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Rasella D, Macicame I, Naheed A, Naidoo M, Landin-Basterra E, Silva N, Moncayo AL, Trotta A, Souza LEPFD. The need for global social epidemiology in the polycrisis era. BMJ Glob Health 2024; 9:e015320. [PMID: 38642929 PMCID: PMC11033662 DOI: 10.1136/bmjgh-2024-015320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 04/22/2024] Open
Affiliation(s)
- Davide Rasella
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Megan Naidoo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- University of Cape Town, Rondebosch, South Africa
| | | | - Natanael Silva
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana L Moncayo
- Pontificia Universidad Catolica del Ecuador, Quito, Ecuador
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Naidoo M, Shephard W, Kambewe I, Mtshali N, Cope S, Rubio FA, Rasella D. Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review. BMC Med 2024; 22:125. [PMID: 38500147 PMCID: PMC10949739 DOI: 10.1186/s12916-024-03333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. METHODS The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. RESULTS Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). CONCLUSIONS Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.
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Affiliation(s)
- Megan Naidoo
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain.
| | - Whitney Shephard
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Innocensia Kambewe
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Nokuthula Mtshali
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Sky Cope
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Felipe Alves Rubio
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Davide Rasella
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
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Hirachund O, Pennefather C, Naidoo M. Mortality trends during the first three waves of the COVID-19 pandemic at an urban district hospital in South Africa: A retrospective comparative analysis. S Afr Med J 2024; 114:e1054. [PMID: 38525584 DOI: 10.7196/samj.2024.v114i2.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the virus responsible for the COVID-19 (C19) pandemic. South Africa (SA) experienced multiple periods of increased transmission. Tertiary, regional and central hospitals were overwhelmed, resulting in low acceptance rates. OBJECTIVES To compare mortality trends of patients who died in hospital from SARS-CoV-2 infection during the first three waves of infection as defined by the National Institute of Communicable Diseases of South Africa. METHODS This was a retrospective cohort study at a district level hospital of 311 adults who died within the first three waves of COVID-19. The study analysed case and crude fatality rates, baseline characteristics, symptomatology, clinical presentation and management of patients. RESULTS Waves 1, 2 and 3 yielded case fatality rates of 14.5%, 27.6% and 6.3%, respectively, and crude fatality rates of 16.7%, 33.0% and 12.2%, respectively. Black Africans were less likely to die during the third wave (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.31 - 0.94). Patients in the second wave had clinical frailty scores of <5 (OR 2.51; 95% CI 1.56 - 4.03). Obesity was most prevalent in the second wave (OR 1.87; 95% CI 1.01 - 3.46), and dyslipidaemia (OR 3.03; 95% CI 1.59 - 5.77) and ischaemic heart disease (OR 3.77; 95% CI .71 - 8.33) were most prevalent during the third wave. Severe ground glass appearance was most common during the second wave (OR 2.37; 95% CI 1.49 - 3.77). Renal impairment was most prevalent during the first wave (OR 3.28; 95% CI 1.59 - 6.77), and thrombo- embolic phenomena were less common during wave three (OR 0.12; 95% CI 0.02 - 0.91). CONCLUSION The Beta variant was the most virulent, with the highest case and crude fatality rates in wave 2.
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Affiliation(s)
- O Hirachund
- Wentworth Hospital, Sidmouth Avenue, Wentworth, South Africa.
| | - C Pennefather
- Wentworth Hospital, Sidmouth Avenue, Wentworth, South Africa.
