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Background: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. Methods: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Results: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Conclusion: Policymakers should consider PWCDs when responding to a public health concern in the future. Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs. [ABSTRACT FROM AUTHOR]

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a common non-communicable disease associated with significant morbidity and mortality globally. It poses a huge public health and economic challenge. People with diabetes need to have adequate knowledge, attitudes and practice (KAP) to prevent complications from diabetes. This study aims to evaluate the KAP towards diabetes among type 2 diabetes mellitus (T2DM) patients attending primary healthcare clinics in Kimberley. Methods: A cross-sectional analytical, quantitative questionnaire-based study was done using a convenient sampling method in Sol Plaatje Municipality, Kimberley, Northern Cape. Results: A total of 363 type 2 diabetic patients took part in the study. Most of the participants (62.0%) were females. Most had good knowledge (67.5%), while 64.5% of the participants showed good attitudes towards diabetes. However, only 35.8% of the participants had good practices towards diabetes. There was a significant association between the participant's level of education and (1) knowledge and (2) practice, with p-values of 0.002 and 0.0075, respectively. No significant association was found between the participant's level of education and attitudes towards diabetes (p = 0.2416). Conclusion: This study demonstrated good diabetes-related knowledge and attitudes but inadequate practices among participants. Educational programmes to assist patients with diabetes to improve their practice towards diabetes should be encouraged and implemented. Contribution: This study will help to create awareness of the need for people with diabetes to improve their practices towards diabetes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the views of students involved in rural community-based medical attachments during their final year at medical school. The programme has been in existence for some time, but no formal evaluation thereof has yet taken place. This paper describes the first two phases of what is described as a quality improvement project: namely to describe the problem state and to discuss possible activities to improve the programme. Design, setting and subjects: The study adopted a mixture of quantitative and qualitative type research. Data were collected by means of a self-administered questionnaire which students at Nelson R Mandela Medical School, University of KwaZulu-Natal, completed at the end of their Family Medicine rotation. Consent was obtained from the participants and ethical approval granted by the University of KwaZulu-Natal Humanities and Social Science Ethics Committee. Results: Students were generally positive about their rural attachment experience. The majority (86%) believed that their skills adequately prepared them to enter the community. Allocation of a supervisor and rostering were found to be of great importance. Academic activities provided adequate learning opportunities. The majority (76%) of students who used hospital accommodation found it to be satisfactory, although it was an area that needed attention. Technological support was lacking. Fewer than 50% of students had access to such facilities. Conclusion: Students' responses were generally positive about the rural attachment experience, but logistical and technological support issues, as well as that of accommodation, need to be addressed if the programme is to flourish. Community-based education in a rural district hospital can provide unique learning opportunities for students if the opportunities are identified and the programme is well managed. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is increasing globally and is associated with multiple complications. Guidelines have been formulated to standardise care among people living with diabetes mellitus (DM), but research shows poor compliance with treatment guidelines. The aim of this study was to assess how well healthcare practitioners in a district hospital in Gauteng complied with the most recent diabetic treatment guideline, Society for Endocrinology Metabolism and Diabetes South Africa (SEMDSA) 2017. Methods: A retrospective cross-sectional review of patient record living with diabetes was done. This study was conducted in the out-patient department of Dr Yusuf Dadoo hospital in the West Rand, Gauteng. A total of 323 records of patients seen from August 2019 to December 2019 were reviewed, and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017. Results: Files were audited in four categories: comorbidities, examinations, investigations and the presence of complications. Six monthly glycated haemoglobin (HbA1c) was assessed in 40 (12.4%), annual creatinine assessed in 179 (55.4%) and lipogram in 154 (47.7%) of patients. More than 70% of patients had uncontrolled glycaemia and two people were screened for erectile dysfunction. Conclusion: Monitoring and control parameters were infrequently done as per guideline recommendations. The resultant effects were poor glycaemic control and thus numerous complications. Contribution: Targeted strategies to improve medical practitioner compliance to guidelines including further research to study factors associated with poor compliance with guidelines are needed to improve the overall care of people living with DM in the West Rand and thus minimise the risk of complications among patients in the district. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa. Methods: This was a cross-sectional design, using a piloted, structured and self-administered questionnaire. Results: Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30--39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%). Conclusion: This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem. [ABSTRACT FROM AUTHOR]

