Showing papers in "South African Family Practice in 2007"

Peptic ulcer disease

Abstract: Peptic ulcer disease usually occurs in the stomach and proximal duodenum. The predominant causes in the United States are infection with Helicobacter pylori and use of non-steroidal anti-inflammatory drugs. Symptoms of peptic ulcer disease include epigastric discomfort (specifically, pain relieved by food intake or antacids and pain that causes awakening at night or that occurs between meals), loss of appetite, and weight loss. Older patients and patients with alarm symptoms indicating a complication or malignancy should have prompt endoscopy. Patients taking non-steroidal anti-inflammatory drugs should discontinue their use. For younger patients with no alarm symptoms, a test-and-treat strategy based on the results of H. pylori testing is recommended. If H. pylori infection is diagnosed, the infection should be eradicated and antisecretory therapy (preferably with a proton pump inhibitor) given for four weeks. Patients with persistent symptoms should be referred for endoscopy. Surgery is indicated if complications develop or if the ulcer is unresponsive to medications. Bleeding is the most common indication for surgery. Administration of proton pump inhibitors and endoscopic therapy control most bleeds. Perforation and gastric outlet obstruction are rare but serious complications. Peritonitis is a surgical emergency requiring patient resuscitation; laparotomy and peritoneal toilet; omental patch placement; and, in selected patients, surgery for ulcer control. Permission from the AAFP was granted to publish this article in the hardcopy only. Kindly refer to www.aafp.org or subscribe to the hardcopy of South African Family Practice.

Diagnosis of Acute Abdominal Pain in Older Patients

Abstract: Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly benign, even with catastrophic conditions such as abdominal aortic aneurysm rupture and mesenteric ischemia. Changes that occur in the biliary system because of aging make older patients vulnerable to acute cholecystitis, the most common indication for surgery in this population. In older patients with appendicitis, the initial diagnosis is correct only one half of the time, and there are increased rates of perforation and mortality when compared with younger patients. Medication use, gallstones, and alcohol use increase the risk of pancreatitis, and advanced age is an indicator of poor prognosis for this disease. Diverticulitis is a common cause of abdominal pain in the older patient; in appropriately selected patients, it may be treated on an outpatient basis with oral antibiotics. Small and large bowel obstructions, usually caused by adhesive disease or malignancy, are more common in the aged and often require surgery. Morbidity and mortality among older patients presenting with acute abdominal pain are high, and these patients often require hospitalisation with prompt surgical consultation. South African Family Practice Vol. 49 (4) 2007: pp. 25-30

Treatment Options for Insomnia

Abstract: The frequency of sleep disruption and the degree to which insomnia significantly affects daytime function determine the need for evaluation and treatment. Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated. However, if insomnia is severe or long-lasting, a thorough evaluation to uncover coexisting medical, neurologic, or psychiatric illness is warranted. Treatment should begin with non-pharmacologic therapy, addressing sleep hygiene issues and exercise. There is good evidence supporting the effectiveness of cognitive behavior therapy. Exercise improves sleep as effectively as benzodiazepines in some studies and, given its other health benefits, is recommended for patients with insomnia. Hypnotics generally should be prescribed for short periods only, with the frequency and duration of use customized to each patient\'s circumstances. Routine use of over-the-counter drugs containing antihistamines should be discouraged. Alcohol has the potential for abuse and should not be used as a sleep aid. Opiates are valuable in pain-associated insomnia. Benzodiazepines are most useful for short-term treatment; however, long-term use may lead to adverse effects and withdrawal phenomena. The better safety profile of the newer-generation non-benzodiazepines (i.e., zolpidem, zaleplon, eszopiclone, and ramelteon) makes them better first-line choices for long-term treatment of chronic insomnia. South African Family Practice Vol. 49 (8) 2007: pp. 34-41

An assessment of the level of knowledge about diabetes mellitus among diabetic patients in a primary healthcare setting

Abstract: BackgroundDiabetes mellitus is a global disease with an extreme effect on the quality of life of affected patients. In the past, South Africans diagnosed with diabetes mellitus were predominantly from the affluent urban community. Now, due to westernisation of the rural community, it is fast becoming prevalent in the rural African population. The increase in the number of peripheral clinics postapartheid has provided essential health care to the masses. There has been an increase in screening for diabetes and easier access to treatment for outlying communities. An important point of consideration is the knowledge that diabetic patients have of their disease. This is an integral component for attaining optimal disease control. Knowledge of diabetes can thus prevent the impending chronic co-morbidities of diabetes mellitus, which impact significantly on the quality of life of the diabetic patient. It would thus be valid to assess the understanding of the primary healthcare patient of his or her dise...

