The exceptional potential in extending primary care exposure for South African medical interns

No abstract available.

Using ChatGPT in family medicine and primary health care

No abstarct available.

Myriad untold stories unfolding daily: South Africa's pursuit of quality primary health care

No abstract available.

Umbilical vein catheterisation for the family physician working in primary health care

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population.

Brain drain in South Africa is affecting health care

No abstract available.

Guiding the emerging primary care researcher: A report of research capacity-building workshop

There is an escalating interest in research capacity building across the globe. Research is an integral part of the continuous improvement process, clinical decision making and health system strengthening and should be embedded into the health system. The South African Family Practice Journal editorial team held a workshop on 19 August 2022 at the 24th National Family Practitioners Congress in Cape Town, with the aim of supporting primary care clinicians in their development from early-career researchers to established clinician-scientists. Small group and plenary discussions yielded valuable insights into the lived experiences of early career researchers and highlighted critical action areas to build the landscape of clinician-led research in the South African context.Contribution: This article contributes to current literature by providing insight into the lived experiences of early-career researchers and explores opportunities for research capacity-building.

After action review of the COVID-19 pandemic response in North West province, South Africa

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act.

Objectives

This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022.

Method

The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination.

Results

The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours.

Conclusion

The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency.

Contribution

This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

Community health workers: essential in ensuring primary health care for equitable universal health coverage, but more knowledge and action is needed

Community health workers (CHWs) have helped improve access to quality primary health care (PHC). However, knowledge gaps exist in designing and implementing CHW-engaged models needed to ensure quality people-centered PHC. In this collection, we call for papers which bridge this knowledge gap, to build sustainable, resilient and equitable CHW programs.

Central venous pressure line insertion for the primary health care physician

Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.

Integration of traditional medicine into the mental healthcare system in Tshwane, South Africa

BACKGROUND

 Mental healthcare providers have a negative attitude towards the integration of traditional health medicine (THM) into the mental health system. The attitude is based on their lack of trust in traditional practices, which are not supported by substantial evidence-based medical research. The study was conducted to determine mental healthcare providers views on the integration of traditional health medicine into the mental healthcare system.

METHODS

 The study was conducted at a psychiatric hospital in the Tshwane district, Gauteng province, South Africa. A cross-sectional, descriptive research design was conducted on 85 respondents who consented to participate. Data were collected using a survey questionnaire from 23 psychiatrists and 62 psychiatric nurses. Data were analysed using descriptive statistics and presented in the form of graphs, frequencies and percentages.

RESULTS

 Mental healthcare providers displayed a negative attitude towards integrating THM in psychiatric hospitals. The results showed no significant difference between psychiatrists and psychiatric nurses in their preference for modern mental healthcare practices (p = 0.25).

CONCLUSION

 There is still doubt among the mental healthcare providers on whether to support integration of the THM into mental health system or not. The doubt is based on the two-health system isolated from each other especially in South Africa.Contribution: This study contributed by showing the need and importance of understanding a patients' cultural background, which supports the integration of a traditional health system into the mental healthcare system, which in turn will lead to the appropriate management of mental illnesses.

Level of patient safety culture among public healthcare professionals in Pretoria

BACKGROUND

 Patient safety culture (PSC) norms set within an organisation prevent harm during medical care. This study assessed the level of PSC among public healthcare professionals (HCPs) in Pretoria, South Africa.

METHODS

 A multi-centre cross-sectional study conducted in three hospitals and 25 clinics in regions 1 and 2 of Pretoria, using a self-administered questionnaire adapted from the Hospital Survey on Patient Safety Culture. Using the Raosoft online sample size formula, from 1238 public HCPs identified, the sample size was calculated at 294; this expanded to 319 as a result of respondents' willingness to participate in the study.

RESULTS

 Of the 319 respondents with a mean age of 39.9 years, the minimum and maximum ages were 22 and 66 years, respectively. The age group of 30-39 years had the highest participation rate (17.6%). Most respondents (41.1%) came from the Odi district hospital and there were more women (78.1%) and nurses (49.2%). Positive attitudes were found for all PSC components, with staff education and training scoring highest (98.7%). Patient safety culture received a satisfactory rating from HCPs from the targeted facilities.

CONCLUSION

 This study showed that public HCPs in Pretoria's regions 1 and 2 have a good PSC, particularly among nurses, professionals with more experience, and at primary care level.Contribution: To maintain or increase awareness of this concept among HCPs, the study advocates a PSC programme as well as ongoing education that can be supported by district and facility managers.

