South African Family Practice - Volume 57, Issue 1, 2015
Volume 57, Issue 1, 2015
The nutrient intake of children aged 12-36 months living in two communities in the Breede Valley, Western Cape province, South Africa : researchSource: South African Family Practice 57, pp 1 –7 (2015) http://dx.doi.org/10.1080/20786190.2014.980158More Less
Objective: The objective of this study was to describe the current macro- and micronutrient intake of children (both boys and girls) in two selected communities in the Breede Valley, Worcester.
Design: This was a quantitative cross-sectional study.
Setting: The study focused on two disadvantaged communities in Worcester (Avian Park and Zweletemba) in the Breede Valley, Western Cape province.
Subjects: The study subjects were 248 children (Avian Park, n = 117; Zweletemba, n = 131) aged 12-36 months.
Method: The macro-and micronutrient intake of the children was determined using a validated, interviewer-administered quantitative food frequency questionnaire, and compared against the estimated average requirement (EAR) and adequate intake (AI) of nutrients. The nutrient adequacy ratio was calculated, as well as percentage deviation from the EAR and AI.
Results: More than 20% of the children had a calcium and folate intake that deviated by more than 50% below the EAR in both communities and for both genders. More participants in Zweletemba had an intake that deviated by more than 50% above the EAR and AI, compared to Avian Park, for carbohydrate, thiamine, niacin and iron.
Conclusion: With the exception of folate, calcium and selenium, the average reported nutrient intake of the children (boys and girls) in both the communities was adequate.
Author Gboyega A. OgunbanjoSource: South African Family Practice 57 (2015)More Less
About four years ago, South Africa's Health Minister Dr. Aaron Motsoaledi, launched the Green Paper on the National Health Insurance (NHI) during a post-cabinet media briefing in Pretoria. The expectations were that the innovative system of healthcare funding would address: access to appropriate, efficient and quality health services; and provision of opportunity for all South Africans to affordable, quality healthcare regardless of the socio-economic status. He was optimistic in his briefing that the timeline for this national project would be 14 years, with the first five years focused on building and preparing the public health system for the changeover. In addition, he stressed that the cornerstone of the proposed NHI is universal coverage, with a financing system that will ensure provision of essential healthcare to all citizens of South Africa including legal long-term residents regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. We are now in the fourth year of implementation and it is time to reflect on progress made so far.
Source: South African Family Practice 57, pp 6 –12 (2015)More Less
Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine consumption, obesity and the use of certain drugs, such as diuretics. Another important risk factor for the development of gout is hyperuricaemia. Hyperuricaemia results from an imbalance between the rate of production and excretion of uric acid in the body. An excess of uric acid thus builds up in the body, supersaturating body fluids and leading to the formation of monosodium urate crystals. These crystals accumulate in tissue and around joints, leading to an acute gout attack. Gout can be divided into four phases, namely asymptomatic hyperuricaemia, acute gout attacks or recurrent gout, intercritical gout and chronic tophaceous gout. Various treatment options are available for gout, and the treatment for each gout patient is determined by the stage of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, corticotropin and colchicine are used for the treatment of acute gout attacks. Allopurinol and probenecid are used for long-term hypouricaemic therapy, while NSAIDs and colchicine are prescribed for the prophylaxis of future gout attacks. All of these treatments have side effects, ranging from mild to life-threatening in nature. There is a need for novel gout therapies that have fewer side effects but are still as effective.
Conditions frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Gauteng, South Africa : researchSource: South African Family Practice 57, pp 8 –11 (2015) http://dx.doi.org/10.1080/20786190.2014.977066More Less
Background: Herbal medications are used worldwide for a variety of diseases and conditions. Patients often elect not to disclose their herbal use history, or health care practitioners fail to enquire about specific alternative therapy. The aim of this study was to assess the conditions most frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Garankuwa, South Africa.
Methods: Patients attending an out-patient's clinic at the Dr George Mukhari Academic Hospital were given a questionnaire regarding their use of herbal remedies for various reasons. Assessment was done on past, current, and possible future use of herbal interventions. These interventions were categorised into acute medical conditions, chronic ailments, and cultural uses.
Results: Respiratory tract infections were most frequently treated (34%). Other highly ranked uses included protection from evil spirits (32%) and for HIV/AIDS (29%). Digestive ailments (27%), hypertension (18%), and general malaise (17%) accounted for the remainder. Previous herbal use amounted to 74%, but only 30% indicated that they would use herbal medication in future.
