South African Family Practice - Volume 56, Issue 4, 2014
Volume 56, Issue 4, 2014
Author Gboyega OgunbanjoSource: South African Family Practice 56 (2014) http://dx.doi.org/http://dx.doi.org//10.1080/20786190.2014.990226More Less
This is a follow-up editorial on the Ebola virus disease (EVD) epidemic in West Africa, with its spread outside the region to the USA and Europe via the few individuals who travelled outside the three countries most affected by the epidemic. The number of infected individuals increases on a daily basis. As of 9 November 2014 (updated 12 November 2014), a total of 14 068 cases, of which 8 688 were laboratory confirmed, as well as 5 147 cumulative deaths, were reported in Guinea, Liberia and Sierra Leone. During the same period, countries with travel-associated cases have reported a total of 30 cases (of which 27 were laboratory confirmed) and 13 deaths, as follows: Mali, four cases (four deaths); Senegal, one case (no deaths); Nigeria, 20 cases (eight deaths); Spain, one case (no deaths) and the USA, four cases (one death).
Source: South African Family Practice 56, pp 206 –211 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786204.2014.953868More Less
Hypertension is a pressing global health issue, contributing to an increase in cardiovascular risk, as well as being the most common condition seen in South Africa. Lack of compliance with the prescribed therapy is one of the largest obstacles to achieving goal blood pressure in antihypertensive patients. The complexity of the drug therapy is a very important factor that is associated with noncompliance, as most patients require treatment with two or more drugs. The use of fixed-dose combination (FDC) therapy has various advantages, including simplification of the regimen, resulting in improved adherence. However, there are also disadvantages, e.g. the inability to provide individualised dose flexibility. This article provides an overview of available FDC therapy for hypertension in South Africa and the rational use thereof, by taking into account each combination's complementary action, efficacy, safety and tolerability.
Source: South African Family Practice 56, pp 212 –215 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953860More Less
The management of fever in children is a subject that garners many different opinions and interventions. Various approaches seem to be acceptable, from the physician who never uses antipyretic medication, to the use of multiple combination therapies. Following the recent publication of guidelines for the management of acute fever in children, there is now a standard against which fever in children should be managed. These guidelines aim to standardise the process of examining pyrexial children, elicit a reasonable history and then investigate the likely illnesses, so as to justify appropriate therapy.
Source: South African Family Practice 56, pp 216 –220 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953864More Less
Complementary and alternative medicines (CAM) are widely used for atopic eczema (AE) with user estimates as high as 63%. Despite the availability of effective conventional therapies, the chronic nature of AE and concerns about long-term steroid use lead many patients to seek alternative treatment. Evidence of the efficacy of these alternative therapies is inconsistent and available published data have shortcomings, making it difficult for clinicians to assess their role, if any, in management. To assess the evidence, systematic reviews of controlled studies have been undertaken for Chinese herbal medicines, homeopathy, evening primrose oil, borage oil, probiotics and certain dietary supplements. This overview summarises the findings from the most recent systematic reviews. Taken together, none of the alternative therapies evaluated demonstrated obvious and indisputable evidence of efficacy. Further studies are warranted with some therapies (Chinese herbal medicines, certain probiotic strains and fish oil), whereas homeopathy failed to show any treatment effect. Further studies on homeopathy, or evening primrose oil and borage oil, are difficult to justify. It must also be remembered that CAM products are currently under-regulated and may not meet the stringent quality standards of conventional medicines.
Source: South African Family Practice 56, pp 221 –222 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953880More Less
A 48-year-old right-hand-dominant cleaner presented to her general practitioner with several months history of right wrist pain. There was no history of previous wrist trauma, and she did not have a history of inflammatory arthropathy. She neither drank nor smoked. An X-ray of the wrist was reported to be normal. A diagnosis of de Quervain's tenosynovitis was made and she was treated with anti-inflammatory drugs and physiotherapy, and received an injection of corticosteroid. Six months' later, the patient complained of worsening symptoms and was referred to an orthopaedic surgeon. The patient reported wrist pain and a longstanding problem of a wrist that "clicked", with deterioration of function over the preceding 12 months. In particular, she had difficulty with power movements of the wrist.
Other health-seeking behaviour of HIV and AIDS patients visiting private sector doctors in the eThekwini Metropolitan Municipality of KwaZulu-Natal : researchAuthor Panjasaram NaidooSource: South African Family Practice 56, pp 223 –228 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953884More Less
Objectives : Although allopathic medicines are used in the treatment of human immunodeficiency virus (HIV), many HIV-infected patients visit alternate medical and health practitioners, and take alternative therapies for their HIV condition. This study was conducted to confirm whether or not a sample of patients who visited private sector doctors used alternative medications, and whether or not they visited other healthcare professionals and/or healers for their condition.