Gender-based violence – An increasing epidemic in South Africa

No abstract available.

Intraosseous line insertion for the primary health care physician

Early rapid access to the vascular system is essential in emergencies and is lifesaving. In this article, we will provide information on the common sites used, the equipment that is required, the indications and contraindications for intraosseous line insertion, how to correctly and safely do the procedure, medication that can be administered, post insertion line management and possible complications. This is a lifesaving procedure and primary healthcare physicians should acquire this skill.

The role of family medicine and primary health care and its impact on the climate crisis

No abstract available.

Awareness of health risks associated with smokeless tobacco use among users in Pretoria

BACKGROUND

Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa.

METHODS

This was a cross-sectional design, using a piloted, structured and self-administered questionnaire.

RESULTS

Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30-39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%).

CONCLUSION

This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem.

Failed tracheal intubation in primary health care

Tracheal intubation in primary health care is a necessary skill and usually one that is necessary for appropriate emergency management of unstable patients. Primary care practitioners may not have an anaesthetist or critical care doctor available to help them in these emergencies and must manage these patients themselves. Often tracheal intubation may fail because of multiple possible factors and a different course of action may be needed to minimise the potential for harm to the patient. The primary care professional or family physician will have to manage this failed intubation. Primary health care facilities providing obstetric services must have guidelines and appropriate equipment for management of airway problems. This article will explore reasons for the failure of tracheal intubation and how this can be managed.

Knowledge of final year undergraduate nursing students about HIV and AIDS in Eswatini

Background

Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are overwhelming health issues globally. They have caused many devastating and draining health issues, which have escalated a critical need for a well-trained and sustainable healthcare workforce in order to meet the needs of people living with HIV and AIDS (PLWHA). Health science students are the future healthcare providers who will implement proper preventive measures, as well as health educational and promotional sessions to promote information and knowledge among the public regarding HIV and AIDS in Eswatini.

Methods

A quantitative cross-sectional study was conducted on 140 final-year undergraduate nursing students in three nursing universities in Eswatini. A questionnaire adapted from Othman and Ali in Malaysia with closed-ended questions was modified and used to collect data. The questionnaire consisted of questions on the virus structure, transmission, prevention and management of HIV and AIDS. Statistical Package for the Social Sciences (SPSS) version 20 was utilised to analyse the data.

Results

The level of knowledge about HIV and AIDS was high, as evidenced by a mean score and standard deviation of (91.02 ± 5.00). However, there were low scores on questions related to the transmission of the disease.

Conclusion

Across all three universities in Eswatini, there were good nursing education programmes on HIV and AIDS, evidenced by the high knowledge level about HIV and AIDS. However, there are still some knowledge gaps on HIV and AIDS transmission and management that need to be attended to.

Contribution

This study contributed by providing knowledge of undergraduate nursing students’ HIV and AIDS training and management of PLWHA.

Social media and health – Is it all good, bad or just ugly?

No abstract available.

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

Background

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01 January 2020 to 30 June 2020.

Methods

A cross-sectional study using a piloted and researcher assistant-administered questionnaire.

Results

Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30–39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12–23 months. From participants’ responses, it seems that Etonogestrel implants may be offered from as early as 15–20 years of age.

Conclusion

Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.

Palpitations: Evaluation and management by primary care practitioners

Palpitations are a common, non-specific presenting complaint in primary healthcare and emergency departments. Palpitations are mostly a symptom of benign underlying disease but a sign of life-threatening conditions. Importantly, palpitations are a symptom and not a diagnosis, and cardiac causes are the most concerning aetiology. Clinicians should seek to identify the underlying cause. History and physical examination are important in the assessment of patients with palpitations, and the use of a 12-lead electrographic (ECG) monitor on presentation is the gold standard of diagnosis. If the aetiology cannot be determined, an ambulatory Holter 24–48-h monitor can be used. Treatment and follow-up of patients presenting with palpitations as the main complaint will depend on the aetiology and investigation findings. Patients with palpitations accompanied by dizziness, excessive fatigue, or chest pains should receive adequate acute care aiming to stabilise their condition before referring to a higher level of care.

Recent advances in positron emission particle tracking: a comparative review

Positron emission particle tracking (PEPT) is a technique which allows the high-resolution, three-dimensional imaging of particulate and multiphase systems, including systems which are large, dense, and/or optically opaque, and thus difficult to study using other methodologies. In this work, we bring together researchers from the world's foremost PEPT facilities not only to give a balanced and detailed overview and review of the technique but, for the first time, provide a rigorous, direct, quantitative assessment of the relative strengths and weaknesses of all contemporary PEPT methodologies. We provide detailed explanations of the methodologies explored, including also interactive code examples allowing the reader to actively explore, edit and apply the algorithms discussed. The suite of benchmarking tests performed and described within the document is made available in an open-source repository for future researchers.

