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Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on the principles of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households.Methods: The study assessed the awareness of the WBOT and the services offered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data were collected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers.Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, ‘Yes’ and ‘No’. A summary of the responses showed that the number of ‘yes’ responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) ‘yes’ responses and 698 (11.1%) ‘no’ responses.Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%.

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization’s six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status ( P = 0.02) and TB diagnosis using only sputum smear test ( P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

Introduction: Households’ satisfaction is an important and commonly used indicator for measuring quality in health care. An amelioration of primary health care services at the level of households, ...

Background: Globally, the benefits of viral load suppression in improving the lives of people living with HIV/AIDS have been established. In 2010, the South African Government decentralised ART to the primary care level. This study intended to determine the effect of this decentralisation in achieving viral load suppression among patients. Objective: To determine the prevalence of HIV viral load suppression and factors related to the suppression among patients initiated on ART at Pedisong 4 clinic, Tshwane District in Pretoria. Methods: A prospective cohort study was conducted on 98 patients initiated on ART between 01 November 2012 and 30 April 2013. Based on the viral load results, they were divided into those who achieved Viral Load Suppression (VLS), and those who did not (NVLS). Analyses were done using SAS® (version 9.2) for Microsoft software. A p < 0.05 was considered significant. Results: Ninety patients (91.8%; 95%CI, 84.7% – 95.8%) achieved viral load suppression while eight (8.2%; 95%CI, 4.2% – 15.3%), did not. Of the 98 patients, 63 (64%) were female. In the NVLS group, the female to male ratio was 7:1 (p = 0.038). There was no relationship between viral load suppression and patients’ baseline characteristics, behavioural characteristics and clinical characteristics (p > 0.05). ART adherence reported in both patient groups was ≥ 87.0%. Conclusion: There was good viral load suppression in patients initiated on ART at Pedisong 4 clinic. Patients’ baseline, behavioural and clinical characteristics were not related to viral load suppression, necessitating further large sample size studies in various health facilities.

Background: In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. Health Care Practitioners (HCPs) are important role-players in its implementation. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase. Objective: To evaluate the awareness of HCPs about the NHI in the pilot Tshwane district of South Africa. Method: A cross-sectional survey was conducted among 1753 HCPs in Tshwane district. At 95% confidence level and 5% error margin, the sample size was 315 HCPs, but we over-sampled to 480. The study was conducted in 25 health facilities within the district. A pre-tested self-administered questionnaire was used. Results: A high proportion of HCPs were unaware of the objectives of the NHI program (p < 0.001); number of NHI pilot sites [(281; 59.4%) versus (145; 30.7%), p < 0.001]; rationale used to select pilot sites [(223; 46.9%) versus (193; 40.5%), p = 0.047]; role of the Integrated School Health Services (ISHP) [(250; 52.7%) versus (70; 14.8%), p < 0.001]; and specialists constituting the District Clinical Specialist Team (DCST) (p < 0.001). However, awareness regarding the Ward-Based Outreach Team (WBOT) leader was high [(236; 49.9%) versus (135; 28.5%), p < 0.001]. Conclusion: HCPs in Tshwane district demonstrated poor awareness of the NHI. This reveals that any awareness effort towards the NHI has not taken effect among the HCPs in this district.

Background An allergic reaction to mammalian meat has recently been reported in rural parts of South Africa and throughout other parts of the world. The cause of this allergic reaction is because of an oligosaccharide antigen known as galactose-alpha-1, 3-galactose (alpha-gal) found in mammalian meat. Hard ticks in various parts of the world have been identified as a cause of sensitisation to the alpha-gal antigen. However, mechanisms of sensitisation in Africa are poorly understood. Aim The aim of this article is to review current literature on the alpha-gal allergy and mammalian meat ingestion and the family physician’s role in diagnosing and managing this condition. Method Indexes were searched using the keywords in the following electronic databases: Elsevier Science Direct, Google Scholar, Medline and PubMed. Results Clinical presentation of the alpha-gal allergy occurs typically as a delayed anaphylaxis occurring within 3–6 hours after the ingestion of mammalian meat. A subset of patients described in South Africa presented with a rapid onset of symptoms occurring within 45 minutes. Furthermore, some of these patients present with abdominal symptoms only, which may be mistaken as food poisoning. Diagnosis is based on a history of reaction to mammalian meats (especially to fatty portions or organs) and serum specific alpha-gal antibodies. The main management of the alpha-gal allergy is avoidance of red meat and in mild reactions treatment with oral H1 receptor antihistamines. Conclusion Sensitisation to the alpha-gal allergy results in adverse reactions to red meat, with tolerance to turkey, chicken and fish. A family physician can safely manage this condition. Keywords alpha-gal allergy; mammalian meat; management; primary care; specific IgE antibody; alpha-gal sensitisation.

