Showing papers in "South African Medical Journal in 2005"

Impact of DDT re-introduction on malaria transmission in KwaZulu-Natal.

Abstract: lIgObjectives.l/Ig To determine whether the re-introduction of DDT in KwaZulu-Natal had any effects on malaria transmission in the province. Design, setting and subjects.l/Ig The 2000 malaria epidemic in KwaZulu-Natal has been attributed to pyrethroid-resistant anopheles mosquitoes in the area. Previous studies have shown that these mosquitoes are still susceptible to DDT. To determine whether DDT re-introduction had any impact on malaria transmission in KwaZulu-Natal, the following variables (preand post-epidemic) were investigated: (i) the number of reported cases; and (ii) the distribution of Anopheles funestusl/Ig in relation to the insecticides sprayed. Outcome measures.l/Ig The notified malaria cases and the distribution of A. funestusl/Ig were measured to determine the effects of DDT re-introduction on malaria transmission. Results and conclusion.l/Ig After DDT re-introduction, the number of malaria cases decreased to levels lower than those recorded before the epidemic. A. funestusl/Ig appears to have been eradicated from the province. The combination of an effective insecticide and effective antimalarial drugs in KwaZulu-Natal has resulted in a 91% decline in the malaria incidence rate. Unfortunately the continued exclusive use of DDT within the malarious areas of the province is threatened by the emergence of insecticide resistance.

Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town

Abstract: Background. The majority of patients with type 2 diabetes mellitus in Cape Town who attend primary care community health centres (CHCs) have unsatisfactory glycaemic control. Insulin is rarely prescribed despite its being indicated for type 2 diabetic patients with inadequate metabolic control on maximum oral glucose-lowering agent (OGLA) therapy.Objective. The study examined barriers to initiating insulin therapy in poorly controlled type 2 diabetes patients on maximum OGLAs in CHCs in the Cape Town metropole.Methods. Five focus group discussions and 10 in-depth semi-structured individual interviews were conducted with 46 medical officers working at the CHCs. The discussions and interviews were transcribed and common themes were identified and categorised.Results. Doctor, patient, and system barriers to initiating insulin therapy were identified. Doctors' barriers include lack of knowledge, lack of experience with and use of guidelines related to insulin therapy, language barriers between doctor and pati...

The South African stroke risk in general practice study.

Abstract: Background. Incidence of stroke is increasing in sub-Saharan Africa and stroke prevention is an essential component of successful stroke management. General practitioners (GPs) are well placed to manage stroke risk factors. To design appropriate strategies for risk factor reduction we need to know the risk factor prevalence in each of the population groups attending GPs. The aim of this study was to establish the prevalence of stroke risk factors in the South African general practice population. Method. We conducted a multicentre, observational study of patients attending general practice in South Africa. Two hundred general practices were randomly selected from lists provided by pharmaceutical representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient's risk factors. The resulting sample is relevant if not necessarily representative in a statistical sense. Results. A total of 9 731 questionnaires were returned out of a possible 10 000. The mean age of particpants was 50.7 years. Seventy-six per cent had 1 or more risk factors and 40% had 2 or more risk factors. Hypertension was the commonest risk factor in all population groups (55%) but was highest in black patients (59%). Dyslipidaemia was commonest in whites (37%) and least common in blacks (5%). Diabetes was commonest in Asians (24%) but least common in whites (8%). Risk factors other than smoking increased with age. Conclusion. This study provides unique data on the prevalence of stroke risk factors in a South African general practice population. Risk factors are common in all population groups, but differ in distribution among the groups. There is considerable opportunity to reduce the burden of stroke in South Africa through GP screening for and treatment of risk factors. S Afr Med J 2005; 95: 334-339.

Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital

Abstract: Objectives . To determine the survival rates for infants weighing 500 - 1 499 g according to birth weight (BW) and gestational age (GA). Design. This was a retrospective cohort study. Pregnancy and delivery data were collected soon after birth and neonatal data at discharge or at death. Setting . Chris Hani Baragwanath Hospital (CHBH), a publicsector referral hospital, affiliated to the University of the Witwatersrand. Subjects . Live births weighing between 500 g and 1 499 g delivered at or admitted to CHBH from January 2000 to December 2002. Outcome measures . BW and GA-specific survival rates for all live infants born at CHBH and for those admitted for neonatal care. Results . Seventy-two per cent of infants survived until discharge. The survival to discharge rate was 32% for infants weighing < 1 000 g, and 84% for those weighing 1 000 - 1 499 g. Survival rates at 26, 27 and 28 weeks' gestation were 38%, 50% and 65% respectively. Survival rates for infants admitted to the neonatal unit were better than rates for all live births, especially among those weighing < 1 000 g or with a GA < 28 weeks. There was a marked increase in survival between the 900 - 999 g and 1 000 - 1 099 g weight groups. Provision of antenatal care, caesarean section, female gender and an Apgar score more than 5 at 1 or 5 minutes were associated with better survival to hospital discharge. Conclusion . Survival among infants weighing less than 1 000 g is poor. In addition to severe prematurity, the poor survival among these infants(< 1 000 g) is most likely related to the fact that they were not offered mechanical ventilation. Mechanical ventilation should be offered to infants weighing < 1 000 g as it may improve their survival even in institutions with limited resources.

Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act.

Abstract: 250 To the Editor: The Choice on Termination of Pregnancy Act appears to have had a very marked impact on abortion-related mortality. This conclusion can be drawn by comparing the number of abortion-related deaths found in the Confidential Enquiries into Maternal Deaths (Department of Health 1999 and 2003) and the 2000 national incomplete-abortion survey with the estimates of pre-legislative reform mortality found in the 1994 national incomplete-abortion survey. The latter survey estimated that there were 425 (78 736) deaths each year in public facilities from unsafe abortion. When the survey was repeated in 2000, no deaths were detected in the 3-week data collection period in any study hospital. We could conclude that a significant decline in mortality had occurred but it was not possible to estimate the annual number of deaths accurately. The Confidential Enquiries, however, provide complete ascertainment of hospital deaths and so no estimation is needed. In the 1998 Confidential Enquiry, 32 abortion-related maternal deaths (5.7% of the total) were found. The Second Report (1999 2001) found 40 abortion-related deaths per year. Comparison of the 1994 research estimate and the 1998 2001 mortality data (averaged) suggests that there has been a 91.1% reduction in deaths from unsafe abortion, with a possible range of 51.3 94.8% depending on the position of the true figure in 1994 within the confidence intervals of the estimate. This reduction in mortality after abortion legalisation is even greater than that reported in other countries, such as Romania, and shows that this legislation has been extremely successful in advancing women's health and rights.

Diagnosis and management of community-acquired pneumonia in childhood--South African Thoracic Society Guidelines.

Abstract: Background Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence, severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective To develop guidelines for the diagnosis, management and prevention of CAP in South African children. Methods The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence, expert opinion was accepted. After peer review and revision, the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations Recommendations based on epidemiological factors include a diagnostic approach, investigations, supportive therapy, appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in paediatrics, paediatric pulmonology, radiology, infectious diseases and microbiology. Published international guidelines have also been consulted.

Provincial mortality in South Africa, 2000 - priority-setting for now and a benchmark for the future

Abstract: Background. Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics. Objective. To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces. Methods. Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africa's 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting. Results. Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga. Conclusion. The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level.

Clinical features and outcome in children admitted to a TB hospital in the Western Cape - the influence of HIV infection and drug resistance

Abstract: Background :l/Ig The Western Cape has a high incidence of tuberculosis (TB) and a rising prevalence of HIV infection. Children form 15 - 20% of this TB burden. Objective :l/Ig To document the clinical features and outcome of TB among children admitted to a regional TB hospital. Method : l/Ig A retrospective, descriptive study was undertaken of children under 15 years of age admitted to Brooklyn Hospital for Chest Diseases from January 2000 to December 2001. Demographic and clinical details of children were recorded routinely in a register that formed the basis of this review. Results : l/Ig Two hundred and thirty-eight of the 250 children admitted had TB, of whom 120 (50.4%) were boys. The median age was 25 months. Reasons for admission were disease severity in 99 cases, social reasons in 36, and a combination in 103. Adult source cases were identified in 138 instances; 9 had drug-resistant TB, 31 drug-susceptible TB and in 98 cases susceptibility was unknown. TB was confirmed by culture in 119 children. Of 79 in whom susceptibility testing was done, 10 had isoniazid-resistant TB and 8 multidrug-resistant TB. HIV serology was positive in 43 of 138 children tested (31%). Previous antituberculosis treatment, severe malnutrition and weight under the 3rd percentile for age, a negative Mantoux test, and mortality were significantly more common in the HIVinfected children. Twenty-two of 41 previously negative Mantoux tests (l 5 mm induration) were positive on retesting. Conclusions :l/Ig HIV infection is common in children with TB and malnutrition, and mortality in this group is high. Repeat Mantoux tests may show an increased number of positive results.