Background: The global pandemic associated with coronavirus disease 2019 (COVID-19) had a considerable effect on higher education in South Africa, with online instruction replacing traditional lectures for many students. Medical students were required to vacate their residences in March 2020 but returned to campus in July 2020 to enable them to continue with clinical teaching and learning. The aim of this study was to understand the learning experiences of 5th year medical students at the University of KwaZulu-Natal (UKZN) during 2020. Methods: This was a qualitative study conducted via Zoom in December 2020 with 18 students in four focus group discussions and four semi-structured interviews. These were all facilitated by an independent researcher with experience in qualitative research. All the interviews were recorded, transcribed verbatim and analysed qualitatively through the identification of codes, categories and themes. Results: The following major themes emerged: A stressful and at times an overwhelming year, mental health issues, developing strategies to cope, and issues that related to teaching and learning. Conclusion: The disruptions caused by COVID-19, the lockdown, a condensed academic programme and uncertainty about their competency resulted in high levels of anxiety and stress among medical students. Participants highlighted strategies that had helped them to cope with the isolation and academic pressures. Given the large volume of work, careful thought needs to be given to what should be taught and how it should be taught to ensure that graduates have the competencies they need to practise. [ABSTRACT FROM AUTHOR]

Background: Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. Methods: This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. Results: Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers' response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. Conclusion: Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is the principal medical intervention used to reduce the high mortality associated with the cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric cardiopulmonary resuscitation (pCPR) amongst doctors in Cape Town. This study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary health care facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors' knowledge of equipment availability. Methods: A cross-sectional study using a questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs. Results: The questionnaire was completed by 173 doctors (84% response rate). The majority (81.8%) had not undergone pCPR training (Paediatric Advanced Life Support or Advanced Paediatric Life Support). Basic life support was done by 88.3%: 28% greater than two years ago. The average pCPR knowledge score was 61% (standard deviation [s.d.]: 20.3, range: 8.3%-100%). Doctors in their community service and internship years had significantly higher knowledge scores compared to grade 3 Medical officers (p = 0.001 and p = 0.010, respectively). Eleven per cent had performed pCPR > 10 times in the past year; 20% had never performed pCPR and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility. Conclusion: Doctors working in Cape Town PHCFs have poor knowledge, have low confidence levels and are poorly prepared to perform pCPR. Urgent attention needs to be given to ensuring formal pCPR training and acquaintance with equipment availability and location in Cape Town PHCFs. [ABSTRACT FROM AUTHOR]

Background: Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa's primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff. Methods: Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital. Results: Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback. Conclusion: Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app. [ABSTRACT FROM AUTHOR]

Background: Interpersonal communication skills by clinicians with patients, carers, fellow health professionals and legal professionals carry many unique challenges in practice. Whilst undergraduate training in communication helps with generic information receiving and information giving, uncomfortable and demanding speciality-specific issues in the various medical specialities are not covered during under- and postgraduate training. Methods: The aim of this study was to determine the self-perceived competence of neurology registrars and neurologists in interpersonal communication and the need for such assessment in college exit exams. We undertook a quantitative, descriptive, cross-sectional survey by using self-administered printed questionnaires and the EvaSYS online system. Neurology registrars in training from the seven training centres in South Africa and neurologists based at the training centres and in the private sector were recruited. Results: We received a 62.9% response rate. One hundred and twenty-nine participants were recruited comprising 42 neurology registrars and 87 neurologists. Registrars were more commonly female, more likely to be multilingual and less likely to use translators. Undergraduate training in communication was considered insufficient, 42.9% and 39.1% for registrars and specialists respectively, and was also considered not relevant to address speciality-specific issues encountered in practice. Most training received has been by observation of others and on-the-job training. Both groups felt strongly that postgraduate training in interpersonal communication was important (registrars 95.2%, specialists 91.9%), especially when dealing with issues of death and dying, disclosing medical errors and dealing with the legal profession. Conclusion: Postgraduate training of interpersonal communication as required of neurology registrars and neurologists was considered insufficient. Most training has been by observation of others or experiential by trial and error. Assessment of interpersonal communication at board exit exams will drive postgraduate training and importantly will embrace the AfriMEDS framework developed to produce the holistic doctor in South Africa. [ABSTRACT FROM AUTHOR]

Background: Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal. Methods: A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data. Results: A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation (n = 383) and extended focused assessment with sonography for trauma (n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours. Conclusion: Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments. [ABSTRACT FROM AUTHOR]

