South African Family Practice - Volume 55, Issue 3, January 2013

Eating disorders frequently appear during the teen years or in young adulthood. Common eating disorders include nervosa, bulimia nervosa and binge-eating disorder. Eating disorders affect both men and women.

Objectives: There are challenges when it is considered that a main role of a rural clinical attachment for medical students is to encourage students to return after graduation to practise in rural areas. This view may lead to the relative neglect of other potential valuable roles with regard to rural exposure. This paper draws on the Force Field Model of teacher development to describe medical students' experiences, illustrate the complexity of interacting factors during rural exposure, caution that experiences cannot be predicted and highlight the positive incentives of a rural clinical attachment.

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Design: The design was explorative, descriptive and qualitative.

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Setting: The study setting was a district hospital in rural KwaZulu-Natal.

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Subjects: The participants were four final-year medical students who had completed a compulsory attachment during their Family Medicine rotation.

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Outcome measures: Data were collected using photo elicitation and analysed using the Force Field Model.

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Results: The participants felt that overall the experience was positive. The effect of biography and contextual forces were not as strong as expected. Institutional forces were important and programmatic forces tended to have a negative effect on experiences. The participants particularly enjoyed being acknowledged and felt empathy for the difficult tasks of doctors.

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Conclusion: The potential role of a clinical attachment may go beyond attracting students to practise in rural areas. The experience can be beneficial, irrespective of where the student decides to practise after graduation. There is a need for a review of the rural attachment curriculum and paedagogy. Caution should be used when screening medical students forsuitability to work in rural areas prior to rural exposure.

Background: Successful administration of antiretroviral therapy (ART) requires full adherence to the regimen by the patient.The introduction of ART needs a well-functioning health system with adequately trained health professionals, laboratory support, a constant supply of drugs and social systems to assist with patients' adherence and to prevent future treatment failure.

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Objectives: The objective of this study was to explore and describe the challenges experienced by nongovernmental organisations with regard to the roll-out of antiretroviral therapy.

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Design: A qualitative, exploratory and descriptive study was conducted to determine the challenges experienced by nongovernmental organisations (NGOs) with regard to the roll-out of ART in KwaZulu-Natal. Nine participants were included purposefully from the NGOs that participated in this study. Data were collected through semi-structured individual interviews. Open coding for analysis was used.

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Results: The findings revealed four themes: challenges relating to sustainability, adherence, health infrastructure and behaviour.

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Conclusion: The results indicate a need for multisectoral collaboration in the roll-out of ART to ensure a concerted,comprehensive and sustainable programme.

Objectives: In Nigeria, most people living with an elevated blood pressure are unaware of it until they suffer complications. The aim of this study was to determine levels of awareness of high blood pressure in Ward F, Ifako-Ijaiye local government area, Lagos, Nigeria.

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Design: A multistage sampling technique was used to select 250 participants as the study population.

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Setting and subjects: Trained interviewers administered questionnaires to collect information from the participants and measured their blood pressure to determine whether or not they had the correct information on their blood pressure readings.

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Outcome measures: The questionnaire included questions on respondents' knowledge of high blood pressure, sources of information or knowledge, awareness of blood pressure status and blood pressure measurement.

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Results:Radio was found to be the most utilised source of information on high blood pressure. The level of awareness of high blood pressure was 79.2%, while 21.6% of participants were aware of having high blood pressure. However, 37.2% had high blood pressure readings.

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Conclusion: Even though the level of awareness among participants was relatively high (79.2%), the study showed that many people who had high blood pressure readings were unaware of having high blood pressure. The knowledge of high blood pressure among these participants was insufficient, especially in grassroots communities. There is an urgent need for community-based high blood pressure awareness programmes.

Background: The Road to Health Chart (RTHC) is a record chart carried by the caregiver that combines essential informationon the growth monitoring of a child, immunisation, vitamin A supplementation, deworming medicine and other illnesses. It provides useful information to the parent and healthcare professional. This study sought to determine the challenges faced by professional nurses in monitoring the RTHC during consultation, the degree of implementation of the RTHC programme,and the most utilised aspect of the RTHC at Louis Trichardt Memorial Hospital and surrounding primary healthcare (PHC)clinics.

