South African Family Practice - Volume 57, Issue 3, 2015
Volume 57, Issue 3, 2015
Source: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976960More Less
Background : Prematurity is globally the leading cause of neonatal mortality, morbidity and long-term disability. The Millennium Development Goals (MDG) of the United Nations, and specifically MDG 4, address child mortality. Neonatal mortality rates contribute to 37% of all under-five mortality, with the largest proportion (30%) due to prematurity. The overall purpose of this study was to determine factors associated with prematurity and to identify treatable and preventable causes at the Bloemfontein Academic Complex in order to decrease the morbidity and mortality associated with prematurity in line with MDG.
Methods : A case control study design was used including all premature babies referred to the Kangaroo Care Unit of the National District Hospital between December 2010 and March 2011. Each baby was included with his/her mother as a pair. For each premature baby and mother pair a term baby and mother pair was included as a control. Data were collected on a data sheet from the mothers' antenatal records, and from maternal notes as well as the neonatal follow-up and discharge notes. Data gathered included baseline characteristics, habits, diseases and medication of the mother during the antenatal period and delivery as well as baseline demographics of the babies.
Results : A total of 194 mothers and 198 babies were included in the study with 109 case mothers and 85 control mothers. Pre-existing medical conditions were more prevalent in the premature group (69%) compared with the control group (27%) with p < 0.0001. These conditions included hypertension, HIV disease and syphilis. Possible causes for prematurity identified in this study included teenage mothers and premature rupture of membranes.
Conclusion : Risk factors identified for prematurity were: teenage mothers, pre-existing medical conditions in the mother, and preterm rupture of membranes. Smoking and alcohol consumption during pregnancy could not be identified as risk factors for prematurity. It is recommended that patients with any of the above-mentioned identified risk factors be classified as high risk for the development of prematurity and shorter follow-up intervals and more aggressive management of pre-existing medical conditions should be practised.
Source: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976978More Less
Background : Growth charts have been used worldwide for about 40 years but their use has always been fraught with problems.
Methods : A cross-sectional descriptive study was carried out on the reported usage of growth charts and whether there are factors that affect usage by the general practitioners working with children in public hospitals.
Data were collected through the use of a self-administered questionnaire. The questionnaire covered four concepts: demographic factors; doctors' self-reported growth chart usage; doctors' attitude towards growth monitoring and use of growth charts; and doctors' knowledge in terms of plotting, interpretation and management of growth patterns.
Results : A total of 90 out of 100 doctors completed the questionnaires. More than half (57%) of the doctors had high workloads. Fifty-six (62.2%) doctors thought they were too busy to use growth charts. Only 37 (41%) doctors achieved an acceptable total knowledge score. Although just over two-thirds of (67.8%) doctors reported a positive attitude towards growth monitoring, their reported usage does not reflect it. Fifty-four (60%) doctors plotted weights correctly. Doctors recognised the most probable cause for the given growth patterns. However, most doctors struggled to choose the most appropriate management option. Skill in plotting was associated with more regular usage. Better knowledge and a positive attitude were associated with higher usage whereas a perception of high workload and several years' experience were associated with lower levels of usage.
Conclusions : While doctors reported a positive attitude towards the use of growth charts, they lacked the knowledge to utilise them optimally and reported that the chart was often not used.
Acute poisoning in the Rift Valley Provincial General Hospital, Nakuru, Kenya : January to June 2012 : researchSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.975448More Less
Background : Information on the patterns of acute poisoning in Kenyan hospitals is limited, and yet such information is crucial for the appropriate management of poisoning. This study attempted to address this knowledge gap by examining admissions in a regional hospital in Kenya.
Method : This was a retrospective review of the hospital records of 96 acute poisoning patients in Rift Valley Provincial General Hospital, Nakuru, in the first six months of 2012. A pretested data collection form was used to obtain data on important variables.
Results : The prevalence of acute poisoning was 0.07% (96 of 141 769 cases). The average age of the patients was 22.6 years ± 11.20 years, the majority of whom were males [odds ratio (OR) 2.06]. The most prevalent toxic agent was pesticide (50, 52.08%). The majority of cases were intentional poisoning (48.96%) versus unintentional poisoning (43.75%), and involved mainly males (OR 3.06). Conversely, females were the majority with respect to accidental poisoning (25%) versus males (17.7%). However, accidental poisoning was most prevalent in patients aged 12 years and younger (23, 23.96%). Overall, acute poisoning was most prevalent in the age category of 20-30 years (40, 41.66%), in which intentional poisoning was predominant (26, 27.08%). The majority of cases of acute poisoning were incorrectly diagnosed (OR 1.79). The three patients who died were males (3.13%).