Background: The World Health Organization aims to reduce tuberculosis (TB) mortality rate from 15% in 2015 to 6.5% by 2025. Aim: This study determined the profile of TB and human immunodeficiency virus (HIV) co-infected patients who died in Mahalapye District, Botswana, while on anti-TB medication and the factors that contributed to such outcome. Setting: The study was conducted in the Mahalapye Health District in Botswana. Methods: This was a cross-sectional study that reviewed patient records from the Mahalapye District Health Management Team Electronic Tuberculosis Register from January 2013 to December 2015. Results: The majority of the TB and HIV co-infected patients were on antiretroviral therapy (ART) (486 [81.63%]) or were initiated cotrimoxazole preventive therapy (CPT) (518 [87.2%]) while taking anti-TB treatment. Seventy-three (13.6%) TB and HIV co-infected patients died before completing anti-TB treatment. Three-quarters (54 [74.4%]) of patients who died before completing anti-TB treatment were on ART, among them two patients who were on ART at least 3 months prior to commencing anti-TB. Also, the majority (64 [87.7%]) of TB and HIV co-infected patients were commenced on CPT prior to death. There was a bimodal density curve of death occurrence in those who did not commence ART and in those who did not commence CPT. Conclusion: This study established that TB and HIV co-infected patients had a TB mortality of 13.6%. A high mortality rate was observed during the first 3 months in those who did not take ART and during the second and the fifth month in those who did not commence CPT. Further study is needed to clarify this matter.

No abstract available.

Background: Ectopic pregnancy (EP) is a life-threatening condition; at Odi Hospital, approximately 7–10 EPs are managed weekly. Our study is the first to assess the management of this life-threatening condition at Odi Hospital. Aim: This study aimed to determine the incidence of EP and to assess the profile of women who presented with EP at Odi District Hospital from 01 January 2010 to 31 December 2014. Setting: The study was conducted at Odi District Hospital, located in Mabopane, a township in Gauteng province, 45 km north of Tshwane, South Africa (SA). Methods: This was a cross-sectional study. Results: We analysed 263 completed patient records. The incidence rate was 22 per 1000 live births. The mean age was 28.9 years (SD ± 6.09), 57% were within the age group of 25–34 years, 90.9% were single and 85.2% were unemployed. Abdominal pain was the most common presenting complaint (81.1%). Ninety-nine (37.8%) were in a state of haemorrhagic shock. Possible risk factors were not documented in the patient files for 95%. A third (34.2%) were operated on within 4 hours of consultation. Early management was associated with poor record-keeping ( p = 0.02). There was a delay in confirming the diagnosis in 48.7%. It was associated with gestational age ( p = 0.0017), previous abdominal surgery ( p = 0.0026), normal haemoglobin level at the time of consultation ( p = 0.0024), considerable haemoperitoneum at operation ( p < 0.00001) and per vaginal bleeding ( p = 0.003). Conclusion: The study highlighted the need to emphasise the importance of good record-keeping and documentation in patients, as well as the urgent need for ultrasound skills training among clinicians to implement the Essential Steps in Managing Obstetric Emergencies programme at this hospital to improve the management of EP and other obstetric emergencies.

Intimate partner violence is a common social problem which causes considerable relationship stress and results in significant morbidity and mortality of the victims. Botswana, like many other countries in sub-Saharan Africa, has tried to address the problem of intimate partner violence with legislations prescribing punitive measures for the perpetrators and protection for the victims. The effectiveness of these measures in reducing the prevalence of intimate partner violence is doubtful. This article is to motivate for an alternative primary preventive approach to the problem as a more pragmatic option.

Background The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS) tool at the Mahalapye District Hospital - Emergency Department (MDH-ED), a setting where the majority of the nurses were not formally trained on the use of the SATS. Methods This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage. Results From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green), 146 (46%) and 125 (40%), respectively, or in the urgent category (yellow), they assigned 140 (44%) and 111 (35%) cases, respectively. Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5), although the level of agreement was satisfactory. Conclusion Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6).