Interventions to facilitate smoking cessation

Abstract: Tobacco use, primarily cigarette smoking, is the leading cause of preventable morbidity and mortality in the United States, and nearly one third of those who try a cigarette become addicted to nicotine. Family physicians, who see most of these patients in their offices every year, have an important opportunity to decrease smoking rates with office-based interventions. The U.S. Public Health Service recommends that primary care physicians use the five A's (Ask, Advise, Assess, Assist, and Arrange) model when treating patients with nicotine addiction. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. Behaviour modification can improve long-term smoking cessation success; even brief (five minutes or less) advice on smoking cessation during an office visit can increase cessation rates. The effectiveness of non-pharmacologic treatments generally is lower; therefore, pharmacotherapy is recommended for smokers who are willing to attempt cessation, unless medical contraindications exist. The pharmacologic agents approved by the U.S. Food and Drug Administration for treatment of tobacco dependence include bupropion (a non-nicotine therapy) and nicotine replacement therapies in the form of a gum, patch, nasal spray, inhaler, and lozenge. These agents have similar long-term success rates. South African Family Practice Vol. 49 (1) 2007: pp. 28-39

An assessment of the level of knowledge about diabetes mellitus among diabetic patients in a primary healthcare setting : original research

Abstract: Background Diabetes mellitus is a global disease with an extreme effect on the quality of life of affected patients. In the past, South Africans diagnosed with diabetes mellitus were predominantly from the affluent urban community. Now, due to westernisation of the rural community, it is fast becoming prevalent in the rural African population. The increase in the number of peripheral clinics post-apartheid has provided essential health care to the masses. There has been an increase in screening for diabetes and easier access to treatment for outlying communities. An important point of consideration is the knowledge that diabetic patients have of their disease. This is an integral component for attaining optimal disease control. Knowledge of diabetes can thus prevent the impending chronic co-morbidities of diabetes mellitus, which impact significantly on the quality of life of the diabetic patient. It would thus be valid to assess the understanding of the primary healthcare patient of his or her disease state and the complications that may arise. This study was therefore aimed at clinics in the KwaZulu-Natal region, where 56,9% of the people live in rural areas, with an estimated 65% literacy rate and unemployment standing at over 50%. The patients at the rural clinics, who have limited access to the health care enjoyed by urban and private patients, would be of particular interest. Methods This was a descriptive study involving 181 patients attending three primary healthcare clinics in KwaZulu-Natal (designated A, B and C). The clinics that were selected either bordered on or were in a rural area. The patients were chosen by convenience sampling. All patients visiting the diabetic clinic were chosen on a voluntary basis. Informed consent was obtained from each patient. The patients could be either type 1 or type 2 diabetics. A two-part patient questionnaire was designed. Section A investigated basic patient history (demographics and disease state), while section B was a basic knowledge test on diabetes mellitus. Section A investigated patient age, race, residence, number of years post-diagnosis and the type of diabetic medication being taken. Diabetes knowledge was assessed with a modified version of the Michigan Diabetes Research and Training Centre's Brief Diabetes Knowledge Test. A total of 13 multiple-choice questions were used, covering key areas in diabetic management, including hypoglycaemic symptom identification, plasma glucose level awareness, knowledge of diet, the possible chronic co-morbidities of diabetes, foot care, exercise, etc. Patients answering seven of the 13 questions correctly were considered as having passed the test. Results A total of 121 of the 181 patients (66.9%) passed the diabetic knowledge test (p<0.05). There was a higher pass in the female group than in the male group, with 69.8% of the female population passing compared to 60% of the male. The overall data across the three clinics indicate a better pass by the Indian than the African population, with 75.9% of the Indian patients passed in comparison to 52.2% of the African patients. Conclusion It should be emphasised that a difference in knowledge scores illustrates a lack of history in the particular group and is a legacy of apartheid, during which there were inequalities in education, health services and all other spheres of life. Further correlations were established regarding diabetes knowledge and age, number of years post-diagnosis of diabetes, counselling received and type of diabetic medication used. There is a problem with regard to the understanding of diabetes by the African population. The majority of the African study population, who were type 2 diabetics and older than forty, grew up during the apartheid era and consequently lacked the benefit of appropriate heath care and education. We therefore need to ensure that our healthcare providers are continuously trained and provided with the essentials in order to comprehensively care for diabetic patients. Furthermore, follow up evaluations should be performed on a regular basis in the clinical environment and re-training administered where appropriate.

Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan

Abstract: BackgroundThis article explores the hypothesis that predisposing and enabling factors of households influence the vaccination status of the children under the age of five in Khartoum State, Sudan.MethodThe study was a cross-sectional survey among a representative sample of 410 male and female children under five years of age from households with varying socio-economic status and mothers with varying levels of education, from both urban and rural localities in the state.ResultsThe correct vaccination coverage rate for children was found to be high. Children in urban and rural areas differed substantially in their correct vaccination rates and their receipt of each vaccine separately. Walking or travelling time to the place of vaccination was found to be longer in rural areas when compared with urban areas. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. ...

Medical management of common urinary calculi

Abstract: Nephrolithiasis is a common condition affecting nearly 5 percent of U.S. men and women during their lifetimes. Recurrent calculi can be prevented in most patients by the use of a simplified evaluation, reasonable dietary and fluid recommendations, and directed pharmacologic intervention. Serum studies and 24-hour urine collections are the mainstays of metabolic investigation and usually are warranted in patients with recurrent calculi. Although some stones are the result of inherited conditions, most result from a complex interaction between diet, fluid habits, and genetic predisposition. Calcium-sparing diuretics such as thiazides often are used to treat hypercalciuria. Citrate medications increase levels of this naturally occurring stone inhibitor. Allopurinol can be helpful in patients with hyperuricosuria, and urease inhibitors can help break the cycle of infectious calculi. Aggressive fluid intake and moderated intake of salt, calcium, and meat are recommended for most patients. South African Family Practice Vol. 49 (3) 2007: pp. 44

Pet-related infections

Abstract: Human contact with cats, dogs, and other pets results in several million infections each year in the United States, ranging from self-limited skin conditions to life-threatening systemic illnesses. Toxoplasmosis is one of the most common pet-related parasitic infections. Although toxoplasmosis is usually asymptomatic or mild, it may cause serious congenital infection if a woman is exposed during pregnancy, particularly in the first trimester. Common pet-borne fungal infections include tinea corporis/capitis (ringworm); campylobacteriosis and salmonellosis are among the most common bacterial infections associated with pet ownership. Less commonly, pets can transmit arthropod-borne and viral illnesses (e.g., scabies, rabies). Infection in a pet can provide sentinel warning of local vectors and endemic conditions, such as Lyme disease risk. Treatment is infection-specific, although many infections are self-limited. Prevention involves common sense measures such as adequate hand washing, proper disposal of animal waste, and ensuring that infected animals are diagnosed and treated. Special precautions are indicated for immunocompromised persons. Increased communication between primary care physicians and veterinarians could improve treatment and prevention of these conditions. Permission from the AAFP was granted to publish this article in the hardcopy only. Kindly refer to www.aafp.org or subscribe to the hardcopy of South African Family Practice.

Guidelines for the management of Chronic Asthma in adolescents and adults

Abstract: Asthma prevalence is increasing worldwide and surveys indicate that the majority of patients in developed and developing countries do not receive optimal care and are therefore not well controlled. The aim of these guidelines is to promote a better standard of treatment based on advances in the understanding of the pathophysiology and pharmacotherapy of asthma and to encourage uniformity in the management of asthma.

