Masters Degrees (Family Medicine)

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Stress, depression and suicidal ideation amongst family members caring for a patient with brain injury.
(2021) Walker, Janet.; Schlebush, Lourens.; Gaede, Bernard Martin.
Background This study investigated the relationship between stress, depression, ill health and suicidal ideation in family members caring for a patient with acquired brain injury. The sample consisted of 80 family caregivers who are members of Headway Gauteng (the brain injury association) located in Johannesburg and Soweto, South Africa. Most were primary caregivers (72.5%) with secondary caregivers making up a smaller percentage (27.5%), their role being to assist and support the primary caregiver. Method and materials The study involved a mixed methodology that incorporated a cross-sectional descriptive and phenomenological approach. This included self-report procedures (structured questionnaires and interviews), post-interview content analyses and three individually administered standardized measures (The Stress Symptom Checklist, The Beck Depression Inventory and Beck’s Hopelessness Scale). Scores were non-normally distributed. Therefore, nonparametric statistical tests were used, including the Kruskal-Wallis, Mann Whitney and Chi-Square Tests with a significance level of p = 0.05. Results The results revealed significant levels of stress, depression, ill health and suicidal ideation in the research participants. Suicidal ideation increased with elevating stress levels and 62.5% (50) of the sample had received a medical and/or psychological diagnosis after they became a caregiver. Five themes were identified as causing the caregivers’ profound stress that highlighted a lack of caregiver support, preparation, referral and education regarding their relative’s acquired brain injury and the stress they experience due to caregiver burden. Most participants (78.7%) did not feel adequately prepared by healthcare professionals (during the acute and sub-acute hospital treatment) for the neuropsychological deficits caused by the acquired brain injury, resulting in reduced coping and family conflict once the patient started receiving home-based care. Predominantly the family caregivers identified the patients’ neuropsychological deficits, such as affect, cognitive ability, behaviour, personality, executive function, and social factors as causing them profound stress. Conclusions This study underscored a significant prevalence of depression, ill health and stress-related suicidal ideation in family members caring for patients with acquired brain injury. Early identification of these problems and referral for appropriate treatment are recommended, along with the need to alert professional healthcare workers to the value of psychological screening for elevated stress and poor coping in family caregivers. Additionally, a collaborative effort between medical and psychological healthcare practitioners is recommended.
Stavudine induced lactic acidosis, risk factors and predictive laboratory markers : a nested case-control study in South Africa.
(2012) Luke, Christopher Alan.; Moosa, Mahomed Yunus Suleman.
Introduction The incidence of antiretroviral therapy induced lactic acidosis and its associated mortality may be reduced by appropriate dosing, risk stratification and early detection. This study describes the epidemiology, risk factors and predictive laboratory markers for lactic acidosis in subjects commenced on stavudine containing antiretroviral therapy between 2004 and 2007 at a hospital in KwaZulu- Natal. Persons with body weight above 60kg received 40mg twice daily and those below 30mg. Methods A nested case-control study design was used. Risk factor analysis was adjusted for the established risk factors of weight and gender. Results Lactic acidosis occurred in 79 (17 per 1000 person years) of 1 762 persons. Significant baseline risk factors were female gender (Adjusted Odds Ratio (AOR) =5.4) and increased body weight (AOR, compared to persons <60 kg, was 6.6 for persons 60 to 69 kg, 6.9 for persons 71 to 80 kg, and 95.7 for persons >80 kg). Predictors six months into therapy were an alanine transaminase >50 IU /L (AOR=11.1) and triglyceride between 1-1.5 mmol/l (AOR=11.2 compared to persons with triglyceride <0.5 mmol/l). No associations were found with regard to age, CD4 counts, viral loads or creatinine and albumin levels. Conclusion Obese females are at greatest risk for lactic acidosis with exponential increased in risk at weights above 80kg. The 30mg dose may be preferable, given that a sharp increase in risk occurred at 60kg, and that that the 30mg dose has been shown to have adequate virologic suppression. Additional risk factors for LA include an increase in alanine transaminase and triglyceride at 6 months of treatment.
An audit of the standard of care received by HIV positive patients on ART at a community health centre in KZN.
(2013) Inderjeeth, Nishana.; Naidoo, Kogieleum.