Unintentional doping through the use of contaminated nutritional supplements.

Abstract: Objective . To determine whether the intake of contaminated nutritional supplements could cause an athlete to fail a dope test. Design . A contaminated nutritional supplement was used, identified in an ongoing study screening over-the-counter nutritional supplements. One capsule of the supplement, containing small amounts of 19-nor-4-androstenedione and 4-androsten-3,17-dione, not listed on the label, was administered to 5 healthy male volunteers. Fractional urine collection was done at prescribed intervals. Outcome measures . The samples were analysed using gas chromatography /mass spectrometry (GC/MS). Samples containing 19-norandrosterone, the main metabolite of 19-nor-4-androstenedione, were quantified using GC/MS. Results . All the volunteers had urinary concentrations of 19-norandrosterone above the World Anti-Doping Agency threshold of 2 ng/ml from 2 hours post administration. In 2 volunteers.19-norandrosterone above the threshold value could still be detected beyond 36 hours post administration. The highest concentration of 19-norandrosterone found in a sample was 54.6 ng/ml at 8 hours post administration. Conclusion . The results of this study showed that the intake of microgram amounts of a prohibited substance in a nutritional supplement could cause an athlete to fail a dope test.

Lack of adherence to the national guidelines on the prevention of rheumatic fever

Abstract: Objectives. To explore the extent to which current practices for the secondary prevention of rheumatic fever (RF) in Cape Town adhere to those outlined in the national guidelines on the primary prevention and prophylaxis of RF and rheumatic heart disease (RHD) for health professionals at primary level. Methods. A combination of qualitative tools was used to evaluate the four priority issues identified in the guidelines as fundamental elements of a comprehensive programme for the secondary prophylaxis of RF/RHD: (i) health education and promotion; (ii) case detection of RF and RHD; (iii) secondary prophylaxis every 3 - 4 weeks at primary level; and (iv) notification of acute rheumatic fever (ARF). The qualitative tools included parent/child interviews of cases diagnosed with ARF in the Cape metropole area during the period 1999 - 2003; a physician questionnaire focused on awareness and adherence to the national guidelines; and a review of the records on acute rheumatic fever notification in the Cape metropole area from 1999 to 2003. Results. The evaluation revealed four key findings. First, patient knowledge on the disease was almost non-existent. Despite this lack of knowledge, adherence to secondary prophylactic treatment was good. Second, the physicians most likely to encounter a case of rheumatic fever were least likely to be aware of and to comply with the national guideline. Third, the guidelines do not clearly state how increased detection of ARF will be achieved. Finally, the RF notification system is dysfunctional, with discrepancies in the reporting of cases at hospital, city and provincial levels. Conclusions. Since the publication of the national guidelines in 1997, little progress has been made towards achieving the implementation of a comprehensive programme for the secondary prevention of RF/RHD.

The cost of treating serious abdominal firearm-related injuries in South Africa

Abstract: Introduction :l/Ig Firearms, the leading external cause of nonnatural deaths in South Africa, claim approximately 15 000 lives annually. Up to 127 000 firearm-injured victims seek state health care assistance per annum. The fiscal burden of treating these injuries is not known. Methods :l/Ig All serious abdominal firearm-related injuries (requiring admission to hospital and emergency surgery) presenting to a state hospital over a 6-month period were reviewed. A cost analysis using five variables was performed: operating theatre time, duration of hospital and high-care unit stay, pharmaceutical and blood products used, laboratory services used and diagnostic imaging studies performed. Results :l/Ig Twenty-three patients with serious abdominal gunshot injuries were admitted, of whom 21 (91%) were treated at the hospital from admission until discharge. Each admission cost approximately US$1 467. Hospital stay (47%) and operating theatre (30%) costs accounted for most of the total cost. Pharmaceuticals and blood products (20%), laboratory services (2%) and imaging studies (1%) contributed less than 25% to the total cost. Conclusion :l/Ig Serious abdominal gunshot injuries cost at least 13- fold more than the annual per capita South African government expenditure on health. This fiscal burden of approximately US$2.9 million, almost 4% of the annual health budget, does not include the cost of treating other serious gunshot injuries. These findings highlight the need for successful violence prevention strategies in South African.