The use of the Road to Health Card in monitoring child health : original research

Abstract: Background: The Road to Health Card (RTHC) provides a simple, cheap, practical and convenient method of monitoring child health. The RTHC could assist in improving health through vaccine compliance and early identification of growth faltering. The purpose of this study was to assess whether the RTHCs are completed and interpreted adequately at primary, secondary and tertiary care levels in South Africa. Methods: The study was carried out at a primary, secondary and tertiary care centre. A questionnaire was administered to 100 subjects at each centre to obtain demographic information, information on whether the RTHC had been brought along and, if not, why it had not been brought. Results: Most children were brought to the centres by their mothers. The RTHC was not brought to 48% of the consultations; of these respondents, about 72% thought that bringing along the RTHC was not necessary. Health workers seldom asked to see the RTHC in the primary and secondary care settings, but 50% of them did so at Ga-Rankuwa Hospital (p = 0,002). In only eight cases overall were the children below the third percentile of weight for age. Approximately 20% had incomplete immunisations. Conclusion: Many parents believe that the RTHC is only required for visits to the Well-baby Clinics, and not for consultations. The RTHC is not often asked for at consultations; the fact that this is more often done at the tertiary care centre may be the result of the service being supplied by paediatricians-in-training. Health workers should ask to see the RTHC in order for mothers to understand the importance of the information contained in it. The study showed that the RTHC is not used to its full potential. The situation in private general practice was not investigated, but is not expected to differ much from that described in this article. Although many family physicians do not offer immunisations as a service, they all deal with sick children and if the general practitioner asks mothers to produce the RTHC and then discusses its reference to her child?s current problem, the mothers are more likely to understand the importance of the RTHC as a tool in monitoring child health.

Knowledge of and attitude towards pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa

Abstract: BackgroundThis study determined women's knowledge of and attitudes to pain relief during labour.MethodsThis descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief.ResultsThe median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3%) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5%) or from friends and relatives (55.3%). Of the women who had knowledge of pain relief (n=85), 65.9% indicated injections. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. ...

Variables influencing delay in antenatal clinic attendance among teenagers in Lesotho

Abstract: BackgroundA delay in deciding to seek antenatal care is predominant among pregnant teenagers in Lesotho. This subsequently leads to delay in reaching treatment and in receiving adequate treatment. Early antenatal care attendance plays a major role in detecting and treating complications of pregnancy and forms a good basis for appropriate management during delivery and after childbirth.Although antenatal care is provided at different levels, Lesotho still has a high maternal mortality rate, estimated at 762 per 100 000 live births, and an infant mortality rate of 72 per 1 000 live births.1 Lesotho has a chronic shortage of doctors and nurses. According to the Lesotho Population Data Sheet of 2000, the doctor-patient ratio for this country for the year 1999 was 1:13 041 and the nurse ratio was 1:2 035. About 31% of the adult population between the ages of 15 to 49 years is infected with HIV/Aids.1This shortage of health care personnel and the impact of HIV/Aids result in insufficient focus on health...

The Use Of The Road To Health Card In Monitoring Child Health

Abstract: Background The Road to Health Card (RTHC) provides a simple, cheap, practical and convenient method of monitoring child health. The RTHC could assist in improving health through vaccine compliance and early identification of growth faltering. The purpose of this study was to assess whether the RTHCs are completed and interpreted adequately at primary, secondary and tertiary care levels in South Africa.Methods The study was carried out at a primary, secondary and tertiary care centre. A questionnaire was administered to 100 subjects at each centre to obtain demographic information, information on whether the RTHC had been brought along and, if not, why it had not been brought.Results Most children were brought to the centres by their mothers. The RTHC was not brought to 48% of the consultations; of these respondents, about 72% thought that bringing along the RTHC was not necessary. Health workers seldom asked to see the RTHC in the primary and secondary care settings, but 50% of them did so at Ga-R...

Management of erectile dysfunction: perceptions and practices of Nigerian primary care clinicians

Abstract: BackgroundErectile dysfunction (ED) is a prevalent health problem in many societies, but the diagnosis is seldom documented in primary care. The objective of this study was to investigate the perception and practices of clinicians regarding the management of ED in primary care settings in Nigeria.MethodsA self-administered semi-structured questionnaire was applied to a purposive sample of clinicians attending conferences/workshops organised by the Society of Family Physicians of Nigeria and Update Courses of the Faculties of Family Medicine of the National Postgraduate Medical College of Nigeria and the West African College of Physicians. Information was obtained on their professional characteristics, experiences with the management of ED and possible barriers to the effective management of ED.ResultsA total of 187 completed questionnaires were analysed. Most (87.2%) of the respondents were general practitioners, while the rest were specialists in various fields (excluding sexual health) who worke...