Conclusion : This study showed that the majority of acute poisoning cases affected males and were intentional. The study also showed that the most prevalent acute toxic agent was pesticide and that acute toxic agents were often misclassified and hence misdiagnosed. These observations should be included when designing focused hospital poison management protocols.
A cross-sectional profile and outcome assessment of adult patients triaged away from Steve Biko Academic Hospital emergency unit : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1024013More Less
Background : Overcrowding is a global problem in emergency medicine. This study examined an approach to this problem at a central hospital.
Methods : A prospective observational study was done to provide a cross-sectional profile of patients triaged away from the emergency unit (EU) and to evaluate their outcome by telephonic survey.
Results : 549 patients were triaged away during the study period. There was no significant difference in the number of male and female patients in the sample. Female patients were significantly younger than males (p = 0.0399). The most common complaint was abdominal pain followed by extremity complaints. Females complained more of abdominal pains (OR 1.87, 95% CI [1.13-3.12]; p 0.0094), and males had more extremity complaints (OR 2.42, 95% CI [1.45-4.09]; p = 0.0003). Only 42 patients were available for telephonic follow-up; 66% of them received care on the same day at another treatment facility. No patients who were available for follow-up had died due to their presenting complaint or needed to be referred back.
Conclusions : The typical patient triaged away was a 40-year-old female from the hospital's referral area with abdominal pain. This study indicated that the method of triage may be safe to determine which patients can be diverted from a central hospital to a lower level of care. There were various limitations to this study; hence, the findings of this study should be interpreted with caution.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2015.1024014More Less
Objective : To describe aspects that create positive experiences for emergency obstetric care (EmOC) clients in public health facilities in Ethiopia.
Design : A qualitative contextual descriptive phenomenological design was used in this study.
Subjects and setting : In-depth interviews were conducted with women who had complications during childbirth and received EmOC in three hospitals in Addis Ababa.
Outcome measures : Content analysis was used to analyse data as it complies with the phenomenological data analysis. The data were analysed using the Atlas ti version 6.2 qualitative data analysis software.
Results : Care that is life-saving, safe, timely, responsive and given in a clean environment, where the service carers show humility, respect, equal treatment and encouragement in an effort to meet the clients' needs and expectations, creates a good experience.
Conclusion : Clients' experiences during the provision of EmOC influence their future decisions on whether to seek care or not. The findings of the study along with the developed guidelines will assist in the improvement of the provision and utilisation of EmOC at public health facilities in Ethiopia.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976945More Less
Background : The decentralisation of antiretroviral therapy (ART) to primary health care (PHC) was rolled-out in South Africa in March 2010. PHC staff members are expected to initiate ART, monitor patients, and detect and refer patients with adverse events or virological failure to designated referral hospitals. The aim of this study was to assess the monitoring and referral of patients on ART who were being managed at a PHC clinic.
Method : This was a cross-sectional, retrospective study on 488 adult patients attending a PHC ART clinic selected by systematic random sampling between June 2011 and June 2012. Data were extracted from the patient files using a standardised data collection sheet, based on the South African national HIV guidelines for 2010.
Results : Pill count, CD4 count and viral load (VL) were all well assessed by June 2011. Thirty-one per cent of patients being followed-up at the clinic had developed virological failure, of whom 84% were referred. By June 2012, 49% of the patients had developed virological failure, of whom only 52% were referred for further management.
Conclusion : The PHC nurses were excellent at monitoring pill count, CD4 count and VL, but were unable to detect and appropriately refer patients with virological failure. This is of great concern, and needs urgent intervention and further research.
Author Thavanesi GurayahSource: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976946More Less
Background : This research is an exploratory pilot study into the phenomenon of caregiving for people with dementia in a rural context in South Africa.
Method : This study used a qualitative method of inquiry for conducting individual interviews with five caregivers to collect the data. The interviews were conducted in the local language of isiZulu. All interviews were audiotaped, and then transcribed into English. Transcriptions were analysed using thematic analysis.