Routinely available cotrimoxazole prophylaxis and occurrence of respiratory and diarrhoeal morbidity in infants born to HIV-infected mothers in South Africa

Abstract: Objectives To examine the influence of cotrimoxazole (CTM) prophylaxis on incidence of lower respiratory tract infections (LRTIs) and diarrhoea Design A prospective observational cohort study Morbidity and feeding data on infants born to HIV-infected mothers were collected routinely at clinic visits at 1 week, 6 weeks and 3 months, and 3-monthly thereafter, with blood drawn for determining HIV status Setting Two hospitals in Durban, South Africa In one hospital (King Edward VIII Hospital), infants born to HIVinfected mothers recieved CTM prophylaxis and in the other (McCord Hospital) infants did not receive CTM prophylaxis Subjects Infants born to HIV-infected mothers Outcome measures Incidence of LRTI and diarrhoea Results In multivariate analysis controlling for breast-feeding status, number of clinic visits and HIV infection status, HIVinfected infants with access to CTM prophylaxis had a significantly lower incidence of LRTI (82%) than those without access to prophylaxis However in HIV-uninfected infants, this was not the case CTM prophylaxis was associated with a non-significant increased risk for diarrhoea in both infected (odds ratio (OR) 158, p = 045) and uninfected infants (OR 152, p = 010) Conclusions This observational study confirms current thinking that CTM prophylaxis is protective against LRTIs in HIV-infected children However, because of a possible association between CTM prophylaxis and an increased risk of diarrhoea, HIV status of infants should be determined as early as possible in order to prevent unnecessary exposure of uninfected infants to CTM prophylaxis, while further studies to quantify both beneficial and adverse effects of CTM prophylaxis are undertaken S Afr Med J 2005; 95: 339-345

Market and product assessment of probiotic/prebiotic - containing functional foods and supplements manufactured in South Africa

Abstract: Objectives. Probiotic and prebiotic products manufactured in South Africa were identified and health and content claims stated on the labels were evaluated according to available scientific evidence, the proposed South African regulations in the Foodstuffs, Cosmetics and Disinfectants Act (Act No. 54 of 1972, www.doh.gov.za), and microbial assessment. Results. The range of products identified included probioticand/ or prebiotic-containing supplements (capsules), food items fortified with probiotics and/or prebiotics, and fermented food containing probiotics, e.g. dairy products. Most of the health-related claims on the labels of the identified products do not comply with proposed South African regulations. However, results also indicate that the proposed South African regulations should be reconsidered to include an additional 5 claims, for which scientifically sound evidence is available. The claims regarding probiotic strains, viable cell numbers, prebiotic type and concentration stated on the labels of the products are mostly in line with the proposed South African regulations. The actual viable cell content of 3 out of 5 probiotic supplements readily available on the South African market did not comply with the content claim stated on the label. However, this problem did not seem to affect the inhibitory activity of the probiotic strains against indicator strains isolated from faeces of patients diagnosed with AIDS. To validate this finding in vivo assessments should be implemented before considering the need to include a wider range of prescribed viable cell numbers in the proposed South African regulations. Conclusions. The proposed South African regulations regarding probiotic- and prebiotic-containing products should be revised based on the results of this research, and the manufacturers of these products should be held responsible for providing the consumer with scientifically sound and legally correct information. S Afr Med J 2005; 95: 114-119.

Barber shaving and blood-borne disease transmission in developing countries

Abstract: 94 The blood-borne viruses, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV), share a number of epidemiological characteristics and infect hundreds of millions of people worldwide. Overwhelmingly, sexual promiscuity remains the major route of HIV transmission around the globe, yet in many developing countries HIV, HCV, and HBV continue to spread because of the contribution of non-sexual risk factors such as lack of routine screening of donated blood, increasing illicit intravenous drug use, and unsafe injections and contaminated medical equipment. In many parts of Africa and Asia the widespread cultural practice among men of community shaving at a shop or roadside barber is an underestimated and largely unaddressed route of blood-borne viral disease transmission.