Screening for diabetes mellitus in a Nigerian family practice population

Abstract: BackgroundDiabetes mellitus is a non-communicable disease with a rising prevalence worldwide. Most of the increase in prevalence is projected to be in the developing countries. As it is recognised that the onset of the disease and its complications predate the symptoms, it is expedient that screening procedures are undertaken to diagnose the disease in the individual as early as possible to minimise the risk of complications. Diabetes mellitus is a chronic disease necessitating life-long therapy, usually with drugs. This creates a life-long financial burden on the family, especially in low socio-economic communities in West Africa, where the majority of the population still lives on less than one dollar a day. This affects the wellbeing of the entire family, hence the need for early detection, prompt and adequate management of the disease and avoidance of its complications.MethodsThe study is an incidental screening to determine the prevalence of diabetes mellitus, its risk factors and the clinica...

Caring for our children

Abstract: Children are severely affected by the global HIV-epidemic, nowhere more so than in sub-Saharan Africa, the region that carries the brunt of the HIV disease burden. HIV has been responsible for more than 25 million deaths to date (WHO 2006) and it is estimated that 38.6 million people are currently living with HIV (UNAIDS 2006), the majority living in sub-Saharan Africa. The HIV prevalence has been declining in a number of African countries, but the most southern parts of the continent (South Africa in particular) are still faced with an escalating epidemic (UNAIDS 2006).

Prevalence of anaemia in pregnancy in the Uthungulu health district of KwaZulu-Natal, South Africa : original research

Abstract: Background: An estimated 30% of the world's population is affected with anaemia. Anaemia in pregnancy is a leading cause of maternal and perinatal deaths in developing countries. In developing countries, anaemia affects almost two thirds of the pregnant population. It is also estimated that anaemia is responsible for as much as 20% of all maternal deaths in sub-Saharan Africa. Maternal anaemia is a risk factor for infant iron deficiency anaemia and, if left uncorrected, can be associated with adverse behavioural and cognitive development in children. The prevalence of anaemia in pregnancy is estimated at between 35% and 75% in sub-Saharan Africa, however, the area-specific health problems during pregnancy are not known. In order to improve maternal health and the health of the foetus during pregnancy, knowledge of the prevalence or incidence of pregnancy-related conditions would be useful for district management teams, as well as for provincial and national maternal, child and women's health programme development. The objectives of this study were to describe haemoglobin levels and estimate the prevalence of anaemia among pregnant women at their booking visit. Methods: A retrospective cross-sectional descriptive study was conducted using the antenatal clinic registers of primary healthcare (PHC) clinics in the Empangeni subdistrict of the Uthungulu Health District from July to December 2003. Data were gathered from 1 214 consecutive pregnant women who attended for antenatal care at three randomly selected primary healthcare clinics during the study period. We examined the distribution of Hb values to determine the percentages of women with anaemia (Hb < 10 gm/dL) and severe anaemia (Hb < 7 gm/dL), and compared this with the prevalence of anaemia according to the WHO definition (Hb < 11 gm/dL). Results: In terms of the South African National Department of Health definition of anaemia in pregnancy, (haemoglobin < 10 gm/dL), 30.1% of the attendees were anaemic. According to the World Health Organisation (WHO) criteria (Hb < 11 gm/dL), the prevalence of anaemia was 57.3%. The difference in the prevalence of anaemia on the basis of the two different criteria was significant (p = 0.000). This finding was comparable to studies conducted in other Sub-Saharan African countries. Conclusion: The prevalence of anaemia in pregnancy in this community is high. The prevalence of anaemia varied greatly when the WHO definition was used. The pregnant women of this community attend the healthcare facility very late for their booking visit, in spite of free maternity services at public health facilities. There is an urgent need for health education and health promotion programmes in this population for early booking for antenatal care. Further investigations are needed to establish the risk factors for, causes of and preventive interventions for anaemia in pregnancy.