Findings : There were three main emergent themes, namely views and responsibilities of the caregiver, impact of caregiving, and skills and services to assist the caregiver. There were numerous subsidiary themes such as acceptance of the ageing process, a sense of duty and kinship in African culture, and dealing with problem behaviours. Caregiving was also viewed as a character-building experience, and has major implications such as promoting social isolation, restricting activities of daily living, reducing employment and increasing financial burden. Services that would alleviate caregiver burden are education, caregiver training, a financial grant and respite care.
Conclusions : Although these findings are not generalisable, it would appear that caregivers of people with dementia suffer significant psychosocial distress, and would benefit from emotional and financial support. It remains to be seen who will provide this support, but policy-makers as well as governmental and non-governmental organisations will have to factor this into their forward planning to render an effective service for people with dementia and their families. Advocacy groups should also disseminate information on dementia and caregiving responsibility, whilst healthcare professionals should screen for caregiver stress or caregiver burden in individuals caring for people with dementia.
Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole : researchSource: South African Family Practice 57, pp 1 –7 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976988More Less
Background : Quality of care for diabetes mellitus and hypertension has been found to be suboptimal at primary health care level. There is an expectation that improving quality will require the increased utilisation of resources. This research was intended to determine the quality of care and cost of prescriptions at 10 facilities in the Cape Town Metropole.
Method : An analytical, cross-sectional study was conducted in order to relate the cost of medication to quality-of-care indicators for patients with diabetes mellitus and hypertension. Data were collected at the 10 facilities in the Cape Town Metropole over a three-month period.
Results : Quality-of-care processes were performed more often in diabetic than in hypertensive patients, i.e. determination of body mass index (BMI) 52.4% vs. 46.4%, creatinine 45.2% vs. 35.7% and cholesterol 44.5% vs. 35.4%, respectively. Nevertheless, outcome measures were better in the hypertensive patients. Targets were achieved in hypertensive vs. diabetic patients, respectively, as follows: BMI (22.2% vs.18.1%), blood pressure (39.8% vs. 28.7%), creatinine (93.2% vs. 91.4%) and cholesterol (46.8% vs. 44%). The median cost per script was R44.66 and R30.06 for diabetic and hypertensive patients with good quality-of-care scores, respectively, and R51.18 and R31.00, for those with poor quality-of-care scores.
Conclusion : The quality of care provided was poor when compared with the guideline recommendations, but was comparable to care provided in many other populations. There was no correlation between quality of care and the cost of the prescriptions.
Author Lushiku NkombuaSource: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976991More Less
Background : The Kingdom of Swaziland, following the introduction of the National Family Planning Programme in 1973, has witnessed insufficient scientific publications on the contraceptive practices in the country despite documented high fertility rates and low contraceptive prevalence rates. This study was conducted to understand the practices and potential determinants of contraception among Swazi women who requested emergency contraception.
Methods : The data were collected over a period of one month and analysed using simple descriptive analysis to summarise the data and bivariate analysis to determine relevant factors associated with the use of contraception.
Results : The majority of participants (79%) use contraceptives. Reasons given for not using contraception previously ranged from medical conditions to not being sexually active. Widely used contraceptives are male condoms, injectable hormones and combined oral contraceptives while the least popular are implants, and post-coital pills. Knowledge of contraceptives came mainly from the health facilities, peers and mass media while parents are the least consulted sources. A high percentage (97%) are aware of sexually transmitted diseases (STDs) and that male and female condoms are the best forms of protection against STDs. Demographic and socio-economic variables are not significantly related to the use of contraceptives.
Conclusion : The study established that the majority of the participants used some form of contraception and they also delayed their sexual debut up to the age of 18-20 years. The observed changes of increased contraceptive use and later age of sexual debut could be associated with increased levels of education of the participants and the predominant relaxed approach by Protestants and Zionists who are usually tolerant of contraception. The recommendations, based on the findings of this study, would assist with the planning and implementation of future family planning programmes for which this study serves as a foundation.
A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976963More Less
Background : Sustainable and aggressive population-based programmes on hypertension awareness, prevention, treatment and control are key to the successful control of this epidemic. The objective of the study was to determine to what extent hypertension and risk factors for its development were prevalent in the Kang village community in Botswana, and specifically to assess its prevalence in the adult population and its relationship with high blood pressure, anthropometric measures and lifestyle factors, i.e. diet and the use of tobacco products and alcohol.
Method : A population-based cross-sectional study was conducted on 161 adult residents of Kang aged 18 years and older from November to December 2008. A questionnaire adapted from the World Health Organization stepwise approach to the surveillance of chronic disease was used for the data collection.