Malnutrition in children under the age of 5 years in a primary health care setting

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

COVID-19 - Inequities, the third wave and vaccination

No abstract available.

A Primary Care Approach to Abdominal Pain in Adults

Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague symptomatology and difficult correlation to specific organ pathology obscures clinical findings leading to incorrect diagnoses. Although most presentations of abdominal pain are benign, a significant number of patients have life-threatening conditions that require a meticulous approach to management in order to prevent morbidity and mortality. The skill in assessing patients presenting with abdominal pain is fundamental for all primary care doctors. This review will discuss an approach to the assessment and diagnosis of abdominal pain in the primary care setting.

Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo

BACKGROUND

Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC.

METHODS

This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value < 0.05 was considered statistically significant.

RESULTS

Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient's questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p< 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 (p< 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC.

CONCLUSION

For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients' education on IC should be displayed in waiting areas at all medical centres.

The experiences of home-based care workers when rendering services in the communities in Northern Tshwane and Madibeng districts

Background

Despite the provision of the policy for Ward-based Primary Healthcare Outreach Teams, which requires home-based care workers to be supported by different categories of health professionals, home-based care workers continue to experience challenges during service provision in the communities. Home-based care workers form an integral part of the Ward-based Primary Healthcare Outreach Teams that form part of the streams of primary healthcare re-engineering. The aim of the study was to explore and describe the experiences of home-based care workers (HBCWs) when rendering services in the communities of Northern Tshwane district in Gauteng province and Madibeng district in the North West province.

Methods

The study design was qualitative, exploratory and descriptive. Purposive sampling was used from the population of HBCWs in Gauteng and North West. Focus group interviews were conducted. Tesch’s data analysis method was used. Themes and subthemes were identified by the researcher and co-coder, and these were summarised into subjects that were interrelated.

Results

Diverse experiences of participants emerged. These experiences included lack of human and material resources, poor funding, lack of knowledge, lack of support and respect and the need for psychological support.

Conclusion

There is a need for a collaborative approach amongst the National Department of Health, non-governmental organisations (NGOs) and HBCWs in patient care. Policies and support structures should be strengthened or reformed to promote comprehensive and integrated care to sustain HBCWs.

The determinants of contraception use amongst female patients attending Odi District Hospital, Gauteng province, South Africa

BACKGROUND

Empowering women to have a full control over the size of their family is not only an issue of human rights but also a sustainable development goal.1 This study sought to determine the factors influencing the use of contraception amongst female patients aged 18-49 years attending Odi District Hospital, Tshwane district.

METHODS

A cross-sectional survey was carried out from September 2018 to February 2019 at Odi District Hospital. A representative sample size of 400 female patients was recruited by systematic random sampling. Logistic regression model was used to determine the most influential predictors.

RESULTS

The mean age in the studied population was 30.65 (±7.57) years. Contraceptive prevalence was estimated to be 55.3%. Dual protection (condom) was used as additional method by up to 72.3% of respondents. Injectables remained the most used contraceptive method, while more permanent methods, such as Bilateral Tubal Ligation (BTL), were less utilised. The source of family planning information, past exposure to contraceptive methods and woman's number of living children (parity) determined the use of contraception amongst Odi district females.

CONCLUSION

This study revealed a discrepancy within the maternal health delivery system regarding the supply and demand chain prompting the need for more insights. The results suggest evidence-based reengineering programme that incorporates contraceptive uptake determinants into the maternal health delivery system.

The attitude and perceptions of doctors at Letaba Hospital towards family medicine: A qualitative study

Background

It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors’ misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions.

Methods

A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty.

Results

The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary health- care and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors’ level of surgical ability. Based on individual interviews, 11 themes were extracted and a ‘wheel’ model was created, depicting the core values of the FM discipline.

Conclusion

The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills.

An overview of the viral haemorrhagic fevers for the primary care doctor

The viral haemorrhagic fevers are infectious diseases that often cause life-threatening illnesses. These diseases are common in the tropical areas of the world, and travel history to an endemic area together with recognising signs and symptoms is essential to aid diagnosis. Treatment is often supportive, and infection control measures need to be instituted early at the point of entry. In this article, we will provide an approach to a patient with viral haemorrhagic fevers in a primary healthcare setting.

