 50 yards. It was also part of the main entrance to the hospital, so it was a place of greetings and roadside conversations in Zulu, a familiar, shared space.
Author O. BrownSource: South African Family Practice 52, pp 536 –541 (2010)More Less
Background: Despite the multitude of challenges that families living with a child with diabetes face, they have been found to adapt to such an extent that diabetes is viewed as a manageable condition. This study was concerned with the factors that enable these families to adapt. The internationally acclaimed Resiliency Model of Stress, Adjustment and Adaptation served as the framework to conceptualise the families' adjustment and adaptation processes.
Methods: The study was triangular in nature, with an exploratory, descriptive approach; non-probability purposive and snowball sampling techniques were employed. Sixteen families participated in the research. A biographical questionnaire, which included an open-ended question, to be completed in written format, was used in conjunction with seven structured questionnaires to gather relevant data. These seven structured questionnaires were an operationalisation of some of the key concepts and processes of the Resiliency Model. Descriptive statistics were used to describe the biographical information. Quantitative data were analysed by means of correlation analysis, while qualitative data were analysed by means of content analysis.
Results: Various resilience factors were highlighted, including family time and routines, communication, hardiness, the acceptance of the diabetes, adherence to a treatment regimen, the obtaining of knowledge and skills, and working together as a family unit in managing the diabetes.
Conclusions: Family plays a powerful role both in the treatment of chronic illness and in paediatric practice. This article highlights the central role of family in the management of type I diabetes and provides practitioners with insight into the challenges that families face, as well as the strengths that can be developed to improve their resilience in relation to this chronic illness. The identified variables are valuable, in that they can be used as a map to guide prevention and intervention efforts in helping families live with type I diabetes.
Use of traditional medicine versus use of the community-based primary health care clinic by the San community at Platfontein : original researchSource: South African Family Practice 52, pp 542 –547 (2010)More Less
Introduction: Working amongst a San community led to the observation that, despite the availability of modern healthcare, high mortality and morbidity associated with disease, such as dehydration, malnutrition and tuberculosis, still prevailed. This study aimed to determine how traditional beliefs and customs influenced the utilisation of Western medicine.
Methods: An observational-descriptive study was conducted. Consenting patients, facilitated by interpreters, completed questionnaires during consultations conducted by nurses and the principal investigator at the Platfontein primary health care (PHC) clinic.
Results: Of the 113 participants, two-thirds were female. The median age was 40 years; 56.7% lacked formal education; 42.5% conversed only in their native tongue. The initial use of the PHC facility was high (71.4%), even though 37% of the participants visited a traditional healer in the preceding year. Circumcision was the condition for which traditional healers were consulted most commonly (28.8%). Conditions preferably requiring clinic visitation were coughing (51.4%), pain (35.1%) and diarrhoea (34.2%). Of the participants leading mostly a traditional lifestyle (n = 48), 30.6 % indicated that they did not use traditional medicine or healers; 72.9% indicated that illness could be caused by a spell. Of the participants not leading a traditional lifestyle (n = 41), 85.4% indicated that they did not use traditional medicine; 41.4% indicated that illness could be caused by a spell.
Conclusion: The assumption that the mortality and morbidity observed for certain conditions were due to the preference for traditional medicine in this community could not be confirmed. Doctors working amongst isolated communities or in multicultural environments, however, should recognise that traditional medicine still plays a role in the health care of their patients.
Validating that palliative care giving is a stressful occupation : the case of the Kanye community home-based care programme, Botswana : original researchAuthor S.M. Kang'etheSource: South African Family Practice 52, pp 548 –556 (2010)More Less
Background: It remains an incontrovertible fact that the phenomenon of HIV/AIDS has not only posed major health and development challenges, but is also a stressor experienced at local, regional and global levels. This article explores the stress-related challenges facing volunteer palliative caregivers in the Kanye community home-based care (CHBC) programme.
Methods: The study was explorative in nature and qualitative in design, and used convenience sampling methodologies to involve 82 registered primary caregivers and the five CHBC nurses in the programme as research participants. Participant observation was also used.
Results: The study found the following aspects inherent in care giving to be immensely stressful and challenging:
- Heavy caseload of the caregivers;
- Ageing of the caregivers;
- Stigma and discrimination abound in care giving;
- Conflict between caregivers and clients;
- Poor state of referral networks;
- Inadequate care packages;
- Poverty of the caregivers themselves; and
- Inadequate food, psychological support and community support networks.
Conclusion: The study recommends that putting in place a favourable working atmosphere and environment to address the stresses and stressors of care giving would be pivotal to improve this occupation.
Determinants of patient satisfaction with physician interaction : a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria : original researchSource: South African Family Practice 52, pp 557 –562 (2010)More Less
Background: Patient satisfaction influences the outcomes of the physician-patient encounter. Patient satisfaction has become a significant health care outcome and a useful indicator of the quality of care. The aim of the study was to assess the level of satisfaction among Obafemi Awolowo University Health Centre attendees in relation to physician-patient interaction and ascertain the relationship between the different aspects of physician-patient interaction, patient satisfaction and adherence intent.
Methods: Demographic information and information on patients' feelings about their doctors was collected from 300 consenting patients in a cross-sectional survey, using an adapted Medical Interview Satisfaction Scale self-administered questionnaire. Data were analysed with SPSS version 11. Logistic regression was conducted to identify the factors predicting patient satisfaction and adherence intent.
Results: Of the 300 patients studied, 63.3% were generally satisfied with their physician-patient interaction. Nineteen per cent of patients were uncertain of their level of satisfaction. Patient satisfaction was positively associated with adherence intent. Patient confidence in the doctor and good communication skills and information provision on the part of the doctor predicted patient satisfaction, while patient confidence in the doctor and information provision by the doctor predicted adherence intent.