Background: Diabetes has been reported as the second leading cause of death and the top leading cause of death amongst women in South Africa; it is important to evaluate any epidemiological or demographic transition related to diabetes. This study evaluated the demographically stratified prevalence of type 2 diabetes mellitus (T2DM) and existing comorbidities amongst an outpatient population in a district healthcare facility in Kwazulu-Natal (KZN). Methods: This retrospective cross-sectional study was conducted at a district hospital, and a retrospective record review of all outpatients who reported to the hospital to be treated for T2DM between the period, August 2018-January 2019, was used. Data, such as age, sex, ethnicity and any coexisting morbidity, were collected from outpatient hospital registers and electronically captured using a record review tool. Results: There were significantly more female patients (3072) compared to male patients (1050) (p < 0.001) with a mean age of 59.21 years. Hypertension (77.9%) and cardiovascular problems (11.16%) were most frequent. Approximately 84% of women presented with T2DM and either one or two morbidities simultaneously. Female patients were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.20;1.71), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83). Conclusion: The prevalence of T2DM and comorbidities differed by demographic factors, such as sex, ethnicity and age. There is a need for flexible and adaptive approaches for the prevention and management of T2DM cases in order to allocate medical resources efficiently and according to the true burden of disease because of T2DM complications. [ABSTRACT FROM AUTHOR]

Background: It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors' misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions. Methods: A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty. Results: The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary healthcare and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors' level of surgical ability. Based on individual interviews, 11 themes were extracted and a 'wheel' model was created, depicting the core values of the FM discipline. Conclusion: The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills. [ABSTRACT FROM AUTHOR]

Childhood malnutrition in South Africa is largely perceived as one of undernutrition, with the opposite end of the spectrum (overnutrition) being evidenced in the increasing prevalence of childhood obesity, demonstrated to be associated with chronic metabolic diseases in adulthood. Targeting childhood malnutrition is a potential interventional strategy to prevent non-communicable diseases amongst adults. As the prevalence of malnutrition (undernutrition and overnutrition) in rural, northern KwaZulu-Natal province, South Africa, is largely unknown, this study aimed to determine the baseline nutritional status of children attending primary healthcare facilities within the Bethesda Hospital catchment area. This quantitative, cross-sectional study included children aged 6 weeks to 19 years, attending any primary healthcare clinics for over a 3 months period. Anthropometric measurements were obtained to categorise the children according to the World Health Organisation's (WHO) nutritional classifications. Stunting in children aged less than 5 years was found to be lower (14%) than nationally representative studies (27%); however, 14.4% of the infants aged 6 weeks to 5 months were overweight, increasing to 32.3% in those aged 14–19 years. Males in the 6-weeks to 5-month age group were more likely to be overweight/obese and stunted than females in the same age group. Undernutrition is showing a downward trend, which is a testament to initiatives to reduce food insecurity amongst the poor. However, the emerging upward trend of overweight/obesity in children of all ages, indicates the need to have a national discussion on over- and undernutrition, its causes and implications. [ABSTRACT FROM AUTHOR]

Background: The incorporation of community healthcare worker (CHW) involvement in the management of patients is in line with the 2006 World Health Report, which advocates increased community participation and the systematic delegation of tasks to less specialised cadres. For CHWs to function optimally, satisfaction in their duties is paramount to promote quality healthcare. The health minister included ward-based outreach teams (WBOT) as part of the National Health Insurance. CHWs form an important link between healthcare facilities and the communities. This study aimed to measure the satisfaction level of the CHWs with WBOT services in the Tshwane district of South Africa. Method: A cross-sectional study on CHWs was conducted in seven sub-districts. Data were obtained by trained data collectors using a piloted self-administered structured questionnaire from October 12 to November 3, 2015 in three local official languages. The study population of CHWs was 1 600. Using a 95% confidence level and 5% confidence interval, the sample size was 310. However, we over-sampled to 431 participants. Results: The mean age was 36 years (SD ± 9.46). The majority were females (82.1%); more than three-quarters (77%) had secondary education. The majority were satisfied with the WBOT services whereby 59.8% was the lowest score and 98.4% the highest score. Close to two-thirds (62%) were not satisfied with their monthly stipends. The majority of the younger members of the team (20–40 years) were not valued by their co-workers (70% or 181/255) [p = 0.03]. The overall satisfaction (n = 8593) was 73.4% (p < 0.001). Conclusion: Overall satisfaction of CHWs with WBOT is good news. Dissatisfaction regarding stipend/compensation must be addressed. CHWs should be valued and motivated. [ABSTRACT FROM AUTHOR]

