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Background: Emergency Centres (ECs) have a prominent trauma burden requiring effective pain management. This study aimed to review analgesia-prescribing habits in minor trauma, reviewing the patient demographics and diagnoses, analgesia-prescribing habits of health care professionals (HCPs) managing these cases, and differences in prescribing noted by patients' age group, gender and triage code. Methods: A prospective, cross-sectional, descriptive study was conducted in a regional EC in KwaZulu-Natal. HCPs managing minor trauma patients completed a closed-ended questionnaire which indicated the patients' demographics, diagnosis and analgesia prescribed. Results: The study comprised of 314 cases of which the demographic most represented were male patients aged between 20-30 years with soft tissue injuries. Simple analgesics and weak opioids (paracetamol, ibuprofen and tramadol) accounted for 87.9% of prescriptions. Referral clinics prescribed less analgesics than that provided in the EC. There were mostly no significant differences in prescription habits by patients' age group, gender and triage code. Conclusion: Presenting complaints in our study were varied and likely to result in mild to moderate pain. Only a minority of patients received analgesics at initial contact. Standardised protocols providing treatment guidance for nurse-initiated pain management at initial contact is thus important. There were no significant differences in analgesics prescribed for adults and the elderly, which is worrisome given the potential negative side effects of analgesics in the elderly. Similar concerns in our paediatric population were not noted. Ensuring adequate analgesia with cognisance for safety at the extremes of age is of paramount importance. [ABSTRACT FROM AUTHOR]

Background: The majority of global HIV infections in children under 10 years of age occur during pregnancy, delivery or breastfeeding, despite improved coverage of 'prevention of mother-to-child transmission' (PMTCT) guidelines to reduce vertical transmission. This article looks closer at one community-based peer mentorship programme [Mentor Mothers Zithulele (MMZ)] in the Eastern Cape, South Africa which aims to supplement the existing heavily burdened antenatal programmes and improve PMTCT care. Methods: Semi-structured interviews were undertaken with HIV-positive women participating in MMZ and women receiving standard PMTCT care without any intervention. A focus group discussion (FGD) was conducted with women working as Mentor mothers (MMs) for MMZ to explore their experience of the impact of peer mentoring on the rural communities they serve. Results: Six main themes were identified in the interviews with antenatal patients: (i) MMs were a key educational resource, (ii) MMs were important in promoting exclusive breastfeeding, (iii) encouraging early HIV testing during pregnancy and (iv) providing psychosocial support to patients in their homes, thereby reducing stigma and sense of alienation. Respondents requested (v) additional focus on HIV education. MMs can (vi) function as a link between patients and health-care providers, improving treatment adherence. During the FGD two themes emerged; MMs fill the gap between patients and health services, and MMZ should focus on HIV awareness and stigma reduction. Conclusion: Peer mentoring programmes can play an important role in reducing vertical HIV transmission in resource-limited, rural settings by providing participants with education, psychosocial support, and a continuum of care. [ABSTRACT FROM AUTHOR]

Clearing the cervical spine in an unconscious blunt trauma patient is an elusive concept. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI). The study was conducted on patients who underwent imaging of both the cervical spine and the brain in one sitting at a busy government healthcare facility in Pietermaritzburg. This was a retrospective, cross sectional study of all the trauma patients presenting to a regional hospital emergency department (ED) in the KwaZulu-Natal (KZN) Province, who underwent computed tomography (CT) imaging of the brain and the cervical spine in one sitting during the period January 2016 to June 2016. Adult males formed the majority (78.9%) of the study population and had the highest incidence of TBI, the most common identified pathology in CT being parenchymal injuries (41%). The mechanisms that resulted in the majority of injuries sustained were assault (38.7%) and motor vehicle collisions (MVCs) (25%), while seven patients (4.76%) had a combined diagnosis of TBI and CSI. The average Glasgow Coma Scale (GCS) was 12. Young adult males are at the greatest risk of sustaining TBI, with assault being the most common mechanism of injury. Combined diagnoses of TBI and CSI are rare and were mostly noted in patients involved in MVCs and pedestrian vehicle collisions. While the chance of an abnormal CT scan increased with a decreasing GCS score, 33% of patients with a mild TBI did not have abnormal CT findings, and 25% patients with severe TBI had no abnormal CT findings. [ABSTRACT FROM AUTHOR]

