Showing papers by "Debbie Bradshaw published in 1996"

Trends in Cervical Cancer Mortality in South Africa

Abstract: Background Cervical cancer is an important cause of death throughout the world, especially in less developed countries. Reports of trends in cervical cancer mortality from less developed countries have been limited by poor data quality and inaccurate population estimates. This paper examines trends in cervical cancer mortality in South Africa from 1949 to 1990 and discusses the impact of cytology screening on these trends. Methods Analysis of national mortality statistics and reconstructed population data. Results The age-standardized mortality rates for Whites declined after the mid 1960s, while that for Coloureds rose, particularly before the 1970s. These trends were affected predominantly by trends among women in the 35-64 age range. Conclusions The pattern of mortality in successive birth cohorts for Whites is consistent with a reduction in age-specific mortality following the advent of cytological screening. The same pattern is not evident in trends for Coloureds, among whom screening has apparently had a minor impact if any at all. The apparent lack of impact of screening in those groups of women most at risk of cervical cancer lends weight to demands for the implementation of equitable and rational screening programmes for cervical cancer in South Africa and internationally.

Public sector primary care of diabetics - a record review of quality of care in

Abstract: AIM To evaluate the quality of health care received by diabetics. DESIGN External audit by means of retrospective record review. SITE: Ambulatory outpatient diabetes clinics at community health centres in black areas of Cape Town. METHOD A stratified random sample (520) of all patients who attended any of five health centres during 1991 was reviewed by a clinician who had been trained to do structured record reviews. RESULTS The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin-dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were recorded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were recorded at 84.6% of visits and for over 99% of patients in 1991, and weight was recorded at 68.8% of visits. In contrast, fundoscopy was recorded for 6% of patients and examination of the feet was performed in 4.7% of patients. Fewer than half (48.9%) of visits resulted in any change in management. Polypharmacy is frequent, with an average of 2.3 non-hypoglycaemic drugs prescribed per visit. CONCLUSION Attendance and examination for treatable complications are inadequate. Care is routinised and reactive and there is polypharmacy. RECOMMENDATIONS Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these sites.

Public sector primary care of diabetics--a record review of quality of care in Cape Town.

Abstract: AIM To evaluate the quality of health care received by diabetics. DESIGN External audit by means of retrospective record review. SITE: Ambulatory outpatient diabetes clinics at community health centres in black areas of Cape Town. METHOD A stratified random sample (520) of all patients who attended any of five health centres during 1991 was reviewed by a clinician who had been trained to do structured record reviews. RESULTS The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin-dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were recorded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were recorded at 84.6% of visits and for over 99% of patients in 1991, and weight was recorded at 68.8% of visits. In contrast, fundoscopy was recorded for 6% of patients and examination of the feet was performed in 4.7% of patients. Fewer than half (48.9%) of visits resulted in any change in management. Polypharmacy is frequent, with an average of 2.3 non-hypoglycaemic drugs prescribed per visit. CONCLUSION Attendance and examination for treatable complications are inadequate. Care is routinised and reactive and there is polypharmacy. RECOMMENDATIONS Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these sites.