Introduction: South Africa has the highest number of HIV infected individuals in the world.2 The South African government has established National treatment guidelines for HIV positive patients to help ensure quality of care. The success of these guidelines depends on the commitment and level of adherence to them by hospitals and clinics. Aim: A descriptive study evaluating the standard of care received by HIV positive patients was undertaken at a community health centre in KwaDabeka, a semi-urban town in Kwa-Zulu Natal. This was benchmarked against the National ART Guidelines for 2010, which was the national policy at the time this study was undertaken. The objectives were to identify any deficiencies in the care of patients with HIV/AIDS, and to suggest possible solutions as well as to identify a demographic profile of the patients accessing care. Methods: The researcher selected three hundred and sixty patient files using a random process and then analyzed them. This sample size was calculated using a confidence interval of 95% of a total number of six thousand patients. Adult patients using ART for the period of 01 January 2011 until 31 December 2011 were only included. Pregnant patients and children were excluded from the study .The variables analyzed were generated using the pre-initiation, initiation and monitoring recommendations of the National ART Guidelines of 2010. A data sheet was drawn-up consisting of the various variables. This was analyzed using SPSS version 21. Simple descriptive statistics, univariate analysis, and frequency distribution tables were used to analyze the data. Tables, pie charts, and graphs have been used to represent the analyzed data. Results: Females comprised 65% and the mean patient age was 39 years. While the overall patient management was in accordance to the guidelines, there were major areas of con- compliance. These included the more than 80% of patients who did not have: pap smears; nutritional assessments; follow-up Tuberculosis (TB) symptom reviews; and mental health evaluations. In addition, there was a significant delay from obtaining a CD4 count to initiation of therapy of two months or longer in more than 50% of patients. Furthermore, the clinic did not comply with fast –tracking 84.5% of patients who needed to be initiated within two weeks of obtaining a CD4 count. Adverse events due to antiretroviral therapy were reported in approximately 41% of the patients, however, 25% did not have their regimen changed despite having a serious adverse event documented. The incidence of concurrent infection with TB was 32%, however none of the remaining non-infected patients (68%), received Isoniazid prophylaxis. Recommendations: The management of KwaDabeka CHC have significant challenges to overcome in order to optimise their treatment of HIV positive patients. Possible solutions must include access to the National ART Guidelines for all relevant health-care workers, regular medical update programmes on the management of HIV positive patients, and improving resources and relevant procedural skills.
An analysis of the use of African traditional medicine by adult patients attending a primary health care clinic in Durban, KwaZulu-Natal.
(2013) Maphophe, T. S.; Naidoo, S. S.
Background: Current evidence indicates that more and more people worldwide are using complementary and alternate medicines. About 80% of people in Africa and Asia have been reported to be using traditional medicines in preference to allopathic medicines.1 Aim: The study intended to evaluate the prevalence and practice of using traditional medicines by a cohort of patients accessing a local state-clinic located in a semi-urban area in KwaZulu-Natal. Methodology: All patients attending the chosen local primary health care clinic in Durban South formed the sample population and a systematic random sampling method was used to determine the study sample. Data were analysed using Statistical Package for Social Sciences (SPSS) -version 19. Results: A total of 299 patients participated in the study. Of these, 224 were female, 73 male and 2 were unspecified. The majority of participants (n=109) were in the age group 20-29 years. The study found that 112(37%) of all participants admitted to the use of African traditional medicines and the majority of these (78%) used them because they expected their illnesses to improve. Conclusion: This study was conducted among Black African study subjects in a predominantly Black African suburb in South Africa; the study results may have been influenced by this bias. A larger study using a bigger and perhaps more diverse study population is recommended to validate the findings shown in the above pilot study.
A review of the management of patients with Type 2 diabetes at Leratong Hospital, 2010.
(2012) Owanga, Ukulu Grevisse.; Ross, Andrew John.
Introduction: The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) acknowledge in their guidelines that diabetic care is complex and requires that numerous issues, beyond glycaemic control, be addressed. To further ensure a high quality of care, it is necessary that healthcare workers constantly check whether the standard of care offered is effective, equitable, efficient and humane. Aim: The aim of the study was to review the clinical management of patients with type 2 diabetes at Leratong Hospital in relation to the SEMDSA guidelines for Diagnosis and Management of Type 2 Diabetes Mellitus for Primary Health Care – 2009. Methods: This was a observational descriptive study using data from the charts of 388 patients with type 2 diabetes who access care at Leratong Hospital. Results: The majority of participants were male. Their average age was 55.7 years (range: 33 to 83 years). The glycosylated haemoglobin was documented in 64.95% of patients, weight in 5.67%, blood pressure in 96.39%, lipid in 21.39%, serum creatinine in 90.46%, urine dipstick in 90.91%, patient education in 98.2%, eye examination in 51.8%, foot examination and micro albumin in less than 1%. Optimal control of glycosylated haemoglobin, systolic blood pressure, diastolic blood pressure, cholesterol and triglyceride was noted in 5.56%, 46.72%, 16.8%, 80.77% and 74.67% respectively. Thirty eight percent of patients were on two oral anti diabetic agents, the majority of patients (94.32%) were receiving an ACE inhibitor for blood pressure control, 34.02% were on statin therapy, and 92.01% were on aspirin. Less than 1% were on Clopidogrel and fibrate. Conclusion: overall the quality of management of patients with type 2 diabetes is poor and there is a need for improvement.