Background: Diabetes mellitus is a worldwide increasing health problem of which type 2 diabetes is the most prevalent. Previously considered as a problem of industrialised countries, diabetes is currently a huge concern in developing countries and the Democratic Republic of the Congo (DRC) is one of the sub-Saharan countries with a high prevalence rate of diabetes. Deficit of knowledge has already been shown to be one of the barriers preventing diabetic patients from controlling their disease.Objectives: This study aimed to assess the knowledge of type 2 diabetic patients seen at the Institut Médical Evangélique (IME) Kimpese Hospital diabetic clinic, DRC, and the factors associated with their knowledge.Methods: A cross-sectional study involving 184 respondents was conducted at the diabetic clinic of the IME Kimpese Hospital, DRC. We administered a pre-tested questionnaire. Out of a total of 10, scores of < 5, 5 to < 7, and ≥ 7 were classified as ‘poor knowledge’, ‘moderate knowledge’ and ‘good knowledge’, respectively, according to expert consensus. All statistical tests were performed using p < 0.05 as the level of statistical significance.Results: The mean age of respondents was 57.5 years (s.d. ± 1.4, ranging from 40 to 83 years), with 56% being male. The mean diabetes knowledge score was poor: 3.2 out of a total of 10 (s.d. ± 1.7), with the range between 0.2 and 7.7. The majority of respondents (72.3%) had poor general knowledge about diabetes mellitus. Respondents also scored poorly in areas of the causes (35.6%), risk factors (39.3%), clinical features (34.9%), complications (20.5%) and management (42.4%) of diabetes mellitus. Using the student t-test analysis, it was found that age (p = 0.001), gender (p = 0.002), educational level (p = 0.007) and duration of disease (p = 0.032) were significantly associated with poor knowledge of diabetes mellitus.Conclusions: Knowledge of diabetes mellitus among type 2 diabetic patients seen at our setting was poor. Areas of deficiency and factors associated with knowledge of diabetes were identified. Our findings suggest the need for a health education intervention programme for our diabetic patients.

No abstract available.

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.1 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.

Background: In 2011, South Africa established ward-based outreach teams (WBOTs) comprising Community Health Workers as part of strategies to strengthen primary healthcare. The new community health workers (CHWs) lacked experience of the programme. This study aimed at assessing perceptions of community health workers on their training, teamwork and practice.Methods: This was a cross-sectional study conducted among CHWs in the seven regions of Tshwane health district between October and November 2015. Data were collected from 431 CHWs in eight Community Health Centres and 11 clinics using a pre-tested, self-administered questionnaire. Outcome measures were CHWs’ perceptions on training, teamwork and practice regarding WBOT programme.Results: A total of 431 CHWs formed the study sample. Participants had a mean age of 36 years (SD ± 9.46). The majority (88.2%) were female. Some 77% had completed secondary school. Overall, most CHWs perceived their training (86.4%), teamwork(87.6%) and practices (67.7%) to be good (p = 0.001). The majority were able to provide efficient health care despite the challenges experienced, which were lack of equipment, walking long distances, and safety on the streets and in households with patients who had mental health problems among others. Fisher’s exact test showed a significant association between training and work challenges (p = 0.006).Conclusion: The study findings showed that most CHWs had good perceptions regarding their training, teamwork and practice. Several concerns raised by CHWs suggest the need for stakeholders to ensure availability of resources for optimal functioning of CHWs.

Background: The aim of this study is to determine the profile of abdominal computed tomography (CT) scan findings of patients diagnosed with pancreatic adenocarcinoma and other pancreatic neoplasm that simulates pancreatic adenocarcinoma, which constitute the majority of pancreatic neoplasm at Dr. George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa. Materials and Methods: A prospective study of abdominal CT scans of 67 patients, aged 12 years and older, with histologically confirmed pancreatic neoplasms, including their medical records and laboratory results, from November 1, 2013 to June 30, 2017, was conducted. CT scan images were acquired with 128 slices, Philips, and GE CT scanners. Statistical analysis was made using a Statistical Program for the Social Sciences software SPSS (version 22.0). Results: There were 36 females (53.7%) and 31 males (46.3%) in this series and four demised. The ages of the patients ranged from 12 to 90 years. The most common clinical presentation was obstructive jaundice (86.6%). The predominant histological diagnosis was adenocarcinoma (74.6%), followed by primary lymphoma of the pancreas (13.4%) and 65.7% of the pancreatic neoplasms were unresectable, while most of the other pancreatic neoplasms based on their CT scan findings masqueraded as pancreatic adenocarcinoma. Pancreatic adenocarcinoma demonstrated both typical and atypical CT scan findings. Conclusion: Accurate diagnosis and appropriate management of pancreatic neoplasms are important because of their high morbidity and mortality. The majority of the pancreatic neoplasms were unresectable at the time of their presentation. A multidisciplinary management team is recommended since pancreatic neoplasms still remain a serious clinical challenge.