Seroprevalence of rubella antibodies among antenatal patients in the Western Cape : original article

Abstract: lIgObjectives.l/Ig To determine the seroprevalence of rubella virus infection among antenatal patients aged between 15 and 45 years in the Western Cape province of South Africa, in order to provide data to determine the need for vaccination to protect women of childbearing age. lbrglIgDesign.l/Ig A cross-sectional study. lbrglIgSetting.l/Ig Virology laboratory, Groote Schuur Hospital, National Health Laboratory Service (NHLS), South Africa. Subjects and methods.l/Ig One thousand two hundred provincial serum specimens from participants in the 2003 Department of Health antenatal HIV / syphilis serosurvey were selected from the 4 districts of the Western Cape. The specimens were agestratified and screened qualitatively for rubella immunoglobulin G (IgG) antibodies by means of a commercial immunoassay during October 2004. lbrglIgResults.l/Ig Within the Western Cape a total of 95.3% of women in the 15 - 24-year age group, 97.5% in the 25 - 34-year group and 98% in the 35 - 45-year age group were immune to rubella. There was no statistically significant difference in the rate of rubella susceptibility between the 4 districts tested. lbrglIgConclusions.l/Ig The study is an important step in addressing the seroprevalence of rubella infection in women of childbearing age in South Africa. Further information is needed on rubella seroprevalence from the other provinces in South Africa as well as formal implementation of rubella and congenital rubella syndrome surveillance to determine the feasibility of routine rubella immunisation.

Seroprevalence of rubella antibodies among antenatal patients in the Western Cape

Abstract: Results. Within the Western Cape a total of 95.3% of women in the 15 - 24-year age group, 97.5% in the 25 - 34-year group and 98% in the 35 - 45-year age group were immune to rubella. There was no statistically significant difference in the rate of rubella susceptibility between the 4 districts tested. Conclusions. The study is an important step in addressing the seroprevalence of rubella infection in women of childbearing age in South Africa. Further information is needed on rubella seroprevalence from the other provinces in South Africa as well as formal implementation of rubella and congenital rubella syndrome surveillance to determine the feasibility of routine rubella immunisation. S Afr Med J 2005; 95: 688-690.

Demographics and presenting clinical features of childhood systemic lupus erythematosus.

Abstract: Objectives. To review the presentation and characteristics of children with systemic lupus erythematosus (SLE).Methods. The records of children with sufficient American College of Rheumatology (ACR) criteria for SLE treated by the renal units of the Johannesburg and Chris Hani Baragwanath hospitals, and the arthritis clinic of the Johannesburg Hospital between January 1974 and March 2000 were reviewed. The clinical presentation, age distribution and race were examined.Results. A total of 36 children met the criteria. There were 26 girls and 10 boys, with a mean age of 11.5 and 10.2 years respectively. The male-to-female ratio was 1:2.6 overall, with a ratio of 1:1.2 under 10 years and 1:4 over 10 years. There were 15 white, 2 Indian and 5 coloured patients. The 14 black patients all presented after 1986. Rashes were found to be the commonest clinical feature present at the time of diagnosis, followed by polyarthritis and renal pathology. Constitutional symptoms were common, as were generalised lymphadenop...

Physician education programme improves quality of diabetes care.

Abstract: Background. Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly instituted.Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic.Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria.Study design. Quasi-experimental controlled before-and after study.Methods. A baseline audit of the quality of care in two comparable diabetes clinics was performed. Three hundred patients were randomly selected for an audit of their hospital records: 141 from the intervention and 159 from the control clinics. Thereafter a physician training programme and a structured consultation schedule were introduced to the intervention clinic and maintained for a 1-year period. The control clinic continued with care as usual. Process and outcome m...

How equitable is the scaling up of HIV service provision in South Africa

Abstract: Objectives . To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. Design . Cross-sectional descriptive study. Setting . Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures . Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. Results . There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v.9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. Conclusion . The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been u':lable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness.

Audit of the outcome of pregnancy in diabetic women in Soweto, South Africa, 1992 - 2002

Abstract: Objective. To audit the outcome of pregnancy among diabetic black women in Soweto following the introduction of a specialised service.Design and methods. An analysis of patients' records was conducted for the period 1992–2002. Maternal characteristics, aspects of treatment and its complications, mode of delivery and perinatal outcome are reported. The incidence of postpartum glucose intolerance in women with gestational diabetes was assessed. Major outcomes from this study are compared with those of an earlier study conducted from 1983 to 1992.Results. A total of 733 diabetic pregnancies was managed over 11 years: 348 women had gestational diabetes, 172 had type 1 diabetes and 213 had type 2 diabetes. Insulin was used in all but 23 women. Mean (± standard deviation (SD)) capillary blood glucose levels varied between 5.7 (± 0.72) and 6.2 (± 0.95) mmol/l in the 3 groups. Severe maternal hypoglycaemia was most common in the type 1 diabetes group (14%). Mean (± SD) neonatal weight varied between 2 922.3 g (± ...