Conclusions: Traditional medication plays an important role in many communities in South Africa. For this reason health care workers need to be aware of the conditions most frequently self-treated with herbal remedies. Having knowledge about the incidence of herbal treatment for a specific condition could alert the health care practitioner to possible reasons for unidentifiable drug interactions, adverse events, treatment failure, or even death.
Factors influencing female doctors' career decisions at Tshwane District Hospital, Pretoria : researchSource: South African Family Practice 57, pp 12 –17 (2015) http://dx.doi.org/10.1080/20786190.2014.976971More Less
Introduction: Most doctors at Tshwane District Hospital in Pretoria are women who experience difficulty combining a career with family responsibilities because of lack of flexitime or part-time posts. They are also frustrated by the hospital management's apparent indifference to their concerns. Consequently, female doctors tend to leave Tshwane District to pursue their careers elsewhere. This study explored factors that influence the career choices of female doctors at Tshwane District Hospital in Pretoria.
Method: Of sixty-two doctors working at Tshwane District Hospital in Pretoria between January 2008 and July 2011, 47 were traced, and 28 completed a four-part, self-administered questionnaire constructed round eight themes that emerged from a focus group discussion involving six female doctors. Questions on levels of burnout and job satisfaction, based on existing validated questionnaires, were included. Of the 28 doctors who completed the questionnaire, 19 were female and nine male. The median age group was 30-39 years.
Results: Forty-six per cent of doctors reported overall job satisfaction. Female doctors were less satisfied than male doctors. Sixty-four per cent reported symptoms of burnout, while a worrying 18% reported either persisting symptoms or complete burnout. The majority of female doctors would prefer to work flexitime and to have the option of part-time employment in an academically stimulating environment. Many of the doctors who participated in the study at Tshwane District Hospital plan to pursue their careers outside the public sector in order to balance their family responsibilities with their professional lives.
Conclusion: Female doctors at Tshwane District Hospital reported having low job satisfaction, an inflexible work schedule, a heavy workload and being given little recognition for their contribution. Together, these factors probably account for the high turnover of doctors at Tshwane District Hospital. If doctor retention is to be improved in public sector facilities, such as Tshwane District Hospital, the particular needs of female doctors with family responsibilities must be addressed.
Author K. OuthoffSource: South African Family Practice 57, pp 13 –14 (2015)More Less
At 9 am on the 23rd of November 1910, Dr Harvey Hawley Crippen, an American who had originally trained as a homeopathic doctor, was dispatched to the next world by public hanging in London's Pentonville prison for murdering his minor-celebrity singer wife, Belle. In court, he was described as "quiet, mild and polite, a docile husband and an apparently entirely unremarkable person." His wife appeared to be "a blowsy, heavy-drinking nightmare, vain, bullying and promiscuous." Nonetheless, after she had been missing for some time and suspicions were raised, parts of the unfortunate Mrs Crippen's dissected body were found hidden under their coal cellar, along with traces of poison. Dr Crippen was arrested when he tried to escape to Canada by passenger liner with his mistress, Ethel Le Neve, who had disguised herself (unsuccessfully) as a young boy. The British public was entranced with this story, one which was peppered with glamour, intrigue, murder, adultery, conflict, a high-speed transatlantic chase and pharmacology: Dr Crippen's poison of choice was hyoscine.
Part 3 : Medico-legal documentation Practical completion of pages 2 and 3 of the J88 form : review (CPD)Source: South African Family Practice 57, pp 16 –22 (2015)More Less
This is Part 3 of a three-part series on medico-legal documentation. Part 1 addressed the knowledge and skills necessary to complete a legal J88 document. Part 2 provided practical guidance on completion of the J88 form in the case of assault. This article will focus on pages 2 and 3 of the J88 document, which deals with the alleged sexual offences of both adults and children. The assumption may exist that the J88 is the only significant document with respect to medical findings in alleged rape and child sexual abuse cases, and that the court needs this information to make a decision on the medical aspects of a case. However, the court needs the information to be interpreted by a medical practitioner, who must indicate the significance of the findings, determine who should supply relevant additional information, and then place the entire picture in context. This article attempts to highlight the value of the relevant aspects, while raising awareness of an unscientific interpretation of clinical examination.
The effectiveness of the implementation of the Cape Triage Score at the emergency department of the National District Hospital, Bloemfontein : researchSource: South African Family Practice 57, pp 18 –23 (2015) http://dx.doi.org/10.1080/20786190.2014.977056More Less
Background: The need for an appropriate South African triage system led to the development of the Cape Triage Score (CTS), a system to prioritise emergency departments' workloads. This study evaluated the effectiveness of the CTS at the National District Hospital emergency department, Bloemfontein.