Occupational exposure to bloodborne viruses amongst medical practitioners in Bloemfontein, South Africa : original research

Abstract: Background: The possibility of occupational exposure to bloodborne viruses such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality for healthcare workers. This study reports on the extent and outcome of doctors? exposure to bloodborne viruses in Bloemfontein. Methods: A descriptive study was done. Doctors (n=441) actively involved in public and / or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV, HBV and HCV). Results: A response rate of 51.7% was obtained. More than half (54.2%, 95% CI [47.7%; 60.5%]) of the respondents were exposed to bloodborne viruses. Of these cases, 48.3% occurred with HIV-positive patients and 4.3% with known HBV-positive patients. No cases involved positive HCV patients. After the exposure had occurred, 68.9% of the patients were tested for HIV, 10.9% for HBV and only 4.2% for HCV infection. The frequency of serological testing for doctors immediately after exposure was 65.3% for HIV, 21.7% for HBV and 8.2% for HCV. No seroconversion to HIV or HCV was reported, while two seroconversions to HBV were reported. Most of the exposures occurred as a result of needlestick injury (85%), often in the operating theatre during procedures (59.3%). The majority (59.8%) of exposed doctors did not take any prophylactic treatment and those who did, did not always complete the treatment. Conclusion: The risk of seroconversion to HIV after occupational exposure was as expected, while seroconversion to HBV was less than expected. The lack of adequate follow-up serological testing after occupational exposure is alarming. It is the responsibility of the occupationally exposed doctor to adequately comply with prophylactic measures and undergo serological testing to ensure the least possible risk of contracting infection from a bloodborne virus.

The role of educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals : original research

Abstract: The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province, South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence, increased the levels of job satisfaction they experienced, increased their willingness to stay in a rural environment, and impacted positively on the quality of services provided. However, the success of educational strategies is heavily dependant on the local environment (context), as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals, however, this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care.

Prevalence of anaemia in pregnancy in the Uthungulu health district of KwaZulu-Natal, South Africa

Abstract: BackgroundAn estimated 30% of the world's population is affected with anaemia Anaemia in pregnancy is a leading cause of maternal and perinatal deaths in developing countries In developing countries, anaemia affects almost two thirds of the pregnant population It is also estimated that anaemia is responsible for as much as 20% of all maternal deaths in sub-Saharan Africa Maternal anaemia is a risk factor for infant iron deficiency anaemia and, if left uncorrected, can be associated with adverse behavioural and cognitive development in children The prevalence of anaemia in pregnancy is estimated at between 35% and 75% in sub-Saharan Africa, however, the area-specific health problems during pregnancy are not known In order to improve maternal health and the health of the foetus during pregnancy, knowledge of the prevalence or incidence of pregnancy-related conditions would be useful for district management teams, as well as for provincial and national maternal, child and women's health program

Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan : original research

Abstract: Background: This article explores the hypothesis that predisposing and enabling factors of households influence the vaccination status of the children under the age of five in Khartoum State, Sudan. Method: The study was a cross-sectional survey among a representative sample of 410 male and female children under five years of age from households with varying socio-economic status and mothers with varying levels of education, from both urban and rural localities in the state. Results: The correct vaccination coverage rate for children was found to be high. Children in urban and rural areas differed substantially in their correct vaccination rates and their receipt of each vaccine separately. Walking or travelling time to the place of vaccination was found to be longer in rural areas when compared with urban areas. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. The mothers' knowledge of and attitudes to vaccination showed a strong relationship with the vaccination status of their children. When the coverage rate for each vaccine was taken separately, the economic level of the households significantly affected only the BCG vaccine coverage. Most vaccinations occurred in public outlet agencies. Conclusion: The large differences found in vaccination coverage by place of residence and level of mother's education suggest that much greater efforts are required by the government if better rates of correct vaccination are to be achieved in rural areas.

Young breast cancer patients in the developing world: incidence, choice of surgical treatment and genetic factors

Abstract: Carcinoma of the breast is the most common cause of cancer in women in Western society. Although breast cancer occurs predominantly in older premenopausal and postmenopausal women, it also occurs in young women. Literature defines breast cancer in a young woman (or early onset breast cancer) as occurring in a woman less than 35 years of age. A diagnosis of breast cancer in a young woman impacts severely on all aspects of her life, as well as on those around her.In Africa and other developing countries, the breast cancer burden is increasing and poor reporting and data availability may underestimate the exact numbers. The average age of diagnosis may be younger for women in developing countries than for women in developed countries. African patients are more likely to be premenopausal at diagnosis and the breast cancers tend to be more advanced at presentation than in other population groups in a country such as South Africa.The choice of surgical treatment in early onset cancer depends on various ...

