Snake bites are common in southern Africa especially in the rural and remote areas. Although all snake bites are not venomous, people bitten by venomous snakes require urgent medical attention and ...many will require antivenom. In the healthcare facility, the type of toxin may be identified by the wound and presenting clinical features which then should be managed appropriately.
Introduction: Erectile dysfunction is common among men with diabetic mellitus and has a negative effect on their quality of life. The proportion of male diabetics who disclosed their problematic ...sexual performance was increasing at Temba Community Health Centre (CHC), which motivated a survey that was conducted from April 2015 till April 2016.
Aim: Assessment of erectile dysfunction among male diabetics attending Temba Community Health Centre.
Setting: Temba Community Health Centre, Pretoria, South Africa.
Method: A cross-sectional survey was conducted using a piloted, structured questionnaire adapted from the International Index of Erectile dysfunction (IIRF-5) questionnaire. Convenience sampling was used to select 191 participants.
Result: From the selected sample, 97.3% of male diabetics were suffering from erectile dysfunction. Among them, 120 (62.8%) were between 41 and 60 years of age, 96 (50.2%) were employed, 81 (42.4%) had a secondary level of education and 84 (44.4%) were married. The duration of diagnosed diabetes varied between 2 months and 564 months (42 years). Hypertension and HIV, as co-morbidities, affected 12.7% of the participants and 56% of participants consulted primarily for erectile dysfunction, not knowing that it was a complication of diabetes mellitus.
Conclusion: The assessment of erectile dysfunction among male diabetics attending Temba CHC in Pretoria showed that more than two-thirds of the selected sample of patients suffered from erectile dysfunction, from a mild to a severe form of the condition. Most of those participating were between 41 and 60 years old, half of them were married, have a secondary level of education and were unaware that erectile dysfunction is a complication of diabetes mellitus.
Abstract A double-blind, placebo-controlled phase II trial (e-Track 444563-014/ NCT00346892 ) was conducted in South Africa to evaluate the co-administration of RIX4414 (live-attenuated human G1P8 ...rotavirus vaccine) and oral poliovirus vaccine (OPV) administered simultaneously. Healthy infants ( n = 450) were randomized into three groups (RIX4414 + OPV, RIX4414 + IPV or Placebo + OPV) to receive two oral doses of RIX4414/placebo with OPV or IPV using two vaccination schedules (6–10 weeks and 10–14 weeks). Serum anti-rotavirus IgA antibodies (ELISA) and neutralizing antibodies (micro-neutralization assay) to poliovirus serotypes 1, 2 and 3 were measured. Co-administration of RIX4414 with OPV did not result in a decrease in the high sero-protection rates against poliovirus serotypes 1, 2 and 3 detected after the third OPV dose (98–100%). The anti-rotavirus IgA antibody sero-conversion rates were higher for the 10–14 weeks schedule (55–61%) compared to the 6–10 weeks schedule (36–43%). Solicited symptoms were reported at similar rates between RIX4414 and placebo groups and no serious adverse events related to RIX4414 were reported. This study provided evidence that RIX4414 can be co-administered with routine EPI immunizations including OPV and that two doses of RIX4414 were well tolerated and immunogenic in South African infants.
Background. A phase II, randomized, double-blind, placebo-controlled study was conducted in South Africa during 2003–2004 to evaluate the safety, reactogenicity, and immunogenicity of 2 regimens of ...the live attenuated oral human rotavirus vaccine RIX4414 when coadministered with the Expanded Program on Immunization childhood vaccines, including oral polio vaccine. Methods. Healthy infants were randomized (2:2:1) to receive either 2 doses of RIX4414 (n = 190 ; at 10 and 14 weeks, with placebo at 6 weeks), 3 doses of RIX4414 (n = 189 ; at 6, 10, and 14 weeks), or 3 doses of placebo (n = 96), all with concomitant routine vaccinations. The antirotavirus IgA seroconversion rate was assessed using enzyme-linked immunosorbent assay at 2 months after the last dose of RIX4414 or placebo. Antipolio types 1, 2, and 3 antibodies were measured using a virus neutralization assay. Solicited symptoms were recorded for 15 days after each dose. Results. The antirotavirus IgA seroconversion rates were similar in the RIX4414 2-and 3-dose groups (44.3% and 44.4%, respectively; P = .544, by 1-sided Fisher exact test) and antirotavirus IgA geometric mean concentrations were also comparable. Seroprotection rates for antipolio types 1, 2, and 3 antibodies were high (93%-100%) and were not significantly different among groups. Solicited symptoms reported within 15 days after vaccination were similar in all groups. Conclusions. The immune seroconversion response to the RIX4414 vaccine with 3 doses was not superior to the 2-dose regimen. There was no interference by either regimen with antibody response to oral polio vaccine, and RIX4414 was well tolerated when given with routine vaccinations.
Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-to-population ratio of 5.5:100 ...000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating.
To determine the proportion of rural-origin students at all medical schools in South Africa.
A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%).
. Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine--27.4%, physiotherapy--22.4%, occupational therapy--26.7%, and dentistry--24.8%.