Background: Non-compliance with designated referral pathways has ramifications such as increased patient waiting time, overburdening of higher levels of care and increasing healthcare costs on patients and the healthcare system. The purpose of this study was to assess the determinants of self-directed referrals amongst patients attending hospitals in the eThekwini district of KwaZulu-Natal. Methods: An analytic, cross-sectional study was conducted at the Medical Outpatient Departments across five district hospitals in eThekwini using interviewer-administered questionnaires. Descriptive statistics were used to determine the proportion and the most frequent factors contributing towards patient self-referral. The likelihood of patients to self-refer was tested using chi-square (X2) and a multivariate regression model. Results: There were 315 patients interviewed with 35% (n = 109/315) having self-referred. The majority (51%; 55/107) of self-referrals were male and were of African race (74%; n = 80/107). Five institutional factors, namely: availability of medication at the pharmacy (98%); quality of care at the facility (93%); waiting time at facility (92%); services provided (90%); and attitude of healthcare workers (87%), were ranked as the main drivers of self-referral. Multivariate logistic regression established a significant positive association between patient self-referral and male gender (OR 1.73; CI 1.04–2.87, p < 0.05). Age < 39 years (OR 0.96; CI 0.94–0.99, p < 0.05); and patient awareness of a referral letter (OR 0.28; CI 0.09–0.86, p < 0.05) emerged as protective factor against self-referrals. Conclusion: Males patients tend to bypass the referral pathway whilst younger patients and patients who were aware of a referral letter were less likely to bypass the referral system. In addition to addressing the systemic challenges of waiting times, quality of care and availability of medication, a patient-oriented approach that comprises education, encouragement and increased patient awareness is an important strategy to improve referral pathway compliance. [ABSTRACT FROM AUTHOR]

Background: While international experience suggests that well-trained primary care physicians improve the quality and cost effectiveness of health care, family medicine (FM) as the discipline of the specialist primary care physician appears to not be an attractive career for medical graduates in South Africa (SA). The aim of this study was to establish final-year medical students' knowledge about FM and its relevance to the healthcare system, explore their perceptions of the discipline's relevance, and identify their specialty preference. Methods: This was a descriptive study conducted amongst final-year medical students at the University of KwaZulu-Natal (UKZN) in 2017 at the conclusion of their seven-week FM module. Data were collected using a self-administered questionnaire and results were analysed descriptively. Results: The response rate of completed questionnaires was 80.2% (157/196). Students reported limited exposure to FM in their early undergraduate years and low levels of awareness about essential public health programmes. Students showed good awareness of the six roles of family physicians (FPs), but FM was only the sixth most popular choice for specialisation. Conclusions: In general, students had favourable views concerning FM and its role in the future of healthcare delivery in SA, although their knowledge of essential health programmes was poor. The majority of students had limited interest in pursuing a career in FM. A key recommendation to address these issues is to introduce FM into the curriculum earlier, to cover the key roles of the FP, and provide teaching that highlights the relevance of FM to health system programmes. [ABSTRACT FROM AUTHOR]

