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Background: According to the World Health Organization (WHO), malnutrition can be linked to 45% of deaths in children under the age of five years. The Integrated Nutrition Programme (INP) was introduced in 1994 to address malnutrition in South Africa. There had been no systematic evaluation of how well clinics perform regarding nutritional services. Malnutrition rates worsened in the Free State from 3.9% in 2009 to 10.7% in 2013. This study aimed to assess the effectiveness of the INP Supplementary Feeding Programme in primary healthcare facilities in the Mangaung University of the Free State Community Partnership Project, known as MUCPP, catchment area of Bloemfontein, Free State, in children aged six months to five years. Methods: This was a retrospective, descriptive cohort study. All children between six months and five years entering the feeding scheme between July 2014 and June 2015 at the MUCPP, which is the hub of the feeding scheme, and three primary healthcare clinics were included. Data were collected from September to November 2015 from the INP registers and captured on dataextraction forms. Results: In total, 730 children were included in the study, 38.8% at risk for malnutrition and 61.2% malnourished. Most of the children (80.7%) stopped attending before change was seen. Only 14.1% exited the INP successfully with a normal weight for age and 3.0% deteriorated despite nutrition interventions. Of all children with one or more follow-up visits, 50.4% (119/236) improved from severe malnutrition to underweight or exited at target weight. Conclusions: The follow-up of the children and the monitoring and implementation of the INP are inadequate. There is some evidence that children who attend the INP regularly benefit from the programme. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1340252

Background: Prematurity is globally the leading cause of neonatal mortality, morbidity and long-term disability. The Millennium Development Goals (MDG) of the United Nations, and specifically MDG 4, address child mortality. Neonatal mortality rates contribute to 37% of all under-five mortality, with the largest proportion (30%) due to prematurity. The overall purpose of this study was to determine factors associated with prematurity and to identify treatable and preventable causes at the Bloemfontein Academic Complex in order to decrease the morbidity and mortality associated with prematurity in line with MDG.Methods: A case control study design was used including all premature babies referred to the Kangaroo Care Unit of the National District Hospital between December 2010 and March 2011. Each baby was included with his/her mother as a pair. For each premature baby and mother pair a term baby and mother pair was included as a control. Data were collected on a data sheet from the mothers’ antenatal records, and from maternal notes as well as the neonatal follow-up and discharge notes. Data gathered included baseline characteristics, habits, diseases and medication of the mother during the antenatal period and delivery as well as baseline demographics of the babies. Results: A total of 194 mothers and 198 babies were included in the study with 109 case mothers and 85 control mothers . Pre-existing medical conditions were more prevalent in the premature group (69%) compared with the control group (27%) with p 0.0001. These conditions included hypertension, HIV disease and syphilis. Possible causes for prematurity identified in this study included teenage mothers and premature rupture of membranes.Conclusion: Risk factors identified for prematurity were: teenage mothers, pre-existing medical conditions in the mother, and preterm rupture of membranes. Smoking and alcohol consumption during pregnancy could not be identified as risk factors for prematurity. It is recommended that patients with any of the above-mentioned identified risk factors be classified as high risk for the development of prematurity and shorter follow-up intervals and more aggressive management of pre-existing medical conditions should be practised.

Background: The need for an appropriate South African triage system led to the development of the Cape Triage Score (CTS), a system to prioritise emergency departments’ workloads. This study evaluated the effectiveness of the CTS at the National District Hospital emergency department, Bloemfontein.Methods: In this retrospective, descriptive, observational study, files of adult patients triaged at the emergency department during February 2013 were randomly selected. Inclusion was subject to the availability of the files. Physiological parameter results were used to calculate the Triage Early Warning Score (TEWS). The side-room investigations and South African Triage Score (SATS) were recorded. Other information gathered included diagnosis, outcome, and times the patient was triaged and seen by the doctor.Results: A total of 396 files were included in the study. Patients, of whom 57.8% were women, were between the ages of 16–89 years. More than half (52%) of side-room investigations were omitted or inapprop...