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work. Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine). Setting: Rural district hospitals in South Africa. Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey. Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context. Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps. [ABSTRACT FROM AUTHOR]

Background. During recent years, a shortage of medical practitioners has been reported in rural underserved areas of South Africa (SA). The Division of Family Medicine, Faculty of Health Sciences, University of Cape Town (UCT), SA, implemented a voluntary 4-week rural rotation in Vredenburg, West Coast District, in 2011 in response to the need for rural training to be included in the medical curriculum. The reason for the decline in the number of students making use of this opportunity, is unknown; therefore, a compulsory 1-week rural rotation, as part of the final-year 4-week clerkship, was implemented in 2015. The rationale for this intervention was to ensure a sustainable rural learning environment and to highlight the need to explore students' expectations and experiences with regard to the rural rotation. Objectives. To explore the expectations and experiences of 6th-year medical students regarding the family medicine rural rotation, and to identify factors that may influence return to a rural setting after graduation. Methods. A qualitative study design was used. Sixth-year medical students (n=31) participated in the pre-rural focus group discussions (FGDs), and 28 in the post-rural FDGs. A content analysis method was used to identify key themes. Results. Key themes for student expectations included programme content, clinical experiences, language barriers and physical environment. Themes for student experiences related to environment and resources, programme content and clinical experience, language barriers and logistics. Positive experiences included good mentorship, autonomy to perform procedures and improved preparedness for internship. Negative experiences included inadequate clinical exposure and time allocation. Most students expressed an intention to enter rural practice; reasons included effective teamwork and making a difference. Results. Key themes for student expectations included programme content, clinical experiences, language barriers and physical environment. Themes for student experiences related to environment and resources, programme content and clinical experience, language barriers and logistics. Positive experiences included good mentorship, autonomy to perform procedures and improved preparedness for internship. Negative experiences included inadequate clinical exposure and time allocation. Most students expressed an intention to enter rural practice; reasons included effective teamwork and making a difference. [ABSTRACT FROM AUTHOR]

Background: Timely initiation of antiretroviral treatment (ART) requires sustained engagement in HIV care before treatment eligibility. We assessed loss to follow-up (LTFU) correlates in HIV-positive adults accessing HIV treatment and care, not yet ART-eligible (CD4 >500 cells/mm(3)).Methods: This was a sub-study of a prospective cohort study (focusing on sexual behaviour) in an area of high HIV prevalence and widespread ART availability in rural KwaZulu-Natal, South Africa. Psychosocial, clinical and demographic data were collected at recruitment from individuals with CD4 >500 cells/mm(3). LTFU was defined as not attending clinic within 13 months of last visit or before death. Individuals starting ART were censored at ART initiation. Data were collected between January 2009 and January 2013. Analysis used Competing Risks regression.Results: Two hundred forty-seven individuals (212 females) were recruited (median follow-up 2.13 years, total follow-up 520.15 person-years). 86 remained in pre-ART care (34.8 %), 94 were LTFU (38.1 %), 58 initiated ART (23.5 %), 7 died (2.8 %), 2 transferred out (0.8 %). The LTFU rate was 18.07 per 100 person-years (95 % CI 14.76-21.12). LTFU before a competing event was 13.5 % at one and 34.4 % at three years. Lower LTFU rates were significantly associated with age (>37 versus ≤37 years: adjusted sub-Hazard ratio (aSHR) 0.51, 95 % CI 0.30-0.87), openness with family/friends (a little versus not at all, aSHR 0.81, 95 % CI 0.45-1.43; a lot versus not at all, aSHR 1.57, 95 % CI 0.94-2.62), children (0 versus 4+, aSHR 0.68, 95 % CI 0.24-1.87; 1 versus 4+, aSHR 2.05 95 % CI 1.14-3.69, 2 versus 4+; aSHR 1.71, 95 % CI 0.94-3.09; 3 versus 4a, aSHR 1.14, 95 % CI 0.57-2.30), previous CD4 counts (1 versus 0, aSHR 0.81, 95 % CI 0.45-1.43; 2+ versus 0, aSHR 0.43, 95 % CI 0.25-0.73), and most recent partner HIV status (not known versus HIV-positive, aSHR 0.77, 95 % CI 0.50-1.19; HIV-negative versus HIV-positive, aSHR 2.40, 95 % CI 1.18-4.88). The interaction between openness with family/friends and HIV partner disclosure was close to significance (p = 0.06). Those who had neither disclosed to partners nor were open with family/friends had lowest LTFU rates.Conclusions: Strategies to retain younger people in pre-ART care are required. How openness with others, partner HIV status and disclosure, and children relate to LTFU needs further exploration. [ABSTRACT FROM AUTHOR]