Background: Health care generates a large amount of healthcare waste (HCW), which is complex to manage because of its variety and potential to create health and safety hazards if improperly handled. It is essential that healthcare workers have appropriate knowledge of and adhere to proper disposal methods for each category of HCW. Aim: The aim of this study was to assess the knowledge, attitudes and practices of staff working at a district hospital about HCW management, and measure associations between these variables. Setting: The setting for this study was a district hospital in KwaZulu-Natal province. Methods: This was an observational descriptive study among 241 professional and non-professional staff. Data were collected using a questionnaire and analysed using the Statistical Package for the Social Sciences. Results: Knowledge of HCW management was generally inadequate, with 42.7% of the participants scoring ‘poor’ overall. Just over half of the participants reported a good attitude towards the appropriate disposal of HCW but only 53.9% demonstrated good HCW management practices. There was a significant (p < 0.05) relationship between knowledge and practice and between attitudes and practices (p < 0.05). Conclusion: Appropriate training and supervision in HCW management as well as relevant and ongoing in-service training is needed to ensure appropriate knowledge, attitudes and safe practice among all members of staff. As poor practices have been reported on a number of occasions from different hospitals in South Africa, relevant training must also be introduced or improved at undergraduate level. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest number of patients on antiretroviral therapy (ART) globally. Various obstacles were identified that influence effective reporting of adverse drug reactions (ADRs) in resource-limited countries. This investigation aimed to identify, classify and analyse the prevalence of ART-related ADRs. Methods: This observational, quantitative and retrospective descriptive investigation utilised ADR forms completed by healthcare professionals in various healthcare facilities in the Tlokwe district, South Africa (January 2010 to December 2014). Descriptive and inferential analyses were carried out. Results: A total of 770 ART-related ADRs were included in the final analysis. The mean age was 40.1 (± 10.1%) years, with significantly higher ADRs reported in females (70.8%). In this study, 99% of the ADRs were reported by doctors. Abnormal fat distribution (58%), peripheral neuropathy (21.6%) and renal dysfunction (6.6%) were most frequently reported. Females presented with abnormal fat distribution and peripheral neuropathy at a significantly younger age (38.1 ± 4.6 vs. 43.4 ± 5.7 years,p < 0.0001 and 39.7 ± 1.1 vs. 45.1 ± 9.2 years,p < 0.001) respectively compared with males. Gender difference was practically significant (Cramer’sV = 0.3) for all three of the major reported ADRs. Conclusions: Gender was highly dependent among the major reported ADR categories, and women presented with abnormal fat distribution and peripheral neuropathy at a significantly earlier age than males. This retrospective analysis can serve as a platform for future ADR studies within this district. Sustainable and continuous efforts should be made to train and create more awareness among healthcare workers in this district. [ABSTRACT FROM PUBLISHER]

Background: Hypertension (HT) and diabetes mellitus (DM) affect millions of individuals in South Africa and are among the leading causes of morbidity and mortality. Given the substantial public health and socio-economic burden South Africa faces due to the rising rates of chronic diseases, prevention strategies with community engagement may play a vital role in controlling these diseases and their associated sequelae. Objectives and methods: Project HOPE, an implementing partner of the Lilly Non Communicable Disease (NCD) Partnership programme in South Africa, conducted screening days and home visits as part of a non-communicable disease awareness campaign in the Zandspruit suburb of western Johannesburg (lower income, informal settlement). Standardised assessment tools were used, which included glucose and blood pressure measurement. Results: Of 7607 participants screened, 2773/7470 (37.1%) of those with blood pressure values could be classified as hypertensive with systolic blood pressure (BP) ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Of the 7607 glucose screened individuals, 630 (8.3%) had referable random capillary glucose levels ≥ 7.8 mmol/l. There was a clear gradient of increased prevalence over age and body mass index (BMI) categories. Conclusions: In this urban low-income suburb hypertension was common with hyperglycaemia less so. The number of participants returning to the clinic for confirmation of diagnoses was less than optimal and highlights the problem of community-based screening. [ABSTRACT FROM AUTHOR]

Background: Almost 60 million people are infected with and 25 million people have already died from HIV/AIDS. Sub-Saharan Africa is the region most affected, with 67% of all people living with HIV and 91% of all new infections amongst children and 14 million children orphaned by HIV-related deaths. HIV can be transmitted from a pregnant mother to her child during pregnancy, birth or breastfeeding. In South Africa (SA) the mother-to-child HIV transmission (MTCT) rate is under 4% at 4 to 8 weeks after birth since implementation of the most recent national prevention of MTCT (PMTCT) programme. Aim: This study sought to investigate the level of knowledge of nurses and doctors working at Odi Hospital in Tshwane, and whether they were putting the current PMTCT programme into practice. Methods: A descriptive cross-sectional survey was undertaken using self-administered questionnaires developed from the current PMTCT guidelines. Results: Of the 102 participants, 12 (12%) were doctors and 90 (88%) nurses, of whom 9 (9%) were male and 93 (91%) female. Mean knowledge percentage was 60.8% and mean practice percentage was 77%. Regarding knowledge, the question on HIV counselling and testing scored an average 93.1%, while that on doses of drugs used in the PMTCT guidelines scored 17.7%. For practice questions scores ranged from 71% to 82%. Conclusion: Nurses and doctors working at Odi Hospital knew that HIV counselling and testing is important and must be done for all mothers; however, they were unsure of the dosages of drugs used for PMTCT. More than two-thirds of the doctors and nurses reported practising the PMTCT guidelines, but as their knowledge was inadequate their practice may not be appropriate. [ABSTRACT FROM AUTHOR]