| | - M Naidoo
- Family Physician, Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Landin Basterra E, Naidoo M, Calvacanti D, Silva NJ, Williams S, Lloyd SJ, Marín C, Ardiles Ruesjas S, Rubio FA, Rasella D. Social protection in global crises: a gap between evidence and action. BMJ Glob Health 2023; 8:e013980. [PMID: 37923321 PMCID: PMC10626864 DOI: 10.1136/bmjgh-2023-013980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Elisa Landin Basterra
- Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Megan Naidoo
- Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | | | - Natanael J Silva
- Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Sarah Williams
- Climate, Air Polllution, Nature, and Urban Health Group, Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
| | - Simon J Lloyd
- Climate, Air Polllution, Nature, and Urban Health Group, Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
| | - Clara Marín
- Policy Department, Barcelona Institute for Global Health, (ISGlobal), Madrid, Spain
| | - Sofia Ardiles Ruesjas
- Climate, Air Polllution, Nature, and Urban Health Group, Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
| | - Felipe A Rubio
- Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Davide Rasella
- Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
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Narayanan A, Naidoo M, Kong VY, Pearson L, Mani K, Fisher JP, Khashram M, Clarke DL. Broad responses and attitudes to having music in surgery (the BRAHMS study) - a South African perspective. S AFR J SURG 2023; 61:30-38. [PMID: 37052283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Music is played in operating theatres (OTs) throughout the world, though controversy around its use exists. While some clinicians may find background music favourable to the theatre mood and a way to augment surgical performance, there is concern raised over its distracting and noise-creating properties. METHODS In this prospective observational study, between August and December 2021, 110 surgeons and registrars in South Africa responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. RESULTS In this cohort, 66% were male, 29% were consultants and the most common age range was 30-39 years old. Eighty per cent of respondents reported that music was played at least "sometimes", with 74% reporting that they enjoyed it. Easy Listening was the most played and preferred genre followed by Top 40/Billboard hits. Overwhelmingly, respondents reported that background music in the OT improved temperament, focus, mood, and performance, though over a quarter felt it worsened communication. Thirty-one per cent of respondents reported that the choice of music depended on the type of operation, and 70% would turn music down or off during crises. Those who enjoyed music in their spare time were significantly more likely to enjoy music in the OT and perceive it positively. CONCLUSION This study provides a window into the surgeons' use of and attitudes to intraoperative music in South Africa. While overall, music is viewed positively by this cohort, some concerns remain regarding communication and distractedness. Further interventional and qualitative studies would be useful.
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Affiliation(s)
- A Narayanan
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - M Naidoo
- Department of Surgery, University of KwaZulu-Natal, South Africa and Department of Surgical Sciences, Uppsala University, Sweden
| | - V Y Kong
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Surgery, University of the Witwatersrand, South Africa and Department of Surgery, University of KwaZulu-Natal, South Africa
| | - L Pearson
- Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - K Mani
- Department of Vascular Surgery, Waikato Hospital, New Zealand and Department of Surgical Sciences, Uppsala University, Sweden
| | - J P Fisher
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - M Khashram
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - D L Clarke
- Department of Surgery, University of KwaZulu-Natal, South Africa and Department of Surgical Sciences, Uppsala University, Sweden
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Dube GQ, Madiba TE, Naidoo M, Molla Z, Manzini V. Thirteen-year audit of the management of anorectal fistulae in a tertiary colorectal unit. S AFR J SURG 2022; 60:235-241. [PMID: 36477051 DOI: 10.17159/2078-5151/sajs3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Persistent anorectal fistulae are referred for assessment in the Durban Metropolitan area to the colorectal unit at the tertiary hospital. This audit aimed to report the assessment and management of these fistulae to benchmark the outcomes from these approaches at a South African tertiary colorectal unit. METHODS Retrospective analysis of prospectively collected data of patients with anorectal fistulae over a 13-year period at a tertiary referral centre. Data analysed included demographics, clinical presentation, comorbidity, management and outcome. Study outcomes measures were healing time and secondary outcome measures were complications of surgery. RESULTS One hundred and thirty-three patients (median age 44 and M:F ratio 2.8:1) with 206 fistulae were accrued. The initial assessment and diagnostic procedures included insertion of seton (126), fistulectomy (14), and fistulotomy (65). Definitive procedures included two-stage seton fistulotomy (43), ligation of the inter-sphincteric fistula tract (LIFT) procedure (39), modified Hanley procedure (17), and mucosal advancement flap (5). One patient had no surgery and nine did not undergo a definitive procedure. Additional procedures included anal sphincter reconstruction (2) and repair of rectovaginal fistula (2). Residual anal incontinence occurred in 13.5%. The failure rate was 6% and healing occurred in 94%. The median healing time was 8 months after the initial surgery and 4 months following the definitive procedure. CONCLUSION The fistula healing rate overall was 94% and was associated with an incontinence rate of 13.5%.