The profile of maternal deaths in a district hospital : a five-year review of maternal deaths at Northdale Hospital (2006-2010).
(2011) Makinga, Polycarpe N'djugumu.; Moodley, Jagidesa.; Titus, Mokete Joseph.
Background The estimated global number of maternal deaths has decreased from 536000 in 2005 to 358000 deaths in 2008. Sub Saharan Africa contributed with 57% of maternal deaths in 2008. Although there is a general decrease in maternal deaths, available data shows that most countries, including South Africa, will not meet their Millennium Development Goal 5 A target by 2015. The South African target is a maternal mortality ratio of 38 deaths per 100000. Based on various sources, South African maternal mortality ratio is on the increase. The United Nations interagency estimates placed South African maternal mortality ratio at 410 in 2008 from 260 in 1990. It is therefore necessary that health facilities, the government and the community at large make an effort to reduce avoidable maternal deaths. Aims The main aim of the study was to clinically and demographically profile maternal deaths at Northdale Hospital, assess the quality of care provided to maternal death patients and make recommendations to the hospital clinical management. Secondary objectives included the determination of the following: the prevalence of Human Immunodeficiency Virus infection among maternal deaths, and the commonest primary and final causes of deaths. Methods This cross-sectional survey retrospectively reviewed maternal deaths patients’ records at Northdale Hospital, a district hospital in South Africa. All 61 pregnancy-related deaths that were reported from January 2006 to December 2010 fulfilled the criteria of maternal deaths and were included in the study. Demographic and clinical characteristics of patients were extracted from patients’ charts using a structured pre-designed data sheet. Descriptive statistics were computed and analysed using IBM SPSS software. Medical records of all 61 deaths were assessed by three assessors who determined the causes of death and evaluated the quality of care received by each patient. Results A decrease in number of maternal deaths and maternal mortality ratio has been noticed during the study period. The average maternal mortality ratio for the study period was 204 per 100000 live births: ranging from 219 to 168. The majority of participants were of African origin aged between 20 to 34 years; with a mean age of 28 ± 6.4 years. Of the 61 maternal deaths reviewed, only 33 patients (54.1%) had attended antenatal clinic. Of these patients who had antenatal care, 57.6% booked at 20th week of gestation or earlier. The median number of antenatal visits was 4 visits. Of the 28 patients who died in the postpartum period, seven delivered at home and six had a caesarean section. Of those patients who had a caesarean section, three died within 24 hours, as a result of anaesthetic complications. Only 73.8% of all maternal deaths and 93.9% of those who attended antenatal care were tested for Human Immunodeficiency Virus. Of the 39 patients who tested positive for Human Immunodeficiency Virus infection, only 17 (43.6%) patients had their Cluster of Differentiation 4 cell count results; 10 patients were on antiretroviral triple therapy and four were on antiretroviral dual therapy. Half of the patients died within 41 hours of admission to the hospital. The five most common primary causes of maternal deaths at Northdale Hospital were non-pregnancy related sepsis (54.1%), miscarriage (14.8%), acute collapse (8.2%), pregnancy related sepsis (6.6%), and anaesthetic complications (4.9%). Antepartum haemorrhage, postpartum haemorrhage, pre-existing maternal conditions, hypertension, embolism and an unknown cause contributed 1.6% each. Almost half of maternal deaths were assessed as avoidable. Equally, almost half of maternal deaths received care that was assessed as substandard. Of these 30 patients who received substandard care, a different approach to the management would have made no difference for eight patients (13.1%) whose deaths were unavoidable anyway. A multidisciplinary approach to patients’ management, availability of blood/blood products and resuscitation medicines, and good communication with consultants at the regional hospital are some of the strengths on which Northdale Hospital should capitalise. Some of the problems that contributed to substandard care include: difficulties in referring patients to the regional hospital, inability of staff to manage emergencies correctly, inconsistent patients’ monitoring, and poor communication with the casualty department and the private sector. Conclusion The study has confirmed that the profile of maternal deaths at facility level may paint a totally different picture to what is found at the national level. While there is an increase at the national level, the number of maternal deaths and the maternal mortality ratio are on the decrease at Northdale Hospital, this decrease should be treated with caution as this may just be a yearly fluctuation. Non-pregnancy related sepsis remains the leading cause at both national and district hospital (Northdale Hospital) levels; the other four major causes of maternal deaths are somewhat different. The fact that almost half of the patients received substandard care and almost half of the deaths were assessed as avoidable is an issue of concern. The hospital should capitalise on its strength and build a basis for improvement in patient care. Recommendations The Primary Health Care coordinator should sensitise the community to improve their health seeking behaviour. The establishment of a mothers’ waiting lodge and acquisition of an ambulance dedicated to pregnant women and stationed at the hospital may reduce the number of home deliveries and delays in women at risk of complications accessing the health facility. The Prevention of Mother-to-Child Transmission programme should be strengthened and contraceptive use by all women but specifically by those tested positive for human immunodeficiency virus should be encouraged. Medical officers should be trained in the management of obstetrical emergencies (especially septic abortion) and resuscitation. Medical Interns should not be left unsupervised when attending to critically ill patients. Family physicians should actively assist the department of Obstetrics and Gynaecology in managing patients with medical conditions. Innovative ways should be found to improve the referral difficulties between Northdale and Grey’s Hospitals.