Design, setting and subjects : A descriptive, cross-sectional study was conducted on 256 HIV patients who visited private sector doctors in the eThekwini Metropolitan Municipality of KwaZulu-Natal. An anonymous, close-ended questionnaire was administered to the patients after obtaining their consent.
Outcome measures : Variables included socio-demographic characteristics, other health-seeking behaviour, medicine and substance use.
Results : Private sector HIV patients engaged in other health-seeking behaviour. The study found that a varying proportion of respondents visited alternate practitioners, such as traditional healers, herbalists, homeopaths and Ayurvedic practitioners, and obtained complementary medicines from pharmacies, while some visited psychologists, psychiatrists, dietitians and religious leaders. The respondents also drank alcohol and took illicit drugs. A significant clinical finding was obtained with alcohol consumption and psychologist intervention. It was found that those respondents who visited a psychologist did not consume alcohol, while those who took alcohol did not visit a psychologist (p-value < 0.05). The latter indicates that HIV patients adopted different mechanisms to help them to cope with their condition.
Conclusion : This study concluded that patients with HIV/acquired immune deficiency syndrome in the private healthcare sector visited traditional healers and utilised other medicines, health professionals and/or therapies for their condition.
The knowledge and beliefs of hypertensive patients attending Katleho District Hospital in Free State province, South Africa, about their illness : researchSource: South African Family Practice 56, pp 229 –234 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953887More Less
Introduction : Hypertension is a common chronic condition. A sound understanding of people's beliefs is required in this regard. Usually, poor compliance and decisions by patients to stop taking conventional treatment and to use complementary remedies and traditional remedies arise from poor knowledge of hypertension. The complications of hypertension in non-adherent patients are a concern at Katleho District Hospital. This study sought to explore the knowledge of and beliefs held by patients attending Katleho District Hospital in Virginia on hypertension.
Method : An exploratory descriptive qualitative study was conducted on hypertensive patients attending the outpatient department of Katleho District Hospital. Ten key informants were purposively selected. The exploratory question asked of participants was: "Could you please explain to me your beliefs on, and what you understand about, high blood pressure?" Themes were identified manually and ideas grouped using the cut and paste method.
Results : Five themes were identified, namely correct knowledge about hypertension, incorrect knowledge of hypertension, lack of knowledge regarding hypertension, beliefs about it and misconceptions about it. There were 19 subthemes. Participants demonstrated good knowledge of hypertension, its causes, symptoms and management. However, beliefs and misconceptions influenced their interpretation and response to hypertension.
Conclusion : This study highlights the importance of understanding patients' knowledge and beliefs in order to forge relationships that promote optimal care and compliance with treatment.
The correlation between the health-related fitness of healthy participants measured at home as opposed to fitness measured by sport scientists in a laboratory : researchSource: South African Family Practice 56, pp 235 –239 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953888More Less
Background : Fitness is defined in the health context as a state of good health or physical condition, primarily as a result of exercise and proper nutrition. Conventional methods of measuring fitness are expensive, time consuming and require specialised methods. There is a need for noninvasive, fast methods of assessing health-related fitness and activity in athlete and non-athlete populations. The aim of this study was to establish any correlation between participants' self-assessed health-related fitness (HRF) index and the HRF index determined by sports scientists, as well as the laboratory-assessed HRF index and maximum oxygen uptake (VO2max) determined by sports scientists via direct methods in a laboratory, and finally, to determine any potential correlation between an activity-recall questionnaire (Kasari) and VO2max.
Method : The participants consisted of 169 male and female volunteers between the ages of 18 and 55 years, taking neither supplements nor medication. The University of Pretoria's HRF index protocol was first carried out by participants on their own at home, and then in the laboratory under the supervision of sport scientists. The complete datasets of 150 participants were statistically analysed to establish correlations.
Results : The results indicated highly significant and substantial correlations (ρ = 0.696, p < 0.001) between the participants' self-assessed HRF index and measurements by the sports scientists. There were moderate correlations between the laboratory-assessed HRF index and the direct VO2max (ρ = 0 512, p < 0.005), as well as the indirect VO2max (ρ = 0.588; p < 0.001). A significant correlation was found between the self-assessed HRF index and the indirect VO2max (ρ = 0.454; p < 0.001). The Kasari questionnaire correlated only weakly with the indirect VO2max (ρ = 0.278, p < 0.002) and not at all with the direct VO2max (ρ = 0.072, p = 0.731).