The cost of a rapid-test VCT clinic in South Africa.

Abstract: lIgContext.l/Ig Demand for HIV voluntary counselling and testing (VCT) will increase as HIV prevention and treatment scale up in South Africa. Understanding the cost of delivering VCT will inform funding decisions. lbrglIgObjective.l/Ig To determine the cost per client completing VCT (pretest counselling, testing and post-test counselling) in a nonresearch- based programme using rapid-test technology. lbrglIgDesign.l/Ig One year of expenditure and output data were collected retrospectively as part of the PANCEA (Prevent AIDS: Network for Cost-Effectiveness Analysis) study. Market prices were determined for donated resources. lbrglIgSetting.l/Ig An urban, church-based, non-profit organisation that offers rapid-test VCT services in KwaZulu-Natal, South Africa. lbrglIgResults.l/Ig Financial expenditure for the 2002/2003 fiscal year was $39 761 (calculated using an average conversion rate for July 2003, which was 0.133). Using market prices for donated resources, the economic cost for the year was estimated at $67 248. Six hundred and sixty-two clients completed VCT, resulting in financial expenditure of $60.06 per client and an economic cost of $101.58 per client. Financial expenditures and economic costs per client decreased over the year by 66% because expenses remained stable as more clients were served. lbrglIgConclusions.l/Ig The cost of providing VCT services was higher than previously reported, but declined with expanding scale.

Where have all the doctors gone? Career choices of Wits medical graduates

Abstract: Objectives: To assess the distribution of University of the Witwatersrand (Wits) medical graduates from 1960 to 1994 with regard to private or public sector work, chosen specialist or generalist careers, and work in urban or rural areas, looking for secular trends and gender differences. Design: A cross-sectional analysis of the register of what was then the South African Medical and Dental Council (SAMDC) and a telephone interview survey of a sample of medical graduates, collecting retrospective career histories. Results: Thirty-six per cent of the sample was working predominantly in the public sector, while 47% of all years worked by graduates were in the public sector. Women graduates spent 68% of their years working in the public sector, compared with 36% for men. The majority (55%) of graduates in the sample who were working in the public sector cited academic and training aspects as the main reason for this choice. Conversely, nearly half (47%) gave income as the main reason for moving to the private sector. Forty per cent of graduates had specialised (46% of men, 22% of women), while 76% were working in the large urban areas. Conclusions: The findings highlight methodological problems with standard cross-sectional analysis of distribution of personnel. They also challenge several assumptions about the likelihood of Wits graduates working as generalists (60%), the voluntary contribution of graduates to the public sector, and in particular the value of women doctors to public service and primary care. South African Medical Journal Vol. 95(6) 2005: 414-419

Lipohypertrophy--a complication of insulin injections.

Abstract: (2006). Lipohypertrophy—a complication of insulin injections. Journal of Endocrinology, Metabolism and Diabetes of South Africa: Vol. 11, No. 2, pp. 64-66.

Childhood atopic eczema consensus document.

Abstract: 3conducted among Xhosa children demonstrated a point prevalence (dermatologist-diagnosed) of 0.7%, 1.1% and 3.7% in rural, peri-urban and urban settings respectively. AE is therefore very rare in Xhosa children in rural settlements and a clear urban/rural gradient exists for the occurrence of AE in black children. AE is frequently undertreated despite severely affecting the quality of life of patients and their families. AE also commonly predates the development of allergic rhinitis and asthma.

Evaluation of an HIV/AIDS peer education programme in a South African workplace.

Abstract: Objectives . To evaluate a South African workplace HIV I AIDS peer-education programme running since 1997. Methods . In 2001 a cross-sectional study was done of 900 retail-section employees in three geographical areas. The study measured HIV I AIDS knowledge, attitudes towards people living with HIV I AIDS, belief about self-risk of infection, and condom use as a practice indicator. The impact of an HIV I AIDS peer-education programme on these outcomes was examined. Results . Training by peer educators had no significant impact on any outcome. Fifty-nine per cent of subjects had a good knowledge score, 62% had a positive attitude towards people with HIV I AIDS, 34% used condoms frequently, and the majority of participants (73%) believed they were at low risk of infection. Logistical regression showed that a very small proportion of the variance in the four outcomes was explained by potential determinants of interest (8% for knowledge, 6% for attitude, 7% for risk and 17% for condom use). Conclusions . The HIV peer-education programme was found to be ineffective and may have involved an opportunity cost. The programme contrasts with more costly comprehensive care that includes antiretrovirals. The private sector appears to have been as tardy as the public sector in addressing the epidemic effectively.