Tuberculosis in medical doctors in KwaZulu-Natal, South Africa : personal experiences and perceptions related to their diagnosis and treatment.
(2011) Naidoo, Ashantha.; Lalloo, Umesh Gangaram.
Title: Tuberculosis in medical doctors in KwaZulu-Natal (South Africa): Personal experiences and reflections related to their diagnosis and treatment. Background: The high tuberculosis (TB) incidence and prevalence fuelled by the concomitant HIV epidemic in South Africa has resulted in a high rate of tuberculosis infection in health care workers. This is the first study to investigate the experiences and reflections of doctors who were diagnosed with active TB during their employment in high TB burden hospitals in KwaZulu-Natal, South Africa. Methods: Consecutive medical doctors working in both the public and private sectors and who were treated for active tuberculosis between 2007 and 2010 were contacted to participate in the study. Each participant completed an informed consent and a validated anonymous self-administered questionnaire. The study received ethical approval from the University of KwaZulu-Natal. Results: Forty doctors participated in the study. The mean age of participants was 33.67±10.63 years. The majority were between 21 and 40 years of age (males (52.5%), and employed in the public sector (95%). Four (10%) had MDR-TB. A number of participants were referred for costly special investigations which are not considered to be part of first line care in South Africa. For example, 15 participants (37.5%) underwent chest CAT scans during the diagnostic period. Eight doctors reported complications following invasive procedures. Nineteen (47.5%) of the 33 participants (82.5%) who had experienced sideeffects related to anti-TB drugs had considered defaulting on their treatment because of the side-effects of these drugs. Many participants expressed concerns about the uncaring attitudes of senior medical colleagues and hospital management. The majority of participants had introspected on their illnesses and experiences and committed themselves to become more caring and empathic towards their patients in future. Conclusions: All health care workers and particularly nurses and medical doctors working in environments with a high burden of infectious diseases such as HIV and TB, are at increased risk to TB infection. They encounter various personal and professional problems following contraction of TB infection. These experiences had impacted in many ways on their professional lives, and some doctors have since left the medical profession because of these experiences. The risks associated with TB must be minimised. Much more therefore remains to be done in the public health care system if these trends are to be reversed; this includes health policy changes, health system changes and attitudes of medical colleagues towards medical doctors who become “victims of illnesses acquired in the course of duty”.
An exploration of anaemia in low birth weight infants exposed to perinatal zidovudine at the neonatal unit in King Edward VIII Hospital.
(2013) Hanley, Sherika.; Ross, Andrew John.; Adhikari, Miriam.
Large clinical trials beginning with the PACTG-076 trial and other trials across Europe and America have showed that perinatal exposure to Zidovudine (AZT) results in haematological side effects in the neonate, mainly anaemia, which are clinically insignificant and reversible. There is however limited data in sub-Saharan Africa on the impact of intrauterine exposure to AZT on neonates, particularly low birth weight neonates, at the height of the HIV/PMTCT era. The aim of the study was to evaluate the prevalence and clinical significance of anaemia among low birth weight neonates, in a diverse South African setting. This observational descriptive study looked at medical records of HIV-exposed, low-birth weight neonates (less than 2500g) admitted to the neonatal unit at King Edward VIII Hospital from May 2008 to February 2010, who have had intrauterine exposure to AZT. A total of 95 neonatal birth and medical records were analysed. The total prevalence of anaemia was 47%. The neonates were placed into categories according to gestational age. The prevalence of anaemia was 16.7% and the mean Hb was 17g/dL in the 26-28 week gestational age category, prevalence of anaemia was 37% and mean Hb was 16g/dL in the 29-31 week category, and the prevalence of anaemia was 54.8% with a mean of 17g/dL in the over 31 week gestational age category. The minimum haemoglobin was 11.0g/dL and maximum haemoglobin was 24g/dL. The mean haemoglobin in the neonates exposed to more than 28 days of Zidovudine was lower than the mean Hb in neonates exposed to less than 28 days in the 29-31week and over 31 week gestational age categories. The haematological side effects of anaemia in neonates resulting from AZT exposure inutero were found to be prevalent but of a mild and clinically insignificant nature in keeping with existing international and continental studies. The severity of anaemia in low birth weight/ pre-term neonates appears to be the same as in term neonates of normal birth weight depicted in these studies. The presence of neonatal anaemia at birth has been shown to be related to the duration of exposure to intrauterine AZT in one of the three age groups. There were no identified issues that would warrant amending current recommendations for the routine use of AZT for the prevention of mother-child HIV transmission however these findings require further research involving larger numbers and follow up of neonates in order to adequately analyse current PMTCT guidelines.