Background: Medical internship in South Africa is a two-year period after completing the basic medical degree. Interns rotate through six different domains, where they are exposed to various clinical procedures. These skills are often not up to standard, and interns feel unprepared for future challenges. This study evaluated the self-perceived readiness of interns rotating through the Universitas Academic Health Complex in performing basic medical procedures, and the frequency of performing these procedures. Methods: This was a descriptive quantitative study. Consenting participants completed an anonymous questionnaire regarding four pre-selected medical procedures per department. Results: The majority of the 61 participants were second-year interns (52.5%), female (54.0%), with a median age of 25 years. Interns felt ready to perform the majority of procedures, but more than 50% reported not being ready to perform circumcisions, episiotomy and perineal repair, assisted delivery and appendectomies. Some procedures in Family Medicine, Internal Medicine, Obstetrics and Gynaecology, General Surgery and Psychiatry were rarely performed by at least half of the participants. Conclusions: Exposure of medical students during their clinical years to practical training is inadequate. The focus in the MBChB curriculum should be increased to a more specific practical approach during both the pre-clinical and clinical years. [ABSTRACT FROM AUTHOR]

Introduction: Intimate partner violence has been recognised globally as a human rights violation. It is universally underdiagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool-short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool-short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool-short was shown to have a sensitivity of 45.2% and specificity of 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants' understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence. Improvement in the sensitivity of the Women Abuse Screening Tool-short in this setting may be achieved by lowering the threshold for a positive result. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe the current macro- and micronutrient intake of children (both boys and girls) in two selected communities in the Breede Valley, Worcester. Design: This was a quantitative cross-sectional study. Setting: The study focused on two disadvantaged communities in Worcester (Avian Park and Zweletemba) in the Breede Valley, Western Cape province. Subjects: The study subjects were 248 children (Avian Park, n = 117; Zweletemba, n = 131) aged 12-36 months. Method: The macro-and micronutrient intake of the children was determined using a validated, interviewer-administered quantitative food frequency questionaire, and compared against the estimated average requirement (EAR) and adequate intake (AI) of nutrients. The nutrient adequacy ratio was calculated, as well as percentage deviation from the EAR and AI. Results: More than 20% of the children had a calcium and folate intake that deviated by more than 50% below the EAR in both communities and for both genders. More participants in Zweletemba had an intake that deviated by more than 50% above the EAR and AI, compared to Avian Park, for carbohydrate, thiamine, niacin and iron. Conclusion: With the exception of folate, calcium and selenium, the average reported nutrient intake of the children (boys and girls) in both the communities was adequate. [ABSTRACT FROM AUTHOR]

Background: Most anaesthesia-related mortality that occurs in level 1 hospitals in South Africa is avoidable. Improving training during internship, and consequently the skills of community service officers, could lead to safer anaesthesia practices. Objectives: The objectives of the study were to determine whether or not the timing of the anaesthesia rotation during internship and other factors affected the outcome of the assessment at the end of the anaesthesia rotation, and to compare the perceptions of first- and second-year interns regarding their confidence levels at the end of their rotation. Method: We conducted a retrospective study that compared 298 intern assessments over a three-year period. It included the assessment of interns by senior doctors in respect of three cases, an overall assessment of the interns' performance, and the number of cases carried out by them. In addition, a questionnaire was used to assess the interns' confidence levels at the end of the rotation. Results: Little variation in the results was evident across comparisons of the year of internship, gender and age. Comparison according to university showed a slight variation. A wide variation in the number of obstetric cases (range 5-58) and endotracheal intubations (range 6-54) was observed. Over 80% of interns, regardless of the year, were confident enough to administer general anaesthesia and perform an endotracheal intubation. However, this perception of confidence by interns did not relate to the assessment of their competence. Conclusion: The variance in the ability of interns to perform anaesthesia could not be accounted for by the training year, institution of undergraduate study, age or gender. It is likely that the assessment technique used did not provide a true reflection of the acquired skills or longevity of knowledge by interns. Further research in this area is recommended. [ABSTRACT FROM AUTHOR]