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Method: A cross-sectional study was conducted among 128 registered professional nurses. A self-administered questionnaire was used.

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Results: Ninety-six questionnaires were completed. Most of the respondents were female and aged 40-49 years. The majority of the PHC professional nurses stated that the challenges faced in monitoring the RTHC were staff shortages, lackof equipment, a work overload and unequal distribution of professional nurses on duty per shift. There was poor knowledge on how to identify malnutrition. The majority of PHC professional nurses had not completed their basic courses.

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Conclusion: PHC professional nurses voiced their concern that challenges encountered during consultations were direct reasons for their poor monitoring of the RTHC. The degree of implementation of the RTHC programme fell short of the norms and standards of the Department of Health and Social Development concerning child health care in South Africa.The most utilised aspect of the RTHC was the expanded programme on immunisation, vitamin A supplementation and deworming medicine.

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs.

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Design, setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata), using probability proportional to size.

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Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services), unmet need for family planning and factors inhibiting use of these services.

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Results: The study revealed that 25% of the older women used some type of FP method. Of this number, 67.9% were aged 50-59 years, 17.4% 60-69 years, 10.1% 70-79 years, and 72% had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome, sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy, lack of education, financial constraints, a perception that healthcare planners limited SRH needs to antenatal and obstetrical services, a cultural reluctance to discuss SRH in public and domestic issues.

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Conclusion: The study recommends comprehensive public health education for older women on human sexuality and fertility, contraceptive use, access to services, effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services.

Objectives: The objectives of this study were to determine the prevalence of erectile dysfunction (ED) in men attending a primary healthcare (PHC) clinic in Durban, KwaZulu-Natal, and to document any relationship between ED and age, smoking, economic status and co-morbid conditions.

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Design: An observational, descriptive, cross-sectional study.

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Setting and subjects: More than 50% of men aged 40-70 years experience some degree of erectile dysfunction. However, no data is available on the prevalence of ED in a primary healthcare (PHC) setting in KwaZulu-Natal. Between February and March 2008, 1 300 questionnaires were distributed to men aged 18 years and older with no exclusion criteria, attending a general PHC clinic.

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Outcome measures: Responses were captured using a validated structured questionnaire (International Index of Erectile Function-15).

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Results: Eight hundred and three questionnaires were eligible for analysis. The overall prevalence rate of ED was 64.9% (621), of whom 14.6% (117) had mild ED, 19.9% (160) moderate ED, and 30.4% (244) severe ED. Erectile dysfunction increased with age, and there was a strong association between ED and economic status and co-morbid conditions.

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Conclusion: The prevalence of ED at this urban PHC clinic was high. Increased awareness by doctors working in the clinic may result in improved assessment and appropriate treatment that will enhance patientsâ?? quality of life.

Up until now, I have been reluctant to undergo any psychometric tests on myself as I had this inner fear that they would reveal my suppressed intentions to eliminate certain persons, especially politicians, from the surface of the planet. I worried that when the points were added up at the end of the questionnaire, that a red flashing sign would appear on the screen saying: "Seek help immediately!" I would be classified in the far end pages of theDSM-IV revised. I had also been, as most doctors are, skeptical of these processes, and put them in the alternative box, along with horoscopes and Madame Placenta, the fortune-teller.

Sometimes it feels to us that, as family physicians in South Africa, we are like the dog that is chasing the bus. Now that we have finally caught it, we aren't quite sure what to do with it. At times, it feels that it would have been better if we had never caught this bus of family medicine becoming a specialty, and all that this brings with it. This may seem like heresy to many colleagues. However, we have many questions as to the state of things in this country of ours, specifically in terms of family medicine and the future of health care. What is the role that we are going to play? What is the role that we are already playing?