A study investigating the prevalence of erectile dysfunctional in a primary health care clinic in KwaZulu-Natal. Centre : Addington Hospital - Primary Health Care Clinic.
(2009) Lockhat, Yusuf Moosa.; Rangiah, S.
Introduction: Erectile dysfunction, the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual performance, is a common problem. Aim: To determine the prevalence of erectile dysfunction among men attending a primary health care clinic in Kwazulu-Natal and to determine the association between erectile dysfunction and age, smoking, economic status and co-morbid conditions. Method: An analytic, quantitative, cross-sectional study was conducted on a group of men attending the Primary Health Care clinic at Addington Hospital. The information was obtained using a structured questionnaire (IIEF15) which had already being validated. The questionnaire was self administered at the time of attending the clinic. Statistical analyses using Pearson Chi square, Mann Whitney and Kruskal-Wallis tests determined the statistical significance of the results. Results: A total of 1300 randomly selected men participated in the study of which 803 were eligible for analysis. The overall prevalence rate for erectile dysfunction was 64.9% (621) with 14.6% (117) having mild erectile dysfunction, 19.9% (160) moderate erectile dysfunction and 30.4% (244) severe erectile dysfunction. There was a strong association between erectile dysfunction and age, economic status and co-morbid conditions. (p<0.01) Discussion: The prevalence of erectile dysfunction in the urban primary health clinic was high. The results indicate that the condition is a common problem and that primary care physicians need to become aware of the condition. The awareness will result in improved assessment and offer of appropriate treatment that will only enhance the quality of life of patients. Furthermore, the strong association of erectile dysfunction with co-morbid conditions will serve as a predictor for undiagnosed medical conditions which would have otherwise not being detected. Conclusion: The prevalence of erectile dysfunction in a primary health centre was high and there is a statistically significant association with co-morbid conditions. Further epidemiological studies in the general population focussing on the incidence of erectile dysfunction are recommended.
Characteristics of women having first trimester termination of pregnancy in a district/regional hospital in KwaZulu-Natal.
(2011) Ngene, Nnabuike Chibuoke.; Ross, Andrew John.
Introduction: Despite the availability of contraceptives, some women still seek an induced abortion. If these women are known, they can be targeted for intensive contraceptive counseling. An accessible termination of pregnancy health facility can also be provided to those who still wish to have an abortion. Aim: To determine the characteristics of women having first trimester induced termination of pregnancy in Newcastle Provincial Hospital in Amajuba district. Methods: Quantitative retrospective chart review. Seven hundred and fifty eight women had an induced first trimester abortion between 1st January and 31st December 2008 at Newcastle Provincial Hospital. The medical records of 254 were systematically sampled and the data obtained from these medical records were analyzed descriptively. Results: Most women (75%) were aged between 20 and 34 years. The commonest age was 23 years while the mean age was 25.27 years. Two percent were less than 16 years of age. Ninety seven percent of the sample were of African race, 75.6% reported having at least one child alive, 93.3% were single, 70.1% of the women reside in Newcastle sub-district while 19.7% reside outside Amajuba district. Eighty nine percent of the women were not using any contraception before the pregnancy that was terminated. Four (1.6%) women had previously had a termination of pregnancy. Fifty eight percent of the women requested abortion between 9 and 12 weeks of gestation (commonest gestational age was 8 weeks). Seventy four percent of the women were self-referred. Ninety six percent of the women reported having an abortion because of socio-econornic reasons. Only 69.7% disclosed their intention to procure abortion to a second person. Every woman was counseled before her pregnancy was terminated. Conclusions: In our patient population, women who are more likely to have an induced first trimester abortion are: in their twenties; African; single; parous; sexually active and not using any contraceptive; residing in Newcastle sub-district and of poor socioeconomic status. These groups of women should be targeted for intensive contraceptive counseling. The proportion of women who are less than 16 years of age shows that statutory rape is still a challenge in South Africa and deserves more attention. Further study is needed to establish if the location of Newcastle Provincial Hospital is denying women living in other sub-districts in Amajuba (apart from Newcastle sub-district) the opportunity to procure an induced abortion. Such a study will thus guide the place where future termination of pregnancy services may be established in Amajuba.