Results : The prevalence of hypertension in the adult population of Kang was found to be 32% (95% confidence interval: 25-40). There was no significant sex difference in the prevalence rate in men (28%) versus women (34%), (p = 0 59). Hypertension was more prevalent in the overweight group than in the normal-weight group (p = 0.3), in the obese group than in the normal-weight group (p = 0.002), and in the obese group than in the overweight group (p = 0.04).
Conclusion : This study showed that hypertension affected almost a third of the adult population of Kang, and was significantly associated with overweight and obesity.
Original research : obesity prevalence and metabolic differences between obese and non-obese school adolescents in south-western Nigeria : researchSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977010More Less
Background : Adolescent obesity is increasingly more common in low- and middle-income countries like Nigeria. Obesity has been associated with metabolic derangement in adolescents in developed countries. This study compared the metabolic parameters in obese and non-obese adolescents in a developing country.
Method : A cross-sectional study was performed on 1 000 adolescents selected by multi-stage sampling from eight secondary schools in Osun State, south-western Nigeria. Socio-demographic information was collected with the aid of a questionnaire. Using the International Obesity Task Force (IOTF) body mass index (BMI) cut-off points, 29 obese adolescents were identified, and 29 suitably matched controls selected. The means for the anthropometric indices [height, weight and waist circumference (WC)], as well as blood pressure (BP), fasting blood glucose and the blood lipid levels of the obese and non-obese participants were compared using an independent t-test and one-way analysis of variance. Data were analysed using SPSS® 16.0 version. A p-value < 0.05 was taken to be statistically significant.
Results : The mean age of the respondents was 13.7 years (standard deviation 2.04). Eight of 100 (7.7%) respondents were overweight and 2.9% obese. More female than male adolescents were overweight or obese. The means for the anthropometric indices and BP increased in general across the spectrum of weight categories, from normal weight to obese. Weight, BMI, WC, and systolic and diastolic blood pressure were significantly higher (p < 0.05) in the obese adolescents than in the non-obese controls. The controls had a significantly higher mean high-density lipoprotein value (1.46 mmol/l) than the obese adolescents (1.21 mmol/l).
Conclusion : Obese adolescents are at higher risk of metabolic diseases than non-obese adolescents. Obese adolescents in low- to middle-income countries should be targeted to adopt lifestyle changes.
Reasons for diabetes patients attending Bishop Lavis Community Health Centre being non-adherent to diabetes care : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977027More Less
Background : Non-adherence to diabetes care is a concern at Bishop Lavis Community Health Centre (BLCHC) as it results in many diabetes complications that could have been avoided. The aim was to explore the reasons for people with diabetes in the Bishop Lavis area being non-adherent to diabetes care.
Methods : A qualitative study was undertaken. Focus groups and in-depth interviews were conducted with patients who had uncontrolled blood sugar and non-compliance. The framework method was used to analyse the data.
Results : The main findings in this study were that the following had a negative impact on compliance with diabetes care: (1) poor knowledge of diabetes mellitus; (2) drug treatment barriers such as shift work and not knowing the importance of taking medication regularly; (3) lifestyle adjustment barriers: dietary barriers and lack of exercise; (4) staff and clinic visit problems, for example over-burdened public health-care facilities; and (5) poor support structures including support from family, the community and financially as well as poor infrastructure.
Conclusion : The main findings in this study were consistent with many of the previous studies done on adherence, i.e. patient barriers, disease and drug-regime barriers and doctor-patient relationship barriers. However, in this poverty-stricken area these participants also face other constraints that influence their compliance behaviour. These include (1) over-burdened public health care facilities, (2) insufficient education, (3) poor support structures, (4) infrastructure that is not wheelchair-friendly, (5) unsafe communities, (6) low income and unemployment.
Risk taking behaviour among urban and rural adolescents in two selected districts in Malaysia : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977048More Less
Background : Risk taking behaviour refers to the tendency to engage in behaviours that have the potential to be harmful or dangerous, which has become a major concern and is rated as one of the public health issues that need special attention. The objective of the study was to compare the prevalence of risk taking behaviour and its associated factors among urban and rural adolescents.
Methods : A comparative cross-sectional study was conducted among 306 adolescents by multistage sampling from two selected schools with involvement of their parents.