Background: Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time Master of Family Medicine (MFamMed) to a full-time Master of Medicine (Family Medicine) [MMed(Fam)] degree, with changes in the curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the postgraduate programme for Family Medicine, at the University of the Free State, and if necessary, to produce a valid and reliable assessment tool that is user-friendly. Method: An action research approach was used in this study, using mixed methods. Firstly, marks given by 15 assessors for four mini-dissertations using the current assessment tool were analysed quantitatively. In Phase 2, the regulation of the assessment bodies and the quantitative results of Phase 1 were discussed by assessors during a focus group interview, and data were analysed qualitatively. An adapted, improved assessment tool (Phase 3) was developed and re-evaluated in Phase 4. Results: The current assessment tool complied with the regulations of the assessment bodies. The scores allocated to specific categories varied with a median coefficient of variation of more than 15% in four of the possible 12 assessment categories. During the focus group interview, reasons for this were identified and the assessment tool adapted accordingly. During reassessment of the tool, individual assessors were identified as the reason for poor reliability. Conclusion: The current assessment tool was found to be valid, but was not reliable for all assessment categories. The adapted assessment tool addressed these areas, but identified lack of training and experience in the assessment of extensive mini-dissertations by certain assessors as the main reason for unreliable assessment. [ABSTRACT FROM AUTHOR]

Objectives: Most of the research on suicidal behaviour in youth focuses on developed countries. Less is known about the prevalence of suicidal behaviour and associated risk factors in community samples of youth who do not present for mental health care in developing countries. This study investigated the prevalence of suicidal behaviour and associated risk factors in grade 8 learners in Durban. Setting and subjects: Grade 8 learners in a government-run, co-educational school were approached to participate in the study after parental consent and child assent were obtained. A descriptive, cross-sectional method was used to gather quantitative data. The grade 8 learners were asked to complete demographic questionnaires and various psychometric assessment scales. Design: The gathered data were divided into two groups, i.e. those who reported personal suicidal behaviour and those who did not. The various variables in these two groups were compared using bivariate and multivariate statistical analyses. Results: The study established that 22 participants (33.8%, n = 75) reported suicidal behaviour (thoughts, plans or attempts in this regard). They also had higher levels of depression, perceived stress, hopelessness and anger (p-value < 0.01) than those who did not report any suicidal behaviour . The same participants had lower scores on scales that assessed self-esteem and perceived social support from family (p-value < 0.01), compared to those who did not report any suicidal behaviour. Logistic regression analysis that was undertaken indicated that a friend's suicidal thoughts [odds ratio (OR) 4.27, p-value < 0.01], alcohol use (OR 3.08, p-value < 0.01), perceived stress (OR 1.05, p-value < 0.01) and depression (OR 1.04, p-value < 0.01), were strong predictors of personal suicidal behaviour in this sample. Conclusion: There is a high prevalence of suicidal behaviour in grade 8 learners in Durban. The identiied risk factors were similar to those found in developed countries. Healthcare providers and other professionals, such as school counsellors, should consider the identiied risk factors when assessing suicidality and planning interventions for youth. [ABSTRACT FROM AUTHOR]

Background: Before 2006, the uptake into the prevention of mother-to-child transmission (PMTCT) for HIV programme was low in South Africa. We determined PMTCT programme uptake, and identified factors that affected enrolment into the PMTCT programme in the rural Limpopo province. Method: This cross-sectional study, conducted from 21 July to 20 August 2008, involved 200 consecutive women who met the inclusion criteria in the immediate postpartum period. An interviewer-administered questionnaire was used to obtain information on participants' knowledge and experience of, satisfaction with, and motivation for, enrolling in the PMTCT programme. Main outcome measures included voluntary counselling and testing (VCT) and PMTCT programme uptake rates, and factors reported to influence enrolment into the programme. Results: Of the 200 invited women, 169 (84.5%) responded. The mean age of participants was 25 years ± standard deviation. The human immunodeficiency virus prevalence rate was 23.6%. VCT and PMTCT programme uptakes were 96.9% and 90.9% respectively. Participants reported being aware of (95.2%) and satisfied with (81.6-97.4%) various aspects of the PMTCT programme. The safety of their babies was reported by most participants to be their motivation for enrolment (71.1%). Participants in the age-group 20-29 years were more likely than others to enrol in the PMTCT programme (p-value = 0.01). Conclusion: VCT and PMTCT programme uptakes were high and influenced by good knowledge, satisfaction with the PMTCT programme and participants' concern for the safety of their babies. [ABSTRACT FROM AUTHOR]