Profile of the asthma clinic at Addington hospital, Durban.
(1996) Lubbinge, A. W.; Pillay, Basil Joseph.
A study was done about the Asthma Clinic at Addington Hospital to show the characteristics and demography of the patients attending the clinic during the study period of one year. Some of the aspects studied were: the onset and duration of asthma, concomitant allergies, smoking behaviour, evaluation of treatment, casualty attendance, hospital admissions and compliance in attending the clinic. Therapy of the patients was aimed at control of inflammation and brocho constriction. Preventative pumps were used in 96% of the patients. The aim was to make the patient symptom free, to live a normal life and to prevent short term and long term complications of asthma. A comparison was made between three different groups of patients. a) non-smokers, b) smokers and ex-smokers, c) non-compliance in attending the clinic. It was found that the non-smoking group showed clinical improvement in lung functions, although not statistically significant.
Profile and management of patients presenting with asthma in outpatients at a community hospital in Escourt.
(1997) Loot, S. M. H.; Pillay, Basil Joseph.
Much work has been done in urban areas to implement national guidelines in the treatment of asthma. There is however a dearth of studies done in rural and semi-rural areas. For this reason this study on the profile and management of patients presenting with asthma at a community hospital was undertaken in Estcourt. The study involved interviewing patients presenting with asthma at an outpatient clinic. The questionnaire and patient records were used. The questionnaire was designed by the author to detect precipitating factors leading to exacerbation of asthma and to assess whether national guidelines were been followed by doctors treating these patients. A hundred patients were interviewed. Eighty seven percent of these patients' treatments were not in keeping with national guidelines. In only 11 % of these patients had a doctor used a peak flow meter in the assessment of the patient. Three percent of patients had an understanding of their disease because of relatives who were medical workers. Patients complained that their illness was not explained to them and-they were not shown methods of coping with an acute attack. In many cases patients and health workers did not appreciate the seriousness of an attack. This is demonstrated by the study which showed seventy four percent of participants did not receive prophylactic treatment such as inhaled steroids or sodium chromoglycate although all were chronic sufferers of asthma. Of the thirty one patients admitted in 1997, twenty five had presented to outpatients in 1997 in the same month of their admission. This proves that the seriousness of their condition was not detected by the health workers attending to them. Recommendations are made in keeping with national guidelines to improve services in the Estcourt area in order to reduce morbidity and mortality in patients suffering from asthma and to increase patient satisfaction.
The impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs, and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal.
(2005) Shamagonam, James.; Jinabhai, Champaklal Chhaganlal.; Reddy, S. P.
Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice.
Profile of sexually transmitted diseases at Addington Hospital, Durban.
(1986) Govind, Uttam.
During the period January 1985 to December 1985, 537 consultations were undertaken at the Special Clinic at Addington Hospital, 483 of these were specifically for venereal disease. The male to female ratio was 2.2:1. The majority of the patients treated were Coloureds. Most of the patients were in the age group of 20-35 years. The majority of the patients were unemployed. Gonorrhoea was diagnosed in 25.13% of the patients, followed by latent syphilis 19.52%. Chancroid was the commonest cause of genital ulceration and was diagnosed in 10.4% of the study population. N. Gonorrhoea was isolated in 42 patients; 40.5% of the isolates were resistant to penicillin, 66.6% to cotrimaxozole and 30.9% to ampicillin. The organism was sensitive to chloromycetin, erythromycin and tetracycline in most cases. All the penicillin resistant strains were sensitive to spectinomycin.
A follow-up study of the respiratory health status of automotive spray painters exposed to paints containing isocyanates.
(1997) Randolph, Bernard Winston.; Lalloo, Umesh Gangaram.