Editorial: Equal opportunities for children with hearing loss by means of early identification

Abstract: Infant hearing loss is a silent, overlooked epidemic of developing countries because its invisible nature prevents detection by means of routine clinical procedures despite being the most common birth defect. Even though it is not a life-threatening condition, failure to intervene in time renders it a severe threat to critical quality of life indicators such as education, employment and societal integration. This stands in stark contrast to current evidence which indicate early identification for infants with hearing loss followed by subsequent intervention leads to linguistic, speech and cognitive development that is comparable to normal hearing peers. Unfortunately initial detection of hearing loss in South Africa is primarily passive, when critical periods have passed, as a result of parental concern about observed speech and language delays, unusual behaviour or the complications of otitis media. Although the South African governmental policy guidelines favour the philosophy of screening for hearing loss in infants the implementation is not realised. Widespread newborn and infant hearing screening programmes must be established to ensure equal opportunities for children with hearing loss in South Africa. South African Family Practice Vol. 49 (1) 2007: pp. 3

Occupational exposure to bloodborne viruses amongst medical practitioners in Bloemfontein, South Africa

Abstract: Background The possibility of occupational exposure to bloodborne viruses such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality for healthcare workers. This study reports on the extent and outcome of doctors' exposure to bloodborne viruses in Bloemfontein.MethodsA descriptive study was done. Doctors (n=441) actively involved in public and/or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV, HBV and HCV).ResultsA response rate of 51.7% was obtained. More than half (54.2%, 95% CI [47.7%; 60.5%]) of the respondents were exposed to bloodborne viruses. Of these cases, 48.3% occurred with HIV-positive patients and 4.3% with known HBV-positive patients. No cases involved positive HCV patients. After the exposure had occurred, 68.9% of the patients were tested for HIV, 10.9% for HBV and only 4.2% for HCV infection. The frequency of serological testing for doctors immediately after ex...

Diabetes in Africa: the new pandemic. Report on the 19th World Diabetes Congress, Cape Town, December 2006

Abstract: The prevalence of diabetes in Africa is predicted to increase by 80% in 2025 and impact younger working age patients. We increasingly live in an obesogenic society that drives the global pandemic of Type 2 diabetes. The powerful commercial, socio-economic and political factors shaping this society encourage individual choices that lead to a sedentary and unhealthy lifestyle. These factors are increasingly seen in lower income countries. The metabolic syndrome is now an established entity which can be identified and treated prior to the development of diabetes. In sub-Saharan Africa there is an emerging relationship between the HIV and diabetic epidemics. For example HAART leads to a higher risk of diabetes and diabetes increases the risk of infections such as TB. The quality of care in sub-Saharan Africa can be improved with relatively simple measures if they are implemented consistently and guidelines have been developed for this context. A vision for the way forward in Africa has been expressed in the 2006 African Diabetes Declaration. South African Family Practice Vol. 49 (6) 2007: pp. 44-50

The role of educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals

Abstract: The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas.

Further reflections on chronic illness care

Abstract: There are seven key principles in the care of patients with chronic illnesses which are fundamental in offering an appropriate service and adequate care for these patients. These are the principles that should underlie the setting up and management of any primary health care service endeavouring to treat patients with chronic illness. They determine how one understands the care of such patients and how to organise a service or practice. These principles are discussed in this article and will provide both the right mindset and the right organisational approach for effective chronic illness care.

Equal opportunities for children with hearing loss by means of early identification

Abstract: (2007). Equal opportunities for children with hearing loss by means of early identification. South African Family Practice: Vol. 49, No. 1, pp. 3-3.

Emergency care provision for, and psychological distress in, survivors of domestic violence

Abstract: BackgroundThis study aimed (i) to ascertain the number of treatment referrals and information about protection orders given to survivors of domestic violence presenting for emergency trauma care, as reported at the one-month visit, (ii) to obtain a profile of violent incidents and injuries, and (iii) to assess self-esteem and posttraumatic and depressive symptomatology in the aftermath of injury.MethodsA survey of 62 participants presenting in the acute aftermath of domestic violence (as defined by the Domestic Violence Act of 1998) was conducted over 12 weeks at the Trauma and Resuscitation Unit of a Level One trauma centre in an urban public hospital in South Africa.1 Following informed consent, face-to-face structured interviews were conducted during admission and a month later. The following instruments were administered at baseline: a Demographic and Injury Questionnaire, the Beck Depression and Rosenberg Self-Esteem Inventories, and the Davidson Trauma Scale. A psychosocial questionnaire was...