In late 2011, I wrote an editorial for this journal on the United Nations conference on Climate Change (COP17), which took place in Durban, South Africa titled: COP17 - Durban: Is this the funeral party for the Kyoto Protocol? 1 There were arguments and counter arguments between developed and developing countries on how to deal with the problems of climate change. One of the most critical issues was an extension of the Kyoto protocol to cut down on greenhouse gas (GHG) emissions, which have been linked to the unpredictable climate changes in recent times. The Kyoto Protocol is the international agreement of the United Nations Framework Convention on Climate Change. The major feature of the Kyoto Protocol sets binding targets for 37 industrialized countries and the European community for reducing greenhouse gas emissions. This amounts to an average of five percent against the 1990 levels over the five-year period 2008-2012. 2 The major distinction between the Protocol and the Convention is that while the Convention encouraged industrialised countries to stabilize GHG emissions, the Protocol committed them to do so.

Background: Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa.Methods: We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant.Results: Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient’s family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013).Conclusion: Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient’s family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.

Introduction: Complications associated with Diabetes Mellitus are a burden to health services, especially in resource poor settings. These complications are associated with substandard care and poor adherence to treatment plans. The aim of the study was to assess the self-reported adherence to treatment amongst patients with type 2 diabetes in Matlala District Hospital, Limpopo Province. Methods: This cross-sectional study used convenience sampling with a standardised, validated questionnaire. Data were collected over 4 months, and Microsoft Excel was used for data capturing. Results: We found that 137 (70%) of the participants considered themselves adherent to their diabetes medication. Younger age (p = 0.028), current employment (p = 0.018) and keeping appointment were factors significantly associated with adherence. Reasons given for poor adherence were that the clinic did not have their pills (29%), they had forgotten to take their medication (16%) and gone travelling without taking enough pills (14%). Reasons given for poor adherences to a healthy lifestyle were being too old (29%), 22% had no specific reason, 13% struggled to motivate themselves and 10% simply forgot what to do. Sixty-eight percent of the adhered participants recommended the use of medication at meal times, 14% set a reminder, and 8% used the assistance of a treatment supporter. Conclusions and recommendations: The study revealed a higher than expected reported level of adherence to diabetes treatment. Further research is needed to assess whether self-reported adherence corresponds to the metabolic control of the patients and to improve services.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Approximately 80% of all cardiovascular-related deaths occur in low- to middleincome countries and at a younger age compared with high-income countries. The economic burden imposed by CVD on developing countries in terms of loss of productive years of life and amount of fiscal resources spent on secondary and tertiary care is considerably high.

In the past decades sub-Saharan Africa (SSA) has witnessed urbanisation at unparalleled rates of increase, together with changing lifestyles. The consequence of this epidemiological transition has been a dramatic increase in the incidence of noncommunicable diseases (NCDs), in particular cardiovascular disease (CVD). At the same time social disintegration and inequality, compounded by the dwindling economy in many countries in SSA, have seriously hindered a cohesive response to NCDs. Moreover, infections remain rife and many societies in SSA have to contend with the twin epidemics of both communicable diseases and NCDs.

South Africa is the epicentre of the human immunodeficiency virus (HIV) pandemic. 1 Based on a wide range of data, including household and antenatal studies, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that HIV prevalence was 17.8% among 15-49 year-olds at the end of 2009. Their high and low estimates were 17.2% and 18.3% respectively. According to their own total population estimation, this implies that at the end of 2009, around 5.6 million South Africans were living with HIV, including 300 000 children under 15 years old. 2 The national prevalence of HIV is around 11%. In 2008, an estimated 5.2 million people were living with HIV and acquired immune deficiency syndrome (AIDS) in South Africa, and it is believed that over 250 000 people died of AIDS. AIDS is a major factor in the overall rising number of deaths. Around 70 000 babies are born with HIV every year. 3 Statistics South Africa (SSA) reveals that the annual number of deaths rose by 93% between 1997-2006. Among those aged 25-49 years, the rise was 173% in the same nine-year period. The overall increase in the number of deaths, as reported by SSA, is attributed to population growth. However, as they point out, these figures do not clarify the disparity in the rise in deaths among people aged 25-49 years. 4 It is believed that AIDS-related deaths are underestimated because many doctors avoid mentioning the cause of death on the death certificates.

