Search

Background: The prevalence and incidence of diabetes in South Africa are high and are expected to increase. Mortality and morbidity may be related to hypoglycaemia, and there is limited information on hypoglycaemia from private practice sites. The aim of this study was to assess patients’ education about, knowledge of and response to hypoglycaemia. Methods: The study site was a general practice, and participants were all patients with diabetes who presented to the practice over a 1-month period. Data were collected using a closedended questionnaire and analysed descriptively. Findings: Most respondents were South Africans of Indian origin and were diagnosed with diabetes at a relatively young age. Despite attending a private practice, most had low incomes and low schooling levels. Just under half reported having experienced hypoglycaemia, and there was a strong association between hypoglycaemia and insulin use. Many reported never having received any education around hypoglycaemia. Discussion: The study highlights the need for early screening for diabetes in this vulnerable population. Hypoglycaemic education should consider low schooling levels even in a private general practice, and further study is required on the quality and frequency of education provided in general practice. Keywords: diabetes; hypoglycemia, KwaZulu-Natal; hypoglycemic education more...

Background: The incidence and prevalence of multidrug–resistant tuberculosis (MDR TB) in the province of KwaZulu-Natal, South Africa, are amongst the highest in the world. Previously, interventions have been largely biomedical based; however, there is growing opinion that interventions must include social aspects such as patient education and attitudes. Methods: This observational study assessed the knowledge and attitudes of 380 patients diagnosed with MDR TB at a centralised MDR TB unit in Durban. Data were collected using a questionnaire that was distributed to every third patient attending the outpatient MDR TB clinic. Data were collected over an 8-week period and analysed descriptively. Results: Just under half of the respondents had primary MDR TB. Most respondents were young, female unemployed and did not receive a social grant. Knowledge around diagnosis of MDR TB was generally adequate. There were important misconceptions about spread of the disease and duration of treatment. Most respondents received knowledge of MDR TB from healthcare workers. Some respondents received knowledge from friends, family and Sangomas and believed that the disease was caused by bewitchment or as a form of punishment. Discussion: The need for strengthening the role of primary care physicians in promoting education and providing support is highlighted. Further study is needed to investigate the high rate of primary MDR TB and to identify the unique challenges faced by women who have MDR TB. Future research could include the possibility of involving traditional healers in a contextually sensitive MDR TB education, training and support programme. more...

Background: This study reviewed pain severity and assessment as recalled by patients with longbone fractures. The focus was on the intervals between admission, pain assessment and analgesic provision, as delay of analgesia for acute pain can result in complex chronic pain syndromes. Aim: The aims were to explore patients’ recollection of pain severity and assessment in an emergency department (ED) and whether analgesia prescribed in the ED correlated with pain severity.' Setting: The study site was a district hospital ED in KwaZulu-Natal, South Africa. Methods: This exploratory study considered aspects of pain in adults with long-bone fracture who were admitted to an ED and later referred to an orthopaedic unit. Data collection took place in the orthopaedic unit where participants were requested to recall their pain severity (using a visual analogue scale) whilst in the ED. Results: Ninety-three patients participated, most of whom were African males. Over 60% recalled their pain severity in the ED as 5 or greater on a visual analogue perception scale. No formal tool was used to assess or record pain in the ED, and there was no association between recalled pain severity and type of analgesia prescribed. Conclusion: The majority of patients were assessed for pain in the ED. Analgesia given to most patients was inadequate for the degree of pain they experienced. A pain assessment protocol should be developed for doctors and nurses to serve as a guideline in assessing patients with long-bone fractures and prescribing appropriate analgesia. more...

Introduction: Staffing of rural and remote facilities is a challenge throughout the world. Umthombo Youth Development Foundation (UYDF) has been running a rurally based scholarship scheme since 1999.The aim of this review is to present data on the number of students selected, their progress, graduation and work placement from inception of the scheme until 2013. Methods: Data were extracted from the UYDF data base using a data collection template to ensure all important information was captured. Results: Since 1999, 430 rural students across 15 health disciplines have been supported by UYDF. The annual pass rate has been greater than 89%, and less than 10% of students have been excluded from university. All graduates have spent time working in rural areas (excluding the 32 currently doing internships) and 72% (52/73) of those with no work-back obligation continue to work in rural areas. Discussion and conclusion: The UYDF model is built around local selection, compulsory academic and peer mentoring and social support, comprehensive financial support and experiential holiday work. The results are encouraging and highlight the fact that rural students can succeed at university and will come back and work in rural areas. With 46% of the South African population situated rurally, greater thought and effort must be put into the recruitment and training of rural scholars as a possible solution to the staffing of rural healthcare facilities. The UYDF provides a model which could be replicated in other parts of South Africa. more...

Background: The importance of dedicated adherence to antiretroviral treatment (ART) in the management of Human Immunodeficiency Virus (HIV) is well documented. Multiple factors may affect adherence and this study explores patients’ and their caregivers’ perceptions of factors which may positively influence adherence to ART. Method: This study was a descriptive, qualitative study that used both free attitude interviews and focus-group discussions. Nineteen patients attending a busy ART-clinic at a district hospital in KwaZulu-Natal and eight caregivers were purposefully selected. Selection criteria included good adherence to ARTs as evidenced by excellent clinic attendance for more than one year with evidence of clinical, immunological and viral improvement. Interviews were tape recorded, transcribed and thematically analysed. Results: Ten female participants, nine male participants and eight caregivers took part in the study. Participants highlighted three main categories that positively affect their adherence to ART namely: patient, disease and health care provider-related factors. Sub-themes included issues related to acceptance, disclosure to significant others, symptomatic improvement on ARTs and the importance of supportive relationships. Participants greatly valued the health care provider relationship and felt that the main role of the health care provider was to educate and support. Conclusion: This study has shown that the factors which most influenced adherence were patient-related (acceptance, disclosure, determination, and family support), disease-related and treatment-related (symptomatic illness and improvement on ARTs), and healthcare worker-related (relationships, and adherence classes). more...