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Affiliation(s)
- G Q Dube
- Colorectal Unit, Department of Surgery, University of KwaZulu-Natal, South Africa
| | - T E Madiba
- Colorectal Unit, Department of Surgery, University of KwaZulu-Natal, South Africa
| | - M Naidoo
- Colorectal Unit, Department of Surgery, University of KwaZulu-Natal, South Africa
| | - Z Molla
- Colorectal Unit, Department of Surgery, University of KwaZulu-Natal, South Africa
| | - V Manzini
- Colorectal Unit, Department of Surgery, University of KwaZulu-Natal, South Africa
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Naidoo M, Kong VY, Clarke DL, Conradie B. Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa. S Afr J Surg 2022; 60:300-304. [PMID: 36477062 DOI: 10.17159/2078-5151/sajs3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND TThis study is a survey amongst surgical trainees in South Africa (SA) designed to document their exposure to laparoscopic appendicectomy (LA) and their perceptions about the procedure and to identify possible barriers to its uptake. METHODS A structured survey was developed using a combination of quantitative and qualitative questions designed to determine the clinical exposure of surgical trainees to laparoscopic appendectomy and then probe possible factors limiting their access to the procedure. A questionnaire was created online, and a link was distributed to various surgical trainees in Southern Africa. A list of trainees was obtained from the Surgreg Training Association of South Africa (STA). RESULTS One hundred and thirty-two (47%) trainees completed the survey out of an estimated 280 general surgery registrars. Ninety-five (72%) were male and 37 (28%) were female respondents. Their median age was 31 years (25-36). There were 14 (11%) year-1 and 21 (16%) year-2, 32 (24%) year-3, 37 (28%) year-4 and 28 (21%) year-5 trainees. The breakdown according to region was area 1 (inland and central) 47 (36%), area 2 (western seaboard) 12 (9%) and area 3 (eastern seaboard) 73 (55%). Forty-three (33%) respondents experienced face-to-face teaching on how to perform a LA. Forty-two (32%) had exposure to laparoscopic simulators. Respondents reported a general lack of experience in performing this procedure. Sixty-nine (52%) had performed this procedure without a senior (i.e., solo) and 13 (10%) had only assisted a senior to perform this procedure. Seventy-four (56%) respondents felt confident performing a LA independently. One hundred and thirteen (86%) respondents expected to be taught this procedure. One hundred and five respondents (80%) were keen to learn to perform LA. One hundred and five respondents (80%) stated that they would be interested in attending an online course on LA. The respondents felt that the following were the significant barriers to performing LA: resource constraints 49 (37%) and time constraints 46 (35%). Thirty per cent of respondents (22) in area 3 reported a reluctance by seniors to teach the procedure. CONCLUSION There appears to be a lack of exposure to and confidence with LA amongst South African surgical trainees. This implies a deficiency in formal surgical training programmes. Addressing this deficiency will require innovative solutions.
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Affiliation(s)
- M Naidoo
- Department of Surgery, Ngwelezana Tertiary Hospital, South Africa
| | - V Y Kong
- Department of Surgery, University of KwaZulu Natal, South Africa and Department of Surgery, Auckland City Hospital, New Zealand
| | - D L Clarke
- Department of Surgery, University of KwaZulu Natal, South Africa and Department of Surgery, University of Witwatersrand, South Africa
| | - B Conradie
- Department of Surgery, University of Auckland, New Zealand
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Naidoo M, Brijlal P, Cader R, Gordon NA, Rayner CA, Viljoen K. Development of a competency-based clinical assessment instrument for exit level Oral Hygiene students at the University of Western Cape. BMC Oral Health 2022; 22:452. [PMID: 36280805 PMCID: PMC9590136 DOI: 10.1186/s12903-022-02498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/04/2022] [Indexed: 11/20/2022] Open
Abstract
Seminal to the process of a health sciences curriculum evaluation is the periodic review of clinical assessment instruments that measure competency. An assessment of quality is facilitated by using a well-structured, authentic and reliable instrument. This process rests on designing and measuring the instrument against a sound framework and validating it for scientific merit. This paper documents the pedagogy and the process taken in developing an improved formative competency-based assessment instrument for the final year students of the Bachelor of Oral Health program (BOH) at the University of the Western Cape (UWC). Methods: A qualitative research study design employing the Nominal Group Technique (NGT) was used as a method for gaining small group consensus on the clinical assessment instrument for exit level Oral Hygiene (BOH3) students within the parameters of assessment principles. The key contributors to the instrument development process were the academic staff of the Department of Oral Hygiene, involved in clinical teaching and assessment of student competency. Results: The domains of ethics and professionalism, patient assessment, diagnosis, treatment planning and implementation was identified as the core elements in the assessment. The principles of assessment, which include, alignment with outcomes, feedback, transparency and validity, were used to guide the instrument development. The assessment criteria were cross examined for alignment to the learning outcomes of the module and the program whilst formative feedback was foregrounded as a central feature to support student learning and progress