Methods: In this retrospective, descriptive, observational study, files of adult patients triaged at the emergency department during February 2013 were randomly selected. Inclusion was subject to the availability of the files. Physiological parameter results were used to calculate the Triage Early Warning Score (TEWS). The side-room investigations and South African Triage Score (SATS) were recorded. Other information gathered included diagnosis, outcome, and times the patient was triaged and seen by the doctor.
Results: A total of 396 files were included in the study. Patients, of whom 57.8% were women, were between the ages of 16-89 years. More than half (52%) of side-room investigations were omitted or inappropriate. The adjustment of the TEWS to the SATS was done incorrectly in 52% of cases. The majority of patients (69.9%) were discharged home after treatment, although 88% were SATS orange coded. Over-triage occurred in 8.1% of TEWS and 67.8% of SATS cases. The mean waiting time from triage until patient was seen by the doctor was 2 hours.
Conclusions: The TEWS proved to predict outcome better than the SATS. Due to inaccurate triage, only 8% of patients were seen within the recommended waiting times. The CTS has not been effectively implemented at the National District Hospital emergency department.
Author D.M. ManyaneSource: South African Family Practice 57, pp 23 –28 (2015)More Less
Headache disorders are a common condition affecting present-day societies worldwide. Headaches are classified by the International Headache Society as being either primary or secondary. Primary headaches are those without an underlying, physical cause, e.g. migraine, cluster and other benign-type headaches. Secondary headaches, as the term suggests, are as a result of an underlying cause, e.g. a tumour, meningitis and a haemorrhage. Tension-type headaches, together with migraines, are the most common primary headaches, affecting 80% of the general population. Various terms has been used to describe tension-type headaches, but these have since been discarded, e.g. "tension headache", owing to ambiguity as to whether or not the cause of the tension was psychological or muscular. Other terms no longer in use include "psychogenic headaches" and "stress headaches".
Source: South African Family Practice 57, pp 24 –27 (2015) http://dx.doi.org/10.1080/20786190.2014.977034More Less
Background: Culture is the framework that directs human behaviour in a given situation. Accordingly, culture also influences the meaning and expression of pain. However, the influence of culture on the communication of pain is not always understood and considered by healthcare practitioners. It is often erroneously anticipated that all children (irrespective of cultural origin) will express pain either through quiet endurance or loud verbal complaints. This view could contribute to the inadequate management of pain that is so often described in pain literature. Pain assessment and measurement are integral components of pain management, but are often negatively affected by the healthcare professional's pre-conceived ideas, as well as by his or her inability to understand the cultural meaning of pain, the non-verbal and verbal language of pain, and the patient's ability to cope with pain.
Method: The aim of this study was to identify the unique meaning of pain in reference to both general and paediatric pain. In addition, the study aimed at gaining insight into the origin and management of pain. This was achieved by means of qualitative methodology. The study group included people from the South African Nguni and Sotho cultures. A total of 42 participants, who were on average 42 years old, were interviewed.
Results: The study indeed indicated variances between the experience and expression of pain and the generally accepted idea that pain is not culture based.
Conclusion: Health care providers need to be increasingly aware of and sensitive to the cultural expression of pain and how differences in the communication of pain could possibly influence their care plan.
The anti-inflammatory properties of simvastatin can benefit statin-naïve rheumatoid arthritis patients with associated risks for cardiovascular disease : researchSource: South African Family Practice 57, pp 28 –30 (2015) http://dx.doi.org/10.1080/20786190.2014.995919More Less
Background: The anti-inflammatory properties of statins are well documented. The aim of this study was to determine if statins may offer therapeutic benefits in rheumatoid arthritis (RA) patients that are also at risk for cardiovascular disease.
Methods: Patients with moderately active RA, despite being on maximum disease-modifying anti-rheumatic drugs (DMARDs) therapy, and that were at risk for cardiovascular disease, were screened for inclusion. Eligible patients were randomised into two groups. In this open-label, cross-over design patients in group 1 received simvastatin treatment (20 mg/day) for a period of 3 months in addition to their usual DMARDs, after which they stopped simvastatin treatment and were followed up for a further 3 months while on their usual DMARDs only. Those in group 2 were allowed to continue on their usual DMARDs without simvastatin treatment for the first 3 months of the study, after which they received 20 mg/day simvastatin for a period of 3 months in addition to their usual DMARDs.