Conclusions: A fifth of the study subjects were dissatisfied with their doctor-patient relationship. This study suggests the need for primary care physicians to be aware of the important place of interpersonal skills development in the application of medical knowledge and expertise in the provision of health care.
Attitudes, perceptions and understanding amongst teenagers regarding teenage pregnancy, sexuality and contraception in Taung : original researchSource: South African Family Practice 52, pp 563 –572 (2010)More Less
Background: South African teenage pregnancy rates remain high by international comparison and, in the rural town of Taung, the rate of 13% is twice the national average of 6.5%. Teenage pregnancy is a risk factor for disruption of education, future unemployment, sexually transmitted infections, HIV, preterm birth and poor mental health. The aim of this study was to understand the attitudes and perceptions of teenagers in Taung regarding teenage pregnancy and to explore their understanding of sexuality and contraception. This study intended to contribute to a deeper understanding by exploring teenagers' own perceptions on the matter, to identify factors that, in their view, may influence the risk of pregnancy and suggest possible interventions. No previous studies from the Taung area have been identified.
Methods: The qualitative study entailed 13 in-depth interviews with pregnant teenagers and three focus groups: one with 10 women aged 19 to 25 years who had a baby as a teenager, one with 14 teenage girls aged 16 to 19 years who had never been pregnant, and one with 11 males aged 18 to 23 years. Qualitative data was analysed through the framework method.
Results: Factors influencing teenage pregnancy were found to be broad and complex:
- Socioeconomic factors included poverty, the controversial influence of the child support grant, transgenerational sex and financial support from an older partner to secure income for the teenage girl or her family.
- Substance abuse, particularly alcohol, in either the teenager or her parents was found to have a critical influence. A lack of alternative entertainment and social infrastructure made shebeens (local bars) a normal part of teenage social life.
- Peer pressure from boyfriends and the broader social network.
- Other factors included the right to motherhood before becoming HIV positive, poor sexual negotiation skills, the need to prove one's fertility, sexual coercion and low self-esteem.
Conclusions: The study identified a number of factors that may influence the teenage pregnancy rate. These factors may influence teenagers' behavioural intentions through altering their perceptions of the personal and social consequences of falling pregnant and their self-efficacy in relation to sexual behaviour. Environmental factors may also facilitate or prevent teenagers from fulfilling their intentions. Teenagers may also vary in their ability to carry out these intentions. Strategies to reduce teenage pregnancy should focus on building social capital for teenagers in communities, further exploring the influence of the child support grant, targeting transgenerational sexual norms, applying the law on underage drinking, making information on contraception more accessible and offering programmes that empower girls in the area of sexuality. Multifaceted and intersectoral approaches are required and it is likely that strategies to reduce teenage pregnancy will also impact on HIV and other sexually transmitted infections.
Author W.N. RaufSource: South African Family Practice 52, pp 573 –575 (2010)More Less
Background: The World Health Organization expressed concern that older people in Africa who are ignored and excluded from HIV-prevention programmes are increasingly being infected with HIV. Studies show an inadequate awareness of the risks of HIV in the older female population. Older women are more susceptible to HIV because menopausal changes, such as vaginal dryness and thinning, increase the risk of HIV infection through tears and abrasions during unprotected sex. Furthermore, progression from HIV to AIDS occurs faster in the older population. Older women need to understand how HIV is transmitted and how it can be prevented in order to protect themselves. It may be postulated that health care providers are reluctant to discuss HIV-related issues with older female patients. The aim of this study was to determine whether older women could recall receiving HIV-related information from health care providers.
Methods: This was a prospective cross-sectional study among 100 women, aged 50 to 80, who attended the out-patient section at the Tshwane District Hospital during November and December 2006. Trained research assistants collected data in the patients' mother tongue. A questionnaire was administered during face-to-face interviews.
Results: Only 36% (95% confidence interval [CI]: 26.6% to 45.4%) of the respondents recalled receiving prior information regarding HIV from their health care providers. Of those, 19 (52.78%) said it was in the form of voluntary counselling and testing (VCT), and the remaining 17 (47.22%) received this information during general consultations. There was a statistically significant difference (p = 0.003; odds ratio [OR]: 0.26; 95% CI: 0.09-0.69) between their age stratification of 50 to 59 years and 60 to 80 years with respect to receiving information regarding HIV. In total, 23% of the respondents said they had been tested for HIV and most (n = 19; 82.61%) said they had received counselling. However, it is cause for concern that 17.39% (n = 4) of the respondents who had been tested could not recall receiving counselling.
Conclusions: This study shows that older women are neglected regarding the provision of HIV-related information. HIV and its risks to older patients is not routinely part of patient care. VCT seems to be an effective solution. However, there are problems even within the VCT system, since some of the participants claim to have been tested for HIV, without receiving counselling. It is suggested that part of the challenge may lie in the mindset of health care providers. Family physicians need to become proactive in terms of their own practice as well as in terms of their engagement with other health care professionals and students.
Source: South African Family Practice 52, pp 576 –578 (2010)More Less
Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is on the increase and accounts for 18% to 63% of OPC. It occurs mostly in young males with no other identifiable risk factors. The vast majority of HPV-associated OPC is attributable to HPV16. The prognosis of patients with HPV-positive OPC is better than patients with HPV-negative OPC. Oral HPV infection is linked to sexual transmission. The natural history, prevalence and possible risk factors in local communities should be studied to implement appropriate prevention strategies.