monitoring. Transparency was obtained by providing students access to the instrument before and after the assessment including the written feedback on their performance. The instrument embodied a range of criteria to be assessed rather than on the awarding of a cumulative score. This allowed for the identification of the criteria or domain within which a student is struggling or excelling. Consensus on the instrument design was achieved using the NGT phases throughout the instrument development process including the weighting of the domains and grading. This level of engagement together with the application of scientifically sound assessment principles contributed to the validation of the instrument. Conclusion: The development of a competency-based assessment instrument was the result of a structured, collaborative and scientifically engaged process framed around specific assessment principles. The process culminated in the development of a formative competency-based clinical assessment instrument that was fit for purpose in the Bachelor of Oral Health program. The Nominal Group Technique served to be a valuable approach for small group consensus in developing the instrument. It served to promote individual perspectives and to generate debate and group discussion between academics that were proficient in clinical teaching and, finally to facilitate group consensus on the instrument structure and system for administration.
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Affiliation(s)
- M. Naidoo
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
| | - P. Brijlal
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
| | - R. Cader
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
| | - N. A. Gordon
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
| | - C. A. Rayner
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
| | - K. Viljoen
- grid.8974.20000 0001 2156 8226Faculty of Dentistry, Department of Oral Hygiene, University of Western Cape, Cape Town, South Africa
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Naidoo S, Bottomley D, Naidoo M, Donnelly D, Thaldar DW. Artificial intelligence in healthcare: Proposals for policy development in South Africa. S Afr J Bioeth Law 2022; 15:11-16. [PMID: 36061984 PMCID: PMC9439582 DOI: 10.7196/sajbl.2022.v15i1.797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite the tremendous promise offered by artificial intelligence (AI) for healthcare in South Africa, existing policy frameworks are inadequate for encouraging innovation in this field. Practical, concrete and solution-driven policy recommendations are needed to encourage the creation and use of AI systems. This article considers five distinct problematic issues which call for policy development: (i) outdated legislation; (ii) data and algorithmic bias; (iii) the impact on the healthcare workforce; (iv) the imposition of liability dilemma; and (v) a lack of innovation and development of AI systems for healthcare in South Africa. The adoption of a national policy framework that addresses these issues directly is imperative to ensure the uptake of AI development and deployment for healthcare in a safe, responsible and regulated manner.
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Affiliation(s)
- S Naidoo
- School of Law, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - D Bottomley
- School of Law, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - M Naidoo
- School of Law, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - D Donnelly
- School of Law, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - D W Thaldar
- School of Law, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
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Chonco SM, Mtetwa PN, Naidoo M, Naidoo VG, Madiba TE. A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit. S AFR J SURG 2021; 59:169-175. [PMID: 34889541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND In South Africa, inflammatory bowel disease (IBD) is increasing in frequency. The purpose of the study was to document our experience with the surgical management of patients with IBD and describe the cohort undergoing surgical management of IBD in a KwaZulu-Natal province tertiary state sector hospital. METHODS Retrospective analysis of a database of patients undergoing surgery for IBD. Demographics, site and disease duration, surgical indications, management and outcome were analysed. RESULTS Of 397 patients with IBD, 136 had Crohn's disease (CD) (African 13, Indian 78, Coloured 10 and White 35) and 261 had ulcerative colitis (UC) (African 67, Indian 158, Coloured 9 and White 27). Eighty-six of 136 patients with CD required surgical referral. Ileo-colonic CD was most common and non-stricturing/non-penetrating disease behaviour predominated. Seventy-four patients with CD underwent 76 abdominal surgical procedures with in-hospital mortality of 3.5% and a morbidity of 20.9%. Twenty patients required anorectal fistula procedures. Recurrence occurred in nine patients (10.5%) and malignant transformation was seen in three patients (2.2%). One hundred and sixty-three of the 261 patients with UC had pancolitis. Failed medical management was the most common indication for surgical referral. Fiftyone patients with UC had surgery, (age 44.5 [IQR 27-56] years). Forty-five patients underwent 63 abdominal surgical procedures with an overall mortality of 17.7% and a morbidity of 39.2%. Colorectal cancer was seen in 10 patients (3.8%). Laparoscopic procedures were undertaken in eight CD patients (10.8%) and 29 UC patients (39%). The median hospital stay was 7 days for both open and laparoscopic resection. CONCLUSION IBD is not uncommon in African patients, with UC being more frequent than CD. Postoperative mortality and potential for malignant transformation are higher for UC.