Impact of the HIV/AIDS pandemic on non-communicable disease prevention.

Abstract: April 2005, Vol. 95, No. 4 SAMJ HIV/AIDS continues to ravage sub-Saharan Africa, and in South Africa accounts for 30% of all mortality, making it the leading cause of death. 1 The epidemic has had other negative effects, which have not been fully realised. Among these is the fact that, paradoxically, the awareness programmes implemented to prevent major spread of HIV/AIDS have complicated the prevention of non-communicable diseases (NCDs).

Paediatric organophosphate poisoning - a rural hospital experience

Abstract: Objectives : To document the presentation and course of organophosphate poisoning (OPP) in children and to record the frequency of atropine toxicity during treatment. Design : A retrospective observational study was conducted of all recorded paediatric cases of OPP admitted to a regional hospital over a 5-year period from 1 June 1996 to 31 May 2001. Setting : The study was conducted at Eben Donges Hospital, a regional hospital in the Boland / Overberg area of the Western Cape, where pesticide-intensive fruit farming remains the largest revenue generator. Subjects : The study included all children aged 12 years or less (as per health services classification) with confirmed OPP. Results : There were 23 patients. Most of the cases came from the De Doorns area (35%), with poisoning by ingestion accounting for 61% of cases. A distinct seasonal predominance was found that coincided with the summer harvest. Mode of presentation was variable and was not related to the initial pseudocholinesterase level. Evidence of atropine toxicity occurred in 8 of the 18 cases treated with atropine. No statistically significant risk factor was found for atropine toxicity. The average duration of hospitalisation was 5.05 days, with 2 children requiring transfer to tertiary facilities. Conclusions : The high number of referrals from a specific geographical area, combined with a 61% accidental ingestion rate, illustrates an area where legislation has failed to limit unnecessary exposure. Awareness of the seasonal predominance could prove pivotal to the success of future preventive strategies. Initial presentation and serum pseudocholinesterase levels did not correlate with duration of stay. The decision to transfer to a tertiary facility should only be explored once the patient has been stabilised with atropine. Atropine treatment is effective but carries a risk of toxicity. Glycopyrrolate may constitute an alternative treatment option. South African Medical Journal Vol. 95(9) 2005: 678-681

Non-closure of peritoneal surfaces at caesarean section — a systematic review

Abstract: Background. Caesarean section (CS) is a very common surgical procedure worldwide. Suturing the peritoneal layers at CS may or may not confer benefit, hence the need to evaluate whether this step should be omitted or not. Objectives. To assess the effects of non-closure as an alternative to closure of the peritoneum at CS on intraoperative, immediate and later postoperative, and long-term outcomes. Search strategy. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2002) and the Cochrane Central Controlled Trials Register (October 2003). Selection criteria. Randomised controlled trials that compared leaving the visceral and/or parietal peritoneum unsutured at CS with suturing the peritoneum, in women undergoing elective or emergency CS. Data collection and analysis. Trial quality was assessed and data were extracted by two reviewers. Main results. Nine trials involving 1 811 women were included and analysed. The methodological quality of the trials was variable. Non-closure of the peritoneum reduced operating time when both layers or one layer was not sutured. For both layers, the operating time was reduced by 7.33 minutes (95% confidence interval (CI): –8.43 - –6.24). There was significantly less postoperative fever and reduced postoperative stay in hospital for non-closure of the visceral peritoneum and non-closure of both layers. There were no other statistically significant differences. The trend for analgesia requirement and wound infection tended to favour non-closure, while endometritis results were variable. Long-term follow-up in 1 trial showed no significant differences. The power of the latter study to show differences was low. Conclusions. There was improved short-term postoperative outcome if the peritoneum was not closed. Long-term studies following CS are limited, but data from other surgical procedures are reassuring. At present there is no evidence to justify the time taken and cost of peritoneal closure. South African Journal of Obstetrics and Gynaecology Vol.11(2) 2005: 40-46