Objective: Various benefits are associated with the adoption and meaningful use of health information technologies (HITs) in the healthcare sector. Despite the associated advantages with the adoption and use of HITs, the South African healthcare sector has been slow to adopt HITs, such as electronic record systems. The purpose of this study was to identify factors that should be addressed to encourage the adoption and meaningful use of HITs in the South African healthcare landscape. Design: A three-round Delphi study was conducted to identify such factors. Setting and subjects: The Delphi panel included 21 participants who were considered to be suitably knowledgeable about the acceptance and significant use of HITs in the context of the South African healthcare setting. Results: A total of 58 factors were uncovered by the participants. Consensus was reached on 42 factors that were considered to have a direct to significant impact on the adoption and meaningful use of HITs in the South African healthcare sector. Conclusion: The results of this study highlight factors that should be addressed to encourage the adoption and meaningful use of HITs in South Africa's healthcare setting. These results indicate that a wide range of factors need to be addressed and involve a multitude of stakeholders. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently, none of the community health centres (CHCs) in Cape Town test for microalbuminuria, and there are concerns about its costs and feasibility. Objectives: The aim of this study was to assess the practicality, costs and consequences of introducing a screening test for microalbuminuria into primary care. Design: Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening, costs and consequences was evaluated. Setting and subjects: Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcome measures: Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria. Results: Of the patients with diabetes, 14.6% already had macroalbuminuria. Of the eligible patients, 69.9% completed the screening process which led to a diagnosis of microalbuminuria in another 11.7%. Of those who were positively diagnosed, the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20%, while 49.2% had ACE inhibitors initiated, or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed. Conclusion: The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal, compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient). [ABSTRACT FROM AUTHOR]

Objective: There is a lack of research on humour among adolescents in South Africa. This article examines cognitive flexibility and humor. The objective was to investigate the roles of gender and language as possible moderating variables in the relationship between adolescents' cognitive flexibility and sense of humour. Design: A correlational research design was used in which pupils were asked to complete the Multidimensional Sense of Humor Scale to assess their sense of humour. In order to determine the cognitive flexibility of the sample group, Martin and Rubin's Cognitive Flexibility Scale was applied. Setting and subjects: The initial sample comprised 1 203 adolescents (Grade 11 and 12 pupils) randomly selected from the Eastern Cape, Gauteng and Mpumalanga. Of these, a final 392 adolescents qualified after eliminating criteria had been applied. Results: No significant correlations were found between the total group or for the two genders. Significant positive correlations were found between cognitive flexibility and two of the scores for humour (creating and expressing humour), as well as for the total score for Afrikaans-speaking participants. Significant negative correlations were found between cognitive flexibility and all five of the scores for humour for the Nguni language speakers. Conclusion: This study recommends that culturally sensitive measuring instruments should be developed. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the relationship between overweight and obesity and the motor performance of nine- to 13-year-old South African children. Design: The study used a one-way cross-sectional design based on baseline measurements. Settings and subjects: The research group comprised 280 Grade 4, 5 and 6 learners (128 boys and 152 girls) from two schools that represented a distribution of socio-economic status, race and gender. Outcome measures: Anthropometric [(body mass index (BMI) and fat percentage] and motor performance measurements (fine manual control, manual coordination, body coordination and strength and agility) were obtained by means of the Fitnessgram and the Bruininks-Oseretsky Test of Motor Proficiency-II. International age-specific cut-off points were used to classify the children's body composition as normal weight, overweight or obese. Data were analysed by means of descriptive statistics, correlation matrices and analysis of variance, followed by a Tukey post hoc analysis. Results: The results showed that running speed and agility decreased significantly with an increase in BMI. Muscular strength also decreased significantly with a smaller practical significance, while fine manual control, manual coordination, and body coordination showed the weakest relationship to BMI. Analysis of variance showed significant relationships between BMI and running speed and agility (p-value < 0.05). These relationships were influenced differently by gender and ethnicity. Conclusion: The motor performance of young South African children was negatively influenced by overweight and obesity. Intervention strategies are recommended to reduce the consequences of overweight and obesity in the overall development of such children. [ABSTRACT FROM AUTHOR]

Objectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART). Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals. Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province. Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents' experience before and after HAART. Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them. Conclusion: Sexuality in HIV is complex, with components described as the "Ps" of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. This discussion will enhance healthcare professionals' understanding of patients' experiences of their illness and should allow for a more effective patient-centred approach to care. [ABSTRACT FROM AUTHOR]