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Affiliation(s)
- S M Chonco
- Department of Surgery, University of KwaZulu-Natal, South Africa
| | - P N Mtetwa
- Department of Surgery, University of KwaZulu-Natal, South Africa
| | - M Naidoo
- Department of Surgery, University of KwaZulu-Natal, South Africa
| | - V G Naidoo
- Department of Gastroenterology, University of KwaZulu-Natal, South Africa
| | - T E Madiba
- Department of Surgery, University of KwaZulu-Natal, South Africa
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Pohl L, Naidoo M, Rickard J, Abahuje E, Kariem N, Engelbrecht S, Kloppers C, Sibomana I, Chu K. Surgical Trainee Supervision During Non-Trauma Emergency Laparotomy in Rwanda and South Africa. J Surg Educ 2021; 78:1985-1992. [PMID: 34183277 DOI: 10.1016/j.jsurg.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The primary objective was to describe the level of surgical trainee autonomy during non-trauma emergency laparotomy (NTEL) operations in Rwanda and South Africa. The secondary objective was to identify potential associations between trainee autonomy, and patient mortality and reoperation. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, observational study of NTEL operations at 3 teaching hospitals in South Africa and Rwanda over a 1-year period from September 1, 2017 to August 31, 2018. The study included 543 NTEL operations performed by the acute care and general surgery services on adults over the age of 18 years. RESULTS Surgical trainees led 3-quarters of NTEL operations and, of these, 72% were performed autonomously in Rwanda and South Africa. Notably, trainee autonomy was not significantly associated with reoperation or mortality. CONCLUSIONS Trainees were able to gain autonomous surgical experience without impacting mortality or reoperation outcomes, while still providing surgical support in a high-demand setting.
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Affiliation(s)
- Linda Pohl
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nazmie Kariem
- Department of Surgery, University of Cape Town, Cape Town, South Africa; Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | | | - Christo Kloppers
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
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Naidoo M, Lee J, Trelles M, Wallis L, Chu KM. Preventing avoidable hospital admissions after emergency care in humanitarian settings: a cross-sectional review of Médecins Sans Frontières emergency departments. BMJ Open 2021; 11:e049785. [PMID: 34257097 PMCID: PMC8278912 DOI: 10.1136/bmjopen-2021-049785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the types of emergency departments (EDs), and the acuity, types and disposition of conditions managed at Médecins Sans Frontières (MSF)-supported EDs in humanitarian settings. DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES This was a multicentre, cross-sectional review of visits to MSF-supported EDs from 1 January 2014 to 31 December 2018. EDs were classified into advanced-level, general-level, paediatric and trauma. Variables analysed included: age group, condition, acuity and ED disposition. Frequencies and percentages stratified by ED type or region were reported. RESULTS MSF supported 26 EDs in 12 countries, with a total of 1 388 698 visits between 2014 and 2018. Most patients were discharged home (n=1 097 456, 79%), with nearly 0% mortality (n=4692). The majority of visits at general-level and paediatric EDs were for medical conditions (n=600 088, 78% and n=45 276, 96%, respectively), while nearly half of advanced-level EDs visits were for surgical conditions (n=201 189, 48%). Almost all visits to trauma EDs were for surgical conditions (n=148 078, 98%). Overall, most surgical conditions were traumatic injuries (n=484 008, 94%), the majority unintentional (n=425 487, 82%). The top three most common classified medical conditions were respiratory infections, malaria and diarrhoea. CONCLUSIONS EDs are critical in improving the agility and access to emergency care (EC) in humanitarian settings. This study demonstrated that EC provision resulted in the majority of patients being discharged from EDs, helping prevent avoidable hospital admissions. These results could help better understand the healthcare needs of vulnerable populations, improve responsiveness to emergency conditions and support programmatic planning in humanitarian settings.