Results: The addition of 20 mg simvastatin to conventional DMARDs produced significant improvements in all of the evaluated parameters. These include significant improvements in DAS28 score, tender joint count, swollen joint count, CRP levels and ESR, while patients were receiving simvastatin treatment.
Conclusions: The addition of 20 mg simvastatin to conventional DMARDs in statin-naive RA patients at risk for cardiovascular disease may add benefit, apart from modifying lipid profiles, by modulating immune function and suppressing disease activity.
Author L. LambertSource: South African Family Practice 57, pp 29 –33 (2015)More Less
A red eye is the cardinal sign of ocular inflammation, and is one of the most common ophthalmological complaints. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or a faulty tear film, can lead to a red eye. The condition is usually benign, self-limiting and can be managed effectively in general practice. While there may be numerous causes of a red eye, conjunctivitis is the most common. A thorough patient history and physical examination of the eye are essential in the management of a red eye when differentiating between an allergic and an infectious cause.
Author D.L. FewsterSource: South African Family Practice 57, pp 31 –34 (2015) http://dx.doi.org/10.1080/20786190.2014.995917More Less
Background: Autism spectrum disorder (ASD) is a debilitating condition for the child as well as the parents and family. Research in ASD is on the increase with many studies coming out of developed countries. To add to the knowledge base in ASD from a South African perspective, the experiences and coping strategies of parents of children with ASD were explored.
Methods: A qualitative phenomenological research design was adopted. The sample consisted of 11 parents of children with ASD. The data was collected using semi-structured interviews. Interviews were audiotaped and transcribed verbatim using pseudonyms for participants' names. Thematic analysis was used to analyse the data into themes.
Findings: There were a number of themes that emerged about parents' experiences and coping strategies while raising a child with ASD. The theme "A road map to coping with ASD" was used in this article to map out guidelines for practitioners when dealing with parents of children with ASD.
Conclusions: As practitioners are often the "first port of call" within the Western context when a parent is concerned about their child's development, they can play a valuable role in the lives of parents who present with vulnerability, by providing timely psychosocial support. This article provides practitioners with guidelines to care for these parents.
Source: South African Family Practice 57, pp 34 –38 (2015)More Less
The self-reported learning needs of primary care doctors in South Africa : a descriptive survey : researchSource: South African Family Practice 57, pp 35 –43 (2015) http://dx.doi.org/10.1080/20786190.2014.1002677More Less
Background: Strengthening primary health care in South Africa is a prerequisite for the successful introduction of National Health Insurance. Primary care doctors from both the public and private sectors are an essential contributor to achieving this goal. In order to prepare these doctors for their future role, a national diploma training programme is being developed. This study aimed to evaluate the learning needs of primary care doctors and to assist with the design of the diploma.
Methods: A descriptive survey of 170 primary care doctors (80 medical officers and 90 private practitioners), from eight provinces in South Africa, in terms of their use of 30 key guidelines, performance of 85 clinical skills and confidence in 12 different roles.
Results: Doctors had read the majority of the guidelines (20/30), but few had been implemented in practice (6/30). All of the doctors had been trained in the clinical skills; however, none had taught these skills to others in the last year. Primary care doctors reported having performed the majority of the skills within the last year (70/85). Doctors had performed 7/12 roles in the last year, while 5/12 had not been engaged with. The weakest roles were those of change agent and community advocate, while the strongest roles were competent clinician, capability builder and collaborator. There were a number of significant differences (p < 0.05) between the learning needs of medical officers and private practitioners.
Conclusion: These findings will help guide the development of a new Diploma in Family Medicine programme for South Africa.
Source: South African Family Practice 57, pp 39 –42 (2015)More Less
South Africa has a particularly high prevalence of smoking compared to the rest of the world. In spite of the fact that smoking rates in South Africa have been declining since the implementation of tobacco control measures in 1993, there are still an estimated 8 million smokers in the country. Smoking has been associated with detrimental heath risks and related complications for decades, and such health issues are further compounded by the high incidence of tuberculosis and human immunodeficiency virus/acquired immune deficiency syndrome in the population. This article aims to provide an overview of the importance of smoking cessation, and the non-pharmacological and pharmacological measures aimed at ensuring that smokers quit.
Source: South African Family Practice 57, pp 43 –49 (2015)More Less
Allergic disease decreases the daily quality of life of many people, and can increase the number of working days lost owing to sick leave. Associated symptoms with allergic disease depend on the origin of the disease, and can either be allergic, non-allergic and purulent, or can cause rhinitis as a result of a common cold. Treatment depends on the origin of the rhinitis. However, an antihistamine is indicated in most instances. Combination treatment includes sympathomimetic drugs (either local or systemic) and corticosteroid medication (when indicated, and in most instances, used locally). The article provides an overview of the nature and the management of allergic disease and the histamine 1 antihistamines.