The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas.
Background. Globally, it is estimated that depressive features occur in 15 - 36% of people suffering from chronic diseases and 60% of people with HIV/AIDS. A high prevalence of mental disorders among ...HIV-infected individuals has been shown in South Africa and other parts of sub-Saharan Africa. Untreated depression leads to poor adherence to treatment and poor quality of life for patients with chronic diseases. Methods. Using the Zung self-rating scale, we screened for depressive features among adult patients receiving highly active antiretroviral therapy (HAART) who attended primary healthcare facilities in the Rustenburg district of North West Province in South Africa during December 2009. Results. Among 117 participants, 81 (69.2 %) had mild depressive features, 2 (1.7%) had moderate depressive features, 1 (0.9 %) had severe depressive features and 33 (28.2%) did not have depressive features. Depressive features were more common in males (77.1%) than in females (69.5%), and were most common in patients taking the combination of efavirenz, lamivudine and stavudine. Conclusion. Depressive features seem to be common among adult patients receiving HAART and attending primary healthcare facilities in the Rustenburg district.
Aim: To determine the characteristics of patients with pulmonary tuberculosis registered in primary health care facilities in Moses Kotane region North West Province.
Method: A retrospective record ...review of pulmonary TB patients registered in five community health centres (CHCs) in 2010 was conducted.
Results: Of the 229 new patients diagnosed using sputum microscopy or culture, 176 were cured and 53 were not cured. The mean age for cured patients was 36.4 years and 34.0 years for not cured patients with standard deviations of 13.5 and 11.4 respectively (p-value 0.195). In total, 97 (55.1%) female patients and 79 (44.9%) male patients were cured while 24 (45.3%) female patients and 29 (54.7%) male patients were not cured (p-value 0.214). Among the 169 unemployed patients, 120 (68.2%) were cured and 40 (75.5%) were not cured. Of the 69 patients with employment, 56 (31.8%) were cured and 13 (24.5%) failed to cure (p-value 0.394). Of 176 cured patients, 130 had directly observed treatment (DOT) support while 31 of 53 not cured patients did not have DOT support (p-value 0.00002). Some 154 (67.2%) patients were HIV positive and among them 119 (67.6%) were cured and 35 (66.0%) were not cured while of the 75 who were HIV negative 57 (32.4%) were cured and 18 (33.9%) were not cured (p-value 0.8680).
Conclusion: DOT support was a strong predictive characteristic for the outcomes of these TB patients during their treatment with a statistically significant difference between cured and not cured patients; the majority of not cured patients did not have DOT support. Other characteristics like gender, age, HIV status, employment or other medical conditions did not show any statistically significant difference between cured and not cured patients.
The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management.
An in-depth ...case study was conducted. A range of qualitative information was collected at both clinics. Data collected in the two clinics were compared, to gain an understanding of the important issues.
Data were collected in a government and an NGO clinic in North West province.
This report presents the findings from patient and staff satisfaction surveys and in-depth individual interviews with senior staff.
Key findings included the following: (i) there are attitudinal differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture.
This research provides lessons regarding key issues in clinic functioning which can make a major difference to the way services are experienced. A respectful and caring approach to patients, and an organisational culture which supports and enables staff, can achieve much of this without any additional resources.
Background: A disability grant is the financial assistance given by the government to South African citizens and bona fide refugees who have debility that results in inability to work. Doctors in ...state hospitals and clinics are tasked with the duty of assessing applicants for this grant. Ideally, the assessment is done by an institutional committee consisting of a doctor, physiotherapist, social worker, occupational therapist and specialised nurses. However, this is not always the case because of a shortage of personnel, particularly in rural areas. A lack of clear guidelines for the assessment process has led to confusion and differences in the outcomes. This poses major problems for the doctors, as well as the applicants, who often are dependent on the grant for survival. The aim of this study was to explore the factors that influence doctors in the assessment of applicants for a disability grant.
Methods: A qualitative study using free attitude interviews was conducted amongst doctors involved in the assessment process in Limpopo province. Content analysis was used to identify themes from the interviews.
Results: The assessment process was not entirely objective and was influenced by subjective factors. These included the mood of the doctors, emotions such as anger and sympathy, and feelings of desperation. Perceptions by the doctors regarding abuse of the system, abuse of the grant, the inappropriateness of the task, lack of clear guidelines and the usefulness of the committees were important in decision making. The doctors' personal life experiences were a major determinant of the outcome of the application.
Conclusion: The assessment of applicants for a disability grant is a subjective and emotional task. There is need for policy makers to appreciate the difficulties inherent in the current medicalised process. Demedicalisation of certain aspects of disability assessment and other social needs that doctors do not view as a purely clinical functions is necessary. In addition, there is a need for clear, uniform policy on and guidelines for the management of the grant, the role of the doctor has to be defined, healthcare practitioners must be trained in disability assessment, institutional committees should be established and intersectoral initiatives should be encouraged to address issues of poverty and dependence.
Background
The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies ...employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement.
Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10. Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.
Methods
A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.
Results
The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits.
Conclusion
The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.
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