Conclusion : Indications are that this test protocol may be conducted at home by individuals, without supervision, to determine exercise ability or fitness, or to monitor changes in physical fitness, thereby limiting expenses and costs.
The after-hours case mix of patients attending the George Provincial Hospital Emergency Centre : researchSource: South African Family Practice 56, pp 240 –245 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953889More Less
Background : The emergency care of patients in South Africa has improved with the establishment of Emergency and Family Medicine as specialities, the introduction of the Cape Triage Scoring (CTS), and the upgrading of emergency care services. The Western Cape Comprehensive Service Plan stipulates that 90% of care should be delivered through primary and district (level 1) services, 8% through general specialist (level 2) services and 2% through super-specialist (level 3) services. Many patients needing level 1 care present after hours at level 2 facilities. This study was undertaken to determine the after-hours emergency centre case mix and workload at George Provincial Hospital Emergency Centre.
Method : This was a descriptive retrospective study. Using the CTS, emergency centre staff triaged 2 560 patients who presented for care after hours in May 2010. The data were entered and analysed in MS Excel®. The case mix and workload were then determined.
Results : Adults comprised 75% of the case mix. Sixty-five per cent of patients had routine (CTS "green") complaints, 27% had urgent (CTS "yellow") complaints, 5% had very urgent complaints (CTS "orange") and 2% needed immediate care (CTS "red"). Trauma, respiratory and gastrointestinal problems were the most common presentations. The workload during the study period from 1-31 May 2010 included 54 patients after hours on weekdays, 138 patients per 24-hour (08h00-08h00) weekend days and 147 on public holidays.
Conclusion : This study showed that 47% of patients who presented after hours at the George Provincial Hospital Emergency Centre required primary or level 1 care. These patients could be more appropriately managed at a level 1 facility.
Source: South African Family Practice 56, pp 246 –250 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953891More Less
Background : Adolescents are tomorrow's adult population, hence their health and well-being are crucial. The objective of this study was to determine the nutritional status of in-school adolescents in Ibadan, south-western Nigeria.
Method : A descriptive cross-sectional survey was conducted on 93 in-school adolescents attending a diabetes mellitus sensitisation and education programme, selected by simple random sampling (the ballot method) using a self-administered, semi-structured questionnaire. Anthropometric measurements were carried out on the subjects by trained researchers. Data were analysed using SPSS® software, version 17.
Results : Study subjects comprised 29 males (31.2%) and 64 females (68.8), with an overall mean age of 15.67 (± 1.25) years. All of them were in senior grades of their secondary education. Approximately 90% of respondents' parents had attained at least secondary education. The television was the most popular source of health information for the study subjects (33.3%). Nearly a third of them were underweight (body mass index (BMI) < 18.5 kg/m2)) and 7.6% of them were overweight or obese (BMI ≥ 25 kg/m2). However, the prevalence of underweight was higher in the male respondents than in their female counterparts (41.4% vs. 23.4%, respectively). Statistically significant differences were also observed when the mean BMI and mean BMI percentiles for age and sex were compared (p < 0.05 in both instances).
Conclusion : The study showed that malnutrition, and especially undernutrition, is still a problem in adolescents, with a higher prevalence in boys. Nutrition education in schools, and special programmes like the one attended by the study subjects, would help considerably in improving the health and well-being of the nation's adolescents; tomorrow's adult population.
The Baby-Friendly Hospital Initiative : foundation stone in ensuring exclusive breastfeeding : letterSource: South African Family Practice 56, pp 251 –252 (2014) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.953892More Less
Globally, breastfeeding has been acknowledged as one of the most effective ways of ensuring the adequate health, development and survival of a child. In 1991, in order to ensure the right start for every infant and to extend the desired support to the postnatal mothers to execute successful breastfeeding, the World Health Organization and the United Nations Children's Fund (UNICEF) implemented the Baby-Friendly Hospital Initiative (BFHI). Irrespective of the multiple advantages of baby-friendly hospitals, none of the evaluation studies have identified completely adherent facilities to the 10 steps. To ensure successful implementation and long-term sustainability of the BFHI in different healthcare facilities, different measures have been proposed. To conclude, despite the availability of a definitive evidence of BFHI having a successful impact on different breastfeeding outcomes, only a comprehensive and multisectoral approach can enable every mother and family to give every child the best start in life.