Background: The United Nations set a two-thirds reduction in child mortality between 1990 and 2015 in the Millennium Development Goals (MDGs) of 2000. The National Department of Health (NDoH) introduced strategies to achieve these MDGs, which included new vaccines, better HIV care and training of healthcare workers. This study investigated whether the strategies implemented by the NDoH decreased child mortality (MDG 4) at National District Hospital (NDH). Method: A retrospective file review was done on all children that died in NDH from 2008 to 2015. Data were collected from patient files and ChildPIP data forms. Deaths before and after the implementation of the strategies were compared. Results: A total of 209 children died during the study period. The mortality rate decreased from 47 per thousand admissions and stabilised at 15 per thousand admissions for the past five years. Deaths due to acute gastroenteritis decreased from 67% of the total to less than 40%. Pneumonia as the main cause of death decreased from 44 during the 2008–2010 period to 19 during the 2011–2015 period. More than 90% of the children who died were malnourished. There was no statistically significant improvement in the malnutrition rates during the study periods (p = 0.85). Conclusion: Child deaths decreased from one a week to one a month at NDH. Strategies to meet the MDG 4 targets, like the introduction of the Rotavirus and Pneumococcal vaccine, the scale-up of anti-retroviral treatment and Prevention of Mother to Child transmission of HIV and better Integrated Management of Childhood Illness training all contributed to the better outcome. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1317991

Background: Multiple losses experienced by children is a topic on which little research has previously been completed. Therefore, a specific definition of multiple losses is unavailable. Multiple losses are traumatic for children and result in the need for intervention and support with respect to grief, loss and bereavement issues. The main goal of this study was to determine the prevalence of multiple losses children who had experienced this from birth to 18 years of age in the National District Hospital in Bloemfontein.Method: A literature search was carried out to define the concept of multiple losses experienced by children appropriate to the South African context. Thereafter, a descriptive study with an analytical component was used to gather information on multiple losses. Structured interviews with the parents or caretakers of the children at the National District Hospital were conducted by the researchers by means of a questionnaire. The interviews were conducted in English or Afrikaans.Results: A...

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.

This is Part 2 of a three-part series on medico-legal documentation. Part 1 addressed the knowledge and skills necessary to complete a legal J88 document. The aim of Part 2 is to give practical guidance on completion of the J88 form in the case of assault. Part 3 will address the sexual assault section of the J88 form. As a legal document, the J88 form must be completed accurately with regard to demographic information, including the time and date of examination, to assist with interpretation of the findings. The full names of the person examined appear on the SAPS 308 form, and must be confirmed by the patient and an identification document, if available. The name of the healthcare provider must be identifiable and contact details must be stated to assist with tracing, if necessary. A complete history is important because a differential diagnosis needs be considered, and the clinical findings must be consistent with the description of the incident in terms of time, mechanism of the injury and the place at which the incident took place, as these all add to the probability that the incident occurred as disclosed. The health worker has a dual responsibility with regard to both the health and medico-legal aspects pertaining to the patient and must record these in the clinical notes. Only medico-legal aspects are recorded on the J88 form. A top-to-toe, back-to-front examination must be performed methodically, since the person may be unaware of certain injuries. The healthcare worker must write a conclusion in the space provided. Support of the history with the clinical picture is the basis for the conclusion.

The management of a rape case in the emergency department is shrouded in an unacceptable level of lack of confidence. Since South Africa has a high incidence of rape, the contribution of health practitioners in addressing the crime successfully is essential. The medical management of such cases carries a high level of uncertainty with an accompanying element of not feeling in control. The intimidation associated with the responsibility of being an expert witness complicates the matter further. This article attempts to address the reluctance to get involved in medico-legal cases and emphasises the holistic management of survivors of rape. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1280900