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Affiliation(s)
- Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - James Lee
- Medical Department, Médecins Sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Miguel Trelles
- Medical Department, Médecins Sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Breedt DS, Odland ML, Bakanisi B, Clune E, Makgasa M, Tarpley J, Tarpley M, Munyika A, Sheehama J, Shivera T, Biccard B, Boden R, Chetty S, de Waard L, Duys R, Groeneveld K, Levine S, Mac Quene T, Maswime S, Naidoo M, Naidu P, Peters S, Reddy CL, Verhage S, Muguti G, Nyaguse S, D'Ambruoso L, Chu K, Davies JI. Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach. BMJ Glob Health 2021; 6:bmjgh-2021-005629. [PMID: 34130990 PMCID: PMC8208008 DOI: 10.1136/bmjgh-2021-005629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.
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Affiliation(s)
- Danyca Shadé Breedt
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Balisi Bakanisi
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Edward Clune
- Department of Anaesthesia, University of Botswana, Gaborone, Botswana
| | | | - John Tarpley
- Department of Surgery, University of Botswana, Gabarone, Botswana
| | - Margaret Tarpley
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Akutu Munyika
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Department of Surgery, Onandjokwe Lutheran Hospital, Oniipa, Namibia
| | | | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Regan Boden
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Chetty
- Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rowan Duys
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Kristin Groeneveld
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Priyanka Naidu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shrikant Peters
- Executive Management, Groote Schuur Hospital, Department of Public Health and Familiy Medicine, University of Cape Town, Cape Town, South Africa
| | - Ché L Reddy
- Harvard Medical School, Boston, Massachusetts, USA
| | - Savannah Verhage
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Godfrey Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shingai Nyaguse
- Division of Anaesthesia, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Kathryn Chu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Motsuku L, Chen WC, Muchengeti MM, Naidoo M, Quene TM, Kellett P, Mohlala MI, Chu KM, Singh E. Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002-2014. BMC Cancer 2021; 21:129. [PMID: 33549058 PMCID: PMC7866437 DOI: 10.1186/s12885-021-07853-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014. METHODS Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex. RESULTS A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6-4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1-2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9-6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5-5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0-6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0-4.8, p-value < 0.01) from 2002 to 2014, respectively. CONCLUSIONS The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.
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Affiliation(s)
- Lactatia Motsuku
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Department of Global Health, South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Mazvita Molleen Muchengeti
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Naidoo
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Patricia Kellett
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Matshediso Ivy Mohlala
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa.
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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Chonco SM, Mtetwa PN, Naidoo M, Naidoo VG, Madiba TE. A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit. S AFR J SURG 2021. [DOI: 10.17159/2078-5151/2021/v59n4a3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT BACKGROUND: In South Africa, inflammatory bowel disease (IBD) is increasing in frequency. The purpose of the study was to document our experience with the surgical management of patients with IBD and describe the cohort undergoing surgical management of IBD in a KwaZulu-Natal province tertiary state sector hospital METHODS: Retrospective analysis of a database of patients undergoing surgery for IBD. Demographics, site and disease duration, surgical indications, management and outcome were analysed RESULTS: Of 397 patients with IBD, 136 had Crohn's disease (Cd) (African 13, Indian 78, Coloured 10 and White 35) and 261 had ulcerative colitis (UC) (African 67, Indian 158, Coloured 9 and White 27). Eighty-six of 136 patients with CD required surgical referral. Ileo-colonic CD was most common and non-stricturing/non-penetrating disease behaviour predominated. Seventy-four patients with CD underwent 76 abdominal surgical procedures with in-hospital mortality of 3.5% and a morbidity of 20.9%. Twenty patients required anorectal fistula procedures. Recurrence occurred in nine patients (10.5%) and malignant transformation was seen in three patients (2.2%). One hundred and sixty-three of the 261 patients with UC had pancolitis. Failed medical management was the most common indication for surgical referral. Fifty-one patients with UC had surgery, (age 44.5 [IQR 27-56] years). Forty-five patients underwent 63 abdominal surgical procedures with an overall mortality of 17.7% and a morbidity of 39.2%. Colorectal cancer was seen in 10 patients (3.8%). Laparoscopic procedures were undertaken in eight CD patients (10.8%) and 29 UC patients (39%). The median hospital stay was 7 days for both open and laparoscopic resection CONCLUSION: IBD is not uncommon in African patients, with UC being more frequent than CD. Postoperative mortality and potential for malignant transformation are higher for UC Keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis, surgical management
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Chu KM, Dell AJ, Moultrie H, Day C, Naidoo M, van Straten S, Rayne S. A geospatial analysis of two-hour surgical access to district hospitals in South Africa. BMC Health Serv Res 2020; 20:744. [PMID: 32791995 PMCID: PMC7425023 DOI: 10.1186/s12913-020-05637-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.