Results : The prevalence of risk taking behaviours was 81 7% in the urban and 83.7% in the rural area (p = 0.650). Parental background factors such as parent's education level, marital status, health status, and income were unrelated with risk taking behaviour among adolescents. The multiple logistic regression test showed that being a male (AOR = 4.55, 95% CI = 2 28-9.07), inadequate number of bedrooms (AOR = 11.54, 95% CI = 1.48-89 75), and presence of family conflict (AOR = 3.64, 95% CI = 1.49-8.89) were the predictors among adolescents for risk taking behaviour in rural areas.
Conclusion : The absence of a balanced healthy family and conducive environment would lead to a negative influence towards adolescent behaviour, which may affect both the individual and community.
Source: South African Family Practice 57, pp 1 –14 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977052More Less
Small bowel obstruction is a common clinical presentation that presents a diagnostic conundrum. Over the last 2 decades, there has been a paradigm shift in the radiological investigation of small bowel obstruction (SBO) and in the indication for and timing of surgical intervention. Cross-sectional imaging (predominantly computed tomography) has largely replaced the widespread use of radiographic small bowel follow-through studies as the imaging modality of choice for SBO. This article illustrates the current imaging modalities available for diagnosis of small bowel obstruction.
Caffeine versus aminophylline for the prevention of apnoea of prematurity in a teaching hospital in South Africa : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.983310More Less
Study objectives : To determine the safety and efficacy of the use of oral anhydrous caffeine and intravenous aminophylline in the neonatal population using therapeutic drug levels and clinical effects as markers for determination.
Design : Prospective randomised study.
Patients : Thirty-one neonates admitted (aminophylline n = 16, caffeine n = 15) with a gestational age of less than or equal to 34 weeks for prevention of apnoea of prematurity (AOP) were enrolled.
Results : Oral anhydrous caffeine or intravenous aminophylline were administered using prescribed study regimens. One peak level was taken for the two drugs on day 4 of treatment 2 hours after the maintenance dose was administered. The two regimens were clinically monitored using cardiovascular, respiratory, gastro-intestinal and central nervous system parameters four hourly. The two groups did not differ significantly for gestational age (p = 0.782), birth weight (p = 1), gender (p = 0 722), and Apgar scores determined at 5 minutes (p = 0.068). Serum concentrations were within range (5-20 µg/ml) for both study groups. The median pulse rate (beats per minute) for two days; day 7: 160 vs. 148 (p = 0.019); day 9: 168 vs. 147 (p = 0.020) and median respiratory rate (breaths per minute) for five days; day 3: 68 vs. 61 (p = 0.039); day 4: 67 vs. 57 (p = 0.014); day 5: 64 vs. 58 (p = 0.045); day 7: 65 vs. 50 (p = 0.021); day 8: 66 vs. 56 p = 0.014) were significantly higher in the aminophylline study arm.
Conclusion : The findings of the study indicated that caffeine is an effective alternative for intravenous aminophylline in prevention of AOP. The oral administration of caffeine may also have an advantage in a resource-poor setting.
Author Gboyega OgunbanjoSource: South African Family Practice 57 (2015)More Less
In September 2000, leaders from 189 countries met at the United Nations offices in New York, USA, and endorsed the Millennium Declaration in which they committed to build a safer, more prosperous and equitable world. At that summit, they pledged to eight time-bound measurable goals within a 15-year timeframe (2000-2015), known as the Millennium Development Goals (MGDs).
Source: South African Family Practice 57, pp 8 –11 (2015)More Less
The new series, "Mastering your Fellowship", will provide examples of the question format encountered in the written examination, Part I of the FCFP(SA) examination. Examples of these question types (according to a theme) will be given in each printed edition of the journal. Women's health is the theme for the first article. Model answers will be available online, but not in the printed edition.
Author Kim OuthoffSource: South African Family Practice 57, pp 14 –17 (2015)More Less
Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalize pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old.
Review of the safety of nonsteroidal anti-inflammatory drugs and selective cyclo-oxygenase-2 inhibitors : reviewSource: South African Family Practice 57, pp 18 –22 (2015)More Less
Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common classes of medication used worldwide, and as the ageing population increases, the prevalence of painful arthritic conditions parallels this, resulting in the increased use of NSAIDs. Selective and nonselective cyclo-oxygenase inhibitors should be avoided, or at best used for short periods at the lowest possible effective dose, in patients with underlying artherosclerotic coronary disease.