Background: Trauma-related consultations, admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital, Goma, Democratic Republic of Congo, and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital.Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital.Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim, and content analysis was used to identify themes from the interviews.Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients, accompanied by other symptoms such as insomnia, poor appetite and psychological symptoms. Most patients felt disabled, were abandoned by relatives or friends and experi...

Most adverse health effects of cigarette smoking are attributed to the products of combustion. Efforts to avoid the adverse health effects of cigarette smoking have led to the promotion of alternative products that are perceived to be less harmful. In this paper, we review the available literature for evidence of the effectiveness of the products commonly presented as alternatives to cigarette smoking, and discuss evidence-based information on whether they should be promoted as safe alternatives for long-term use or are effective as cessation aid. Water pipe smoking is becoming prevalent among young people and the electronic cigarette has been recently introduced as smoking alternative in smoke-free areas. Available limited data suggest that while smokers may perceive these alternatives as safer than cigarette smoking, they contain toxic substances and therefore are not harmless alternatives. Data on herbal products are not easily available and where they are, evidence shows that these products are also not effective alternatives. Smokeless tobacco products vary in composition and health effects worldwide. The available literature suggests that these products may be associated with adverse health outcomes and that they cannot be promoted as ‘safe’ alternative tobacco products. Nicotine replacement therapy (NRT) formulations, such as chewing gums and skin patches, have been well studied and evidence suggests that all forms are effective smoking cessation aids, either used alone and in combination with other NRT or cessation medication and behavioural therapy. Primary care physicians should therefore only offer NRT to smokers who are willing to quit in combination with behavioural therapy or other cessation medications approved by the South African Medicines Control Council.

Background: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. The aim of the study was to conduct an audit of the anaesthetic preoperative evaluation of general surgery patients at Dr George Mukhari Hospital (DGMH), Garankuwa. Method: This was a retrospective study, using a sample of 88 files of general surgery patients who underwent elective surgery during 2008 at DGMH. The proportion of complete information recorded on the PEF used at DGMH was compared with a modified standardised PEF that uses the Global Quality Index (GQI). Result: Seventy-five of the 88 files (85%) that were retrieved contained the PEF. The modified GQI scores for the sample of 75 patients ranged between 33.3-100%. The mean modified GQI score was 72.2 ±13.9%. The median was 73.3%, while the lower quartile was 60%, and the upper quartile, 80%. The GQI scores were low for the following criteria: preoperative diagnostic procedure (46.7%), medications prescribed by surgeons (46.7%), and preoperative fasting status (32%); and very low in terms of recording patients’ weight (34.7%) and the history of allergies (34.7%) reported during the preoperative assessment. The PEF was completed in full in line with the modified GQI score in only in 1.3% of the files. Conclusion: The overall quality of the preoperative evaluation was relatively incomplete with regard to a number of the modified GQI score criteria, suggesting the need for improvement in the completion of preoperative assessment of patients by anaesthetists at the hospital.Keywords: anaesthesia, audit, records, medico-legal, preoperative evaluation

Background: Doctors are exposed to various stress factors in their personal and family lives, as well as in the workplace. Stress inherent to the responsibilities and challenges of the medical field may become a health hazard and threaten the well-being of the medical practitioner. Methods: The aim of this study was to investigate the personality traits and coping resources that contribute to the wellbeing of medical practitioners. A cross-sectional study of 44 out of 45 (98% response rate) family medicine vocational trainees at the Medical University of Southern Africa (now known as the University of Limpopo) was conducted. A biographic questionnaire was utilised to obtain specific information regarding the participants. The principal researcher used the Coping Resources Inventory (CRI) questionnaire to assess coping resources, and the 16PF personality analysis (16PF) to establish a personality profile of the participants. Results: The majority of participants (81.8%) indicated that they mainly experienced work-related stress. Thirty-two participants (72.72%) self-medicated. Fourteen participants (31.81%) claimed to experience burn-out and twenty (45.45%) reported fatigue. In terms of their coping resources, 24 male participants (54.54%) did not cope socially (p ≤ 0.008) and eight (18.18%) also did not cope physically (p ≤ 0.024). Conclusions: The medical practitioners had a universal personality profile. They lacked insight regarding the symptoms they were experiencing that warranted management, e.g. depression and anxiety. The medical practitioners in this study did not utilise their social and physical coping resources optimally and reported poor help-seeking behaviour. Keywords: personality; coping resources; family medicine; stress; vocational trainees