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Affiliation(s)
- Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa. .,Department of Surgery, University of Cape Town, Cape Town, South Africa. .,Department of Global Health, University of Stellenbosch, Francie Van Zijl Dr Tygerberg Hospital, Cape Town, 7505, South Africa.
| | - Angela J Dell
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Harry Moultrie
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, Cape Town, South Africa
| | - Candy Day
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Kauta NJ, Groenewald J, Arnolds D, Blankson B, Omar A, Naidu P, Naidoo M, Chu KM. WhatsApp Mobile Health Platform to Support Fracture Management by Non-Specialists in South Africa. J Am Coll Surg 2020; 230:37-42. [DOI: 10.1016/j.jamcollsurg.2019.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/08/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Von Pressentin KB, Naidoo M, Ras T, Torlutter M. Mastering your Fellowship. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i6.5069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written and clinical examinations, Final Part A of the FCFP(SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.
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Naidoo M, Von Pressentin KB, Ras T, Mabuza H. Mastering your Fellowship. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i5.4943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written and clinical examinations, Final Part A of the FCFP(SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.
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Von Pressentin KB, Naidoo M, Mabuza LH, Mash RJ, Ras T. Mastering your Fellowship. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i4.4958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The series, “Mastering your Fellowship”, provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online.
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Naidoo M, Von Pressentin KB, Ras T, Steinberg H. Mastering your Fellowship. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i3.4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The series, “Mastering your Fellowship”, provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online.
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Naidoo M. An approach to acute pulmonary embolism in the primary emergency care environment. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i2.4985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Pulmonary embolism (PE) is a common emergency presenting among high risk patients. It is important to have a structured approach to clinical assessment, diagnosis and management of this potentially life-threatening emergency. Clinical and management pathways have improved over the last 10 years as clear guidelines have emerged. Newer diagnostic modalities have become available and will hopefully improve the pick-up rate of PE and reduce the morbidity and mortality. High level evidence presented by the American Society of Haematology and the European Society of Cardiology forms the basis for this review.
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Naidoo M, Lin F, Jameson M, Shelly K, Srivastava A. Prophylactic cranial irradiation in patients with extensive-stage small-cell lung cancer (ES-SCLC): An updated tertiary cancer centre experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy425.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Soogun S, Naidoo M, Naidoo K. An evaluation of the use of the South African Triage Scale in an urban district hospital in Durban, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1307908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - M Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Von Pressentin KB, Naidoo M, Ogunbanjo G. Mastering your Fellowship, Vol 58, No 1 (2016). S Afr Fam Pract (2004) 2016. [DOI: 10.4102/safp.v58i1.4441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.