In order to evaluate the respiratory health status of spray painters exposed to paints containing hexamethylene diisocyanates (HDI) and to obtain more insight into the relationship between occupational exposures to isocyanates and chronic obstructive airway diseases, a follow up study on 33 of an original cohort of 40 randomly selected workers was undertaken. The original investigation was conducted by the author in 1989. The subjects were studied using a standardised American Thoracic Society (ATS) approved respiratory health questionnaire, baseline pre and post shift spirometry and ambulatory peak flow monitoring. Bronchial hyperresponsiveness tests using histamine (PC20) were performed. Immunological tests including IgE, RAST (HDI), and house dust mite evaluations were also made. The subjects were stratified into exposed (n=20), partially exposed (n=5) and no longer exposed (n=7) groups. One subject was excluded from the group analysis because of his indeterminate isocyanate exposure. Warehouse assistants (n=30) in a non-exposed occupation were used as controls. The worker's compliance with safety regulations and the employers provision of safety requirements was assessed by means of a questionnaire. The environmental conditions in the workplace were measured by the evaluation of the isocyanate concentrations at the worker's breathing zone. Spray booth efficiency was measured using measurements of airflow velocities and airflow patterns within the booth. Longitudinal changes in respiratory health status was assessed by comparison with baseline data studied in 1989. The exposed group showed the largest mean cross-shift declines of 297 ml (± 83.8) in forced expiratory volume in one second (FEV1). The decline in the partially exposed group was 282 ml (± 102.7) and 54 ml (± 140) in the no longer exposed group. The results of the first study, when compared with the second study, showed a mean cross-shift decline in FEV1 of 130.5 ml. (± 203) (p=0.0002) and 297ml. (± 323) (p=0.0001) respectively. Furthermore, of the spray painters examined, 10 (25%) showed clinically significant cross-shift declines in FEV1 viz. decreases >250 ml in the first study (n=40) compared with 9 (45%) in the second study (n=33). In contrast to the HDI exposed spray painters, a closely matched control group (n=30) showed a mean cross-shift increase in FEV1 of 17.4 ml ( ± 63.04). Only 2 subjects had a diagnosis of asthma which was made in childhood and not related to occupation. The mean annual baseline decline in FEV1 was greatest in the exposed group 41.25 ml (25% showed a decline greater than >90 ml per annum). These values exceeded the predicted annual declines for both smokers and non smokers due to age. The decline in the no longer exposed group was 7.85 ml per annum. Immunological tests showed no correlation with declines in FEV1 . This study demonstrates the difficulties in correlating immunological status with clinical and lung function findings in workers exposed to HDI, as a means of predicting occupational asthma. Although measurements in cross-shift declines in FEV1 appear to be a suitable predictor of occupational asthma, in some cases it was found that the forced expiratory flow rate (FEF 25-75 %) was a more sensitive predictor of early changes in the small airways. The mean isocyanate concentration in the spray painter's breathing zone was 14.65 mg/m3 (±12.219), exceeding the current South African Occupational Exposure Limit - Control Limit (OEL-CL) of 0.07 mg/m3 for isocyanates. Fifty per cent of the subjects suffered from eye irritation and 40% had dermatitis of the hand. This was expected since none of the spray painters wore goggles or gloves. Whilst no subject had evidence of clinical asthma related to spray painting, a large proportion demonstrated significant cross- shift changes in lung function implying short- term adverse effects of exposure. In addition longitudinal declines in lung function which was worse in those who continued spray painting in the follow-up study, is of major concern. The lack of cases of clinical or occupational asthma may be due to the healthy worker effect. Recommendations include, routine spirometric lung function testing of all spray painters, the use of high volume-low pressure spray guns and the wearing of positive pressure airline masks complying with the South African Bureau of Standards (SABS) safety standard. In terms of current legislation it was further recommended that spray booths be regularly monitored, including the measurement of HDI concentrations, airflow velocities and airflow patterns within the booth and the implementation and enforcement of stricter control measures. Workers demonstrating excessive declines in both cross-shift and longitudinal spirometry, require special attention.
Cannabis use : social risk factors and knowledge of health risks in a sample of adolescents.
(1997) Van Niekerk, Antoinette Elisabeth.; Schlebusch, Lourens.
A study was conducted at a Durban high school which has a mixture of socioeconomic classes and races. All grade 10 pupils present on the day of the study were asked to complete a questionnaire under examination-like conditions. The aim was to determine the prevalence of dagga smoking as well as the pupils' knowledge of the effects and health risks of dagga smoking and the prevalence of associated features such as alcohol use, cigarette smoking and sexual activity. Dagga smoking was found to occur commonly (22.9%) and to be mainly a white male group activity. There was a strong association with cigarette smoking and alcohol abuse and a general lack of knowledge concerning the adverse health effects of dagga smoking. Peer pressure and relief of stress were cited as the commonest reasons for dagga smoking. More information and life skills training is required for this group of students as well as further research into substance abuse related topics in general.
Twenty four hour ambulatory blood pressure monitoring in general practice.
(1997) Rugnath, Thirjbahadur.; Vythilingum, S.