The factors that attract healthcare professionals to and retain them in rural areas in South Africa : researchSource: South African Family Practice 57, pp 44 –49 (2015) http://dx.doi.org/10.1080/20786190.2014.977023More Less
Background: Attracting healthcare professionals (HCPs) to rural areas and retaining them there remains a challenge. Current retention strategies focus on the factors that cause people to leave rural areas, but these strategies continue to fail to retain HCPs in these areas, and the situation in which there is a lack of quality and inadequacy of the type of health services is perpetuated. The literature describes factors that attract healthcare workers to work in rural areas, and this study contributes to a deeper understanding of this.
Method: This was a qualitative study in which in-depth interviews and focus groups were used, together with an appreciative inquiry approach. Fourteen participants were purposively selected for the study. Data were coded and the themes extracted and critically analysed by two researchers. Ethics clearance was obtained from the University of the Free State.
Results: Intrinsic themes included having a "calling" to work in an area, team work and community affiliation. Extrinsic themes related to the geographical location, diversity of work, functional referral networks, and strong management and leadership structures.
Conclusion: This research offers a different way of viewing what attracts healthcare workers to work in rural areas by focusing on the positive factors that encourage them to remain, rather than on the negative factors that make them want to leave. The findings complement the existing literature, and also include fresh ideas with regard to understanding the reasons behind the retention of rural healthcare workers from an asset-based perspective. The resulting conceptual framework helped to foster a paradigm shift with respect to re-thinking the retention strategy.
Treatment outcome of tuberculosis patients at National Hospital Abuja Nigeria : a five year retrospective study : researchSource: South African Family Practice 57, pp 50 –56 (2015) http://dx.doi.org/10.1080/20786190.2014.995913More Less
Background: The HIV/AIDS epidemic in Nigeria has militated against efforts to control TB. This study determined the differences in TB treatment outcome between patients with TB/HIV co-infection and those without HIV co-infection in National Hospital Abuja, Nigeria.
Methods: This was a retrospective cohort study on pulmonary TB patients that were treated in National Hospital Abuja, Nigeria from January 2007 to December 2012. Data was collected from the Directly Observed Treatment Shortcourse (DOTS) clinic and hospital records and analysed using stata version 12. The HIV sero-prevalence was determined and TB treatment outcomes in patients co-infected with TB and HIV was compared to that of HIV negative patients. The t-test and chi square test was used to verify differences in means and proportions and multiple logistic regression to adjust for potential confounders. Sensitivity analysis was done to address the problems of loss to follow up and missing data.
Results: A total of 389 cases were assessed. The HIV sero-prevalence rate in the study was 42.7%. Fifty-three percent of the study population were within the age category 30-49 years. There was strong evidence of an association between TB/HIV co-infection rate among the various age categories (p = 0.01). HIV positive cases had a lower treatment success rate, 48.8% vs. 78.5% (p < 0.001), a higher rate of treatment failure, 10.8% vs. 4% (p = 0.01), and a higher rate of default, 38.6% vs. 17% (p < 0.001).
Conclusion: The study provides evidence that TB/HIV co-infection impacts negatively on TB treatment outcome.
Evidence that changes the way you practise : the pharmacological management of gastro-oesophageal reflux disease : reviewAuthor A. MaraisSource: South African Family Practice 57, pp 53 –55 (2015)More Less
Gastro-oesophageal reflux disease (GORD) is defined as a chronic symptom-based disease that affects the upper gastrointestinal tract, resulting in mucosal damage caused by the retrograde flow of gastric acid from the stomach through an incompetent cardiac sphincter into the lower oesophagus. Typically, symptoms include dyspepsia, epigastric pain, heartburn, belching, bloating, nausea, early satiation and postprandial fullness. Several risk factors have been identified, which mainly include alcohol (15%), aspirin and nonsteroidal anti-inflammatory drugs (25%), corticosteroids, obesity and pregnancy (10%), hiatal hernias (60-80%), hypercalcaemia, Helicobacter pylori infection (40-90%) and hypersecretory states Zollinger-Ellison syndrome). Complications of GORD include non-oesophageal reflux disease, erosive oesophagitis, Barrett's oesophagus and adenocarcinoma. A study in the USA showed that GORD was responsible for the greatest direct cost of any gastrointestinal disease, and most of that expenditure was on pharmacotherapy. The pharmacological management of GORD will be the focus of this article.