Novel coronavirus pandemic: A clinical overview

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent public health crisis threatening the current world health establishment. The SARS-Co-2 was first identified in Wuhan, Hubei Province, China, in December 2019. There have been about 6.5 million reported cases of coronavirus disease 2019 (COVID-19) and about 350 000 reported deaths throughout the world within the last 6 months from the onset of the epidemic. The virus is primarily transmitted by inhalation or contact with infected droplets. The COVID-19 patient usually presents with fever, cough, sore throat and breathlessness. Currently, available data indicate that the majority of people with the disease have mild symptoms, while about 20% present with moderate-to-severe disease. About 5% of these may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction. To date, there is no recommended medical treatment, and supportive measures are a crucial part of management. The case fatality rate of SARS-CoV-2 is lower than that of its two coronavirus predecessors, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The full impact of this new pandemic on health, social and economic well-being of humankind is yet to be ascertained.

Challenges facing professional nurses implementing the Integrated Management of Childhood Illness programme in rural primary health care clinics, Limpopo Province, South Africa

BACKGROUND

Under-five mortality and morbidity could be reduced through increased implementation of the Integrated Management of Childhood Illness (IMCI) strategy. The aim of the study was to determine challenges facing IMCI-trained professional nurses on implementing this strategy when managing children less than 5 years of age.

METHODS

A quantitative descriptive survey method was used. The target populations were IMCI-trained professional nurses with the sample of 208 respondents. Data were collected through self-report questionnaires and analysed using statistical analysis system software.

RESULTS

The implementation of the IMCI strategy by IMCI-trained professional nurses in Vhembe primary health care (PHC) clinics continues to face challenges, making it difficult for professional nurses to follow guidelines. These challenges range from staff barriers, management barriers, poor management process and poor infrastructure. All these challenges lead to poor-quality under-five patient care.

CONCLUSION

Regardless of the IMCI strategy being implemented since its inception in 1999, the under-five mortality remains not reduced. This is related to the identified challenges facing the IMCI-trained professional nurses implementing the strategy.

Reasons women terminate their pregnancies legally and their contraceptive practices at Soshanguve 3 Community Health Centre, Tshwane district, South Africa

Background: Various reasons have been cited in studies conducted in South Africa on why women legally terminate their pregnancies. We sought to determine the reasons for women to terminate their pregnancies legally and their contraceptive practices. This study was conducted at Soshanguve 3 Community Health Centre (CHC), located in a semi-rural zone in the north-west of Pretoria, Gauteng province of South Africa.Method: A cross-sectional study design was adopted in this study.Results: Of the 250 respondents, high participation (23.2%) was noted amongst women aged 18–20 years. Eighty-three (33.2%) respondents did not have children, 108 (43.2%) had completed their secondary school education and 226 (90.4%) were Christian. Of the participants, 80% were single and 62.8% were unemployed. About 85.6% (214) of respondents had not had a previous abortion. A total of 24% of respondents requested abortion because they wanted to focus on their education, while 23.1% were not ready to be parents and 21.7% experienced financial difficulties. With regard to practice, all respondents had already used contraception and the most used contraceptive was the male condom (43.5%), followed by an injectable contraceptive (7.1%).Conclusion: While academic reasons, not being ready to be a parent and financial difficulties were named as the main reasons for terminating a pregnancy legally, the selected pregnant women at Soshanguve 3 CHC demonstrated an unsatisfactory practice of contraceptive measures.

A primary care approach to the management of Arthritis

Arthritis is a common condition seen frequently by family practitioners, and there are many types of arthritis. Management of arthritis depends largely on the specific type of arthritis that the patient suffers from. In this article, we will provide the primary care doctor with practical information for managing arthritis, focussing on the management of osteoarthritis and rheumatoid arthritis.

Health care is all about relationships

No abstract available.

A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa

Introduction: Caesarean section (CS) is a common obstetric procedure that prevents neonatal and maternal death when performed correctly if indicated; however, CS can give rise to complications that lead to maternal and perinatal morbidity and mortality. Rates of CS are increasing worldwide, although the World Health Organization (WHO) has indicated an ideal rate of 5–15%. South African CS rates are higher than the ideal.Methods: Maternity records of 2015 were reviewed at Odi District Hospital (ODH) to assess whether ODH complies with the ideal CS rate. In this study, extracted data include date and time of CS, maternal age, parity, gestational age, total number of previous CSs, elective or emergency, indications, anaesthesia used and registration of the surgeon.Results: There were 3 336 deliveries and 1 064 CSs (32%). The majority of women were aged from 19 to 34 years (59%), 72.8% were multiparous and 54% between 37–39 weeks’ gestation. The most common (40.1%) overall and emergency indication was foetal distress. Most CSs were emergencies (61.70%). Most elective CSs were because of a previous CS and spinal anaesthesia was used in 91.73%. Medical officers performed most of the CSs (79.0%) during working hours. The CS rate of 32% was significantly higher than the ideal 5–15% and higher than in other sub-Saharan countries with similar maternal characteristics. Indications for emergency and elective CSs were similar to previous research.Conclusion: The Caesarean section rate at ODH is higher than the recommended rate. Potential CSs therefore need to be evaluated more intensely to assess the true need for surgical intervention.