Objectives: To assess the role of ambulatory blood pressure monitoring in the diagnosis of hypertension in general practice. Background: Hypertension is usually diagnosed by casual office blood pressure readings. However, ambulatory blood pressure monitoring has shown that a significant proportion of patients diagnosed as hypertension in fact do not have hypertension. Method: Sixty four Indian patients diagnosed as having mild to moderate hypertension by casual measurements were subjected to a twenty four hour ambulatory blood pressure monitoring. A blood pressure load of >35% was classified as true hypertension and < 35% as white coat hypertension. White coat hypertensives were compared to the hypertensive group with respect to various demographic characteristics, and to correlate ambulatory blood pressure monitoring and casual blood pressure readings. Results: A prevalence of 23.44% white coat hypertension was found. In addition, the demographic profile of such patients show a preponderance of non-obese females (73.33%), the majority of whom are on concomitant medication (60%). A poor correlation was found between the casual office blood pressure readings and the twenty four hour ambulatory blood pressure readings in the white coat hypertensives as compared to the hypertensive group. Conclusion: White coat hypertension is common in patients diagnosed as having mild to moderate hypertension by casual blood pressure readings. There are no reliable clinical indicators to identify patients with white coat hypertension. Ambulatory blood pressure monitoring has been shown to be a useful method for differentiating white coat hypertensives from true hypertensives.
Isoenzyme polymorphism in entamoeba histolytica : an epidemiological survey in a rural South African population.
(1989) Gathiram, Vinodh.; Jackson, Terry F. H. G.; McLeod, I. N.
Isoenzyme characterisation of Entamoeba histolytica into pathogenic and non-pathogenic zymodemes substantiated previously held views that this parasite con5titutes two distinct strains or even sub-species that are morphologically identical but vary in their pathogenicity. A reappraisal of the epidemiology of amoebiasis and investigation of the patho-physiological relationships between these pathogenic and non-pathogenic zymodemes and their host was therefore indicated. Only pathogenic zymodemes were isolated from hospitalised patients with amoebic liver abscess (ALA) and amoebic dysentery (AD). In the amoebiasis endemic peri-urban population of Durban, I. histolytica occurred at an overall prevalence of 10%. Carriers of non-pathogenic zymodemes constituted 9% of the population. A key observation was that asymptomatic infections with pathogenic zymodemes occurred at a prevalence of 1%. Higher prevalence of E. histolytica occurred in association with poor sanitary conditions. Furthermore., both pathogenic and non-pathogenic zymodemes tended to cluster into family units suggesting person-to-person transmission of the parasite by the faecal-oral route. Although invasive amoebiasis occurs far more frequently in males than females (8:1) both pathogenic and non-pathogenic zymodemes are equally distributed in male and female E. histolytica cyst passers. Ninety percent of carriers of pathogenic zymodemes spontaneously cleared their infections and remained asymptomatic throughout the study period of 2 years while 10% developed AD which required treatment with metronidazole. No spontaneous changes in zymodemes from the non-pathogenicto the pathogenic type was observed in a longitudinal study. The serological response of asymptomatic carriers of pathogenic zymodemes (100% seropositive) was identical to that of patients with ALA or AD with a high proportion (94-100%) of them being strongly seropositive. The prevalence of seropositivity amongst subjects who were not infected by E. histolytica (13% seropositive) was not statistically different (p>0,5) from that of the random population of this endemic area (19% seropositive) and carriers of non-pathogenic zymodemes (21% positive); the prevalence of strongly seropositive reactions among this group was only between 2-4%. It is concluded that a positive serological response is directly due to past or present contact with pathogenic zymodemes. This is further substantiated by the observation that the proportion of seropositive subjects was found to increase dramatically in a population near Cape Town where an outbreak of invasive amoebiasis (ALA and AD) occurred indicating a high prevalence of pathogenic zymodemes in this community. Another community in northern Transvaal (Gazankulu) where ALA and AD does not occur was, as expected, uniformly seronegative. Axenic growth of pathogenic zymodemes was possible but could not be accomplished with the non-pathogenic zymodemes. Even though monaxenic growth together with Trypanosoma cruzi was possible with both strains, the pathogenic zymodemes tended to grow more prolificly. No zymodeme changes from non-pathogenic to pathogenic and vice versa were observed with such changes in culture conditions. Cyst production by the pathogenic zymodemes in vivo was confirmed experimentally, thereby demonstrating the ability of pathogenic E. histolytica to independently complete their life-cycle thus giving it the ability to propagate itself successfully as a species.
Health care of the geriatric Indian population of Port Shepstone.
(1986) Naidoo, D. M.
No abstract available.
Disability grant assessments at Nqutu, Kwazulu-Natal.
(1994) Mhlambi, Sibusiso D. L. A .
No abstract available.

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