Presents an interview with Lizo Mazwai, the Dean and Professor of Surgery, Faculty of Medicine and Health Sciences, at the University of Transkei (UNITRA) in South Africa. What drew Mazwai to a career in medicine; Reactions of family to his career choice; Racial breakdown of Transkei; Accomplishments and achievements at Transkei; Things that he is most proud of in his stewardship as Dean of Transkei; Percentage of Transkei graduates that are practicing medicine in rural areas; Skills provided by Transkei that are needed by graduates to function effectively in rural areas; Role in the Colleges of Medicines; His role in the regional health group called The Network.

Background: There is little information available on the range of conditions presenting to generalist run rural district hospital emergency departments (EDs) which are the first point of acute care for many South Africans., Aim: This study aims to assess the range of acute presentations as well as the types of procedures required by patients in a rural district hospital context., Setting: Zithulele is a 147-bed district hospital in rural Eastern Cape., Methods: This is a cross-sectional study assessing all patients presenting to the Zithulele hospital emergency department from 01 October 2015 to 31 December 2015. Data collected included the triage acuity using the South African Triage Scale system, patient demographics, diagnosis, outcome and procedures performed. Diagnoses were coded retrospectively according to the international statistical classification of diseases and related health problems version 10 (ICD 10)., Results: Of the 4 002 patients presenting to the ED during the study period, 2% were triaged as emergencies and 45% as non-urgent. The most common diagnostic categories were injuries, infections and respiratory illnesses respectively. Diagnoses from all broad categories of the ICD-10 were represented. 67% of patients required no procedure. Diagnostic procedures (n = 877) were more prevalent than therapeutic procedures (n = 377). Only 2.4% of patients were transferred to a referral centre acutely., Conclusion: Patients with conditions from all categories of the ICD-10 present for management at rural district hospitals. Healthcare professionals working in this setting need to independently diagnose and manage a wide range of ED presentations and execute an assortment of procedures.

The article reports on the efforts of a team of doctors to reform Zithulele Hospital in South Africa. Zithulele Hospital was established by missionaries in 1956 and is run by the provinical health department. In 2009, the hospital has expanded into a multidisciplinary team consisting of 22 members, including doctors, physiotherapists, occupational therapists and pharmacists, among others. Despite the challenges they encounter, the team was able to manage and improve maternal and child health care in the hospital. The author argues that Zithulele Hospital offers a signal of hope to rural health.

Announces that the South African government has reversed its previous refusals to use antiretroviral drugs to treat AIDS and will introduce the world's largest comprehensive AIDS treatment plan. Decision which was made by President Thabo Mbeki's cabinet; Intense pressure from AIDS activists in the county, leadership from Nelson Mandela and pressure from outside the country which is credited with the shift in policy; How the plan will work; Budget for the distribution of therapeutics; Training of staff; Plan to reach those in rural areas.

Reports that the proposal of South Africa's Health Minister, Nkosazana Zuma to make rural medicine a specialty has been accepted by Department of Health director general Olive Shisana. Western Cape regional government's allocation of funds to provide incentives for doctors who are willing to work in rural areas; Proposal requiring doctors to spend two years in community service.