An overview of Pneumocystis jirovecii pneumonia for the African generalist practitioner

Introduction

Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in humans, which is more common among immunocompromised patients. Classically patients present with fever, non-productive cough, and dyspnoea. In the HIV-infected individuals the symptoms may be subtle at first, but gradually progress over several weeks. In the HIV-uninfected patient, however, the duration of symptoms is shorter and more severe, mainly due to the increased inflammatory response of the HIV-uninfected patient.

Methods

This article focuses on the diagnostic methods and then the management and prophylaxis principles of PCP by reviewing the best current practices and guidelines in Africa.

Conclusion

This overview is presented by clinicians who have experience with PCP and is directed mainly at first-line healthcare providers.

Stress and coping mechanisms of officers of the South African Police Service based in Tzaneen, Limpopo province, South Africa

Background

In this study, stress is conceptualised as a psychological syndrome in response to stressors. Stress and inappropriate coping mechanisms constitute a serious problem in police profession. Organisational causes of stress, such as lack of support from management, are additional stressors. The ability to cope with this stress is influenced by marital status, gender, rank, age and years of service. In managing stress, police officers may use adaptive or maladaptive coping mechanisms.

Aim

To investigate stress and the coping mechanisms used by police officers.

Setting

The study was set in Tzaneen, Limpopo province, South Africa.

Methods

This cross-sectional study used a self-administered questionnaire based on the Police Stress Inventory (PSI) and Coping Orientation to Problems Experienced (COPE) tools.

Results

Of the 104 participants, female police officers had significantly higher stress intensity scores, while constables and captains had statistically significant lower stress scores. The highest ranked stressors were killing someone in the line of duty, a fellow officer killed in the line of duty, and knowledge of and experiencing the death of a fellow officer in the line of duty. The five most frequently occurring stressors were organisational in nature. Respondents were more likely to use coping strategies that were problem-focused.

Conclusion

Organisational stressors were common, suggesting that the South African Police Services (SAPS) management should provide interventions that reduce the effects of work-related stressors. The majority of respondents used problem-focused coping strategies, indicating that most handle stressors in a positive manner.

Management of the patient with chronic obstructive airway disease (COPD) in a primary health care context

This paper describes the incidence of chronic obstructive airway disease (COPD), the risk factors, staging, investigations and management of COPD. The differential diagnosis for COPD is also presented as COPD can be confused with other clinical conditions. This paper is presented in practical terms for the clinician working in a primary health care context.

Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level.

Optimising the learning environment for undergraduate students in the Department of Family Medicine at Sefako Makgatho Health Sciences University

Background: An important determinant of a medical student’s behaviour and performance is the department’s teaching and learning environment. Evaluation of such an environment can explore methods to improve educational curricula and optimise the academic learning environment.Aim: The aim is to evaluate the educational environment of undergraduate students in the Department of Family Medicine as perceived by students.Setting: This descriptive quantitative study was conducted with one group of final-year students (n = 41) enrolled in 2018, with a response rate of 93% (n = 39). Students were in different training sites at SMU.Methods: Data were collected using the Dundee Ready Educational Environmental Measure (DREEM) questionnaire. Total and mean scores for all questions were calculated.Results: The learning environment was given a mean score of 142/200 by the students. Individual subscales show that ‘academic self-perception’ was rated the highest (25/32), while ‘social self-perception’ had the lowest score (13/24). Positive perception aspects of the academic climate included: student competence and confidence; student participation in class; constructive criticism provided; empathy in medical profession; and friendships created. Areas for improvement included: provision of good support systems for students; social life improvement; course coordinators being less authoritarian and more approachable; student-centred curriculum with less emphasis on factual learning and factual recall.Conclusion: Students’ perceptions of their learning environment were more positive than negative. The areas of improvement will be used to draw lessons to optimise the curriculum and learning environment, improve administrative processes and develop student support mechanisms in order to improve students’ academic experience.