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Nadasen DM, Naidoo M. Patients with type 2 diabetes and difficulties associated with initiation of insulin therapy in a public health clinic in Durban. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- DM Nadasen
- Phoenix Community Health Centre; Department of Family Medicine, University of KwaZulu-Natal, Durban
| | - M Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, Durban; Department of Health, KwaZulu-Natal
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Jimoh OS, Naidoo M. Immune reconstitution in human immunodefciency virus-positive patients on highly active antiretroviral therapy at an urban public sector district hospital. S Afr J Infect Dis 2014. [DOI: 10.1080/23120053.2014.11441580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- O S Jimoh
- Department of Family Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
| | - M. Naidoo
- Department of Family Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
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Naidoo K, Naidoo M, Gengiah S, Nkupiso N, Singh C, Leask K, Kharsany ABM. P3.233 Genital Tract Abnormalities in HIV-TB Co-Infected Women Initiating Antiretroviral Therapy (ART). Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ntloko S, Gounden A, Naidoo M, Madiba TE, Singh Y, Ramdial PK, Hadley GP. Intestinal inflammatory myofibroblastic tumour. S AFR J SURG 2011; 49:190-193. [PMID: 22353270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 11/05/2010] [Indexed: 05/31/2023]
Abstract
BACKGROUND Inflammatory myofibroblastic tumours (IMFTs) are rare tumours characterised by nosologic, histogenetic and aetiopathogenetic controversy and variable clinicopathological features. We report our experience with intestinal-IMFTs (I-IMFTs) that have been reported mainly as single case reports to date. METHODS Five patients with I-IMFTs, identified between 2005 and 2008, formed the study cohort. The clinicopathological features were obtained from departmental and hospital records. RESULTS The median patient age was 13 years. While 4 patients presented with symptoms and signs of intestinal obstruction, one IMFT was an incidental finding at laparotomy for trauma. Three I-IMFTs were located in the small bowel and 2 in the colon. Complete resection with end-to-end anastomoses was performed. The gross morphology included 1 polypoid myxoid tumour that served as a lead point for an intussusception, 3 multinodular whorled masses and 1 firm circumferential, infiltrative tumour. Microscopically, all tumours had typical features of IMFT with variable expression of ALK-1, a low proliferation index and tumour-free resection margins. All patients had an uneventful recovery. One patient was lost to further follow-up. Four patients were well, without local recurrence or metastases at 6 months to 3 years. CONCLUSIONS Surgery with tumour-free resection margins is the gold standard of care of adult and paediatric I-IMFTs. Heightened recognition of I-IMFT, albeit rare, as a cause of intestinal obstruction, including intussusception, is necessary for pre-operative suspicion of I-IMFT.
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Affiliation(s)
- S Ntloko
- Department of Surgery, University Of KwaZulu-Natal, Durban
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Naidoo M, Singh B, Ramdial PK, Moodley J, Allopi L, Lester B. Lymphoepithelial lesions of the parotid gland in the HIV era--a South African experience. S AFR J SURG 2007; 45:136-140. [PMID: 18069581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Historically, lymphoepithelial lesions (LELs) have been a peripheral indication for surgery on the parotid gland, accounting for less than 1% of all parotidectomies undertaken. In the HIV era the profile of parotidectomy has changed, with LEL becoming a common indication for parotidectomy, prompting a review of our current experience. DESIGN A retrospective study was undertaken between January 1998 and December 2005. Setting. Surgical services at King Edward VIII Hospital, Durban. SUBJECTS All patients presenting with parotidomegaly. RESULTS One hundred and sixty-two patients with parotidomegaly were evaluated; 53 (32.7%) had LEL lesions. A total of 151 parotidectomies (including 42 parotidectomies undertaken for LEL lesions) were performed in 147 patients. Radiotherapy was offered to 11 patients with LEL lesions. Complications following parotidectomy for LEL included facial nerve palsy (N=3), seroma formation (N=5) and facial artery false aneurysm (N=1). Three patients required re-parotidectomy for recurrent LEL parotidomegaly. In the patients who underwent radiotherapy, there was a satisfactory outcome; 2 patients who received 4 Gy radiation per sitting developed mild skin discolouration of the treated area. CONCLUSION Although surgical management of LEL parotidomegaly may provide a satisfactory result, this approach is technically challenging and is associated with complications and recurrences. For these reasons, the non-operative approach employing radiotherapy should be considered.
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Affiliation(s)
- M Naidoo
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban
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Smith LL, Semple SJ, McKune AJ, Neveling N, Caldeira M, Swanepoel JM, Tsomele L, Naidoo M, Sibanda E. Changes in neutrophil count, creatine kinases and muscle soreness after repeated bouts of downhill running. S Afr j sports med (Online) 2007. [DOI: 10.17159/2078-516x/2007/v19i3a260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. A primary objective was to examine circulating neutrophil count after repeated bouts of downhill running. An additional aim was to determine creatine kinase (CK)
levels during the initial 12 hours, after repeated DHRs.
Design. Eleven healthy, untrained Caucasian males performed 2 x 60 min bouts of DHR (-13.5%), spaced 14 days
apart, at a speed equal to 75% VO2max on a level grade. Blood was collected before, after, and every hour for 12 hours, and every 24 hours for 6 days. Absolute neutrophil
count, CK, and delayed-onset muscle soreness (DOMS) were assessed. Results were analysed using repeated measures ANOVA (p
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Misser SK, Maharajh J, Campbell HT, Naidoo M, Gounden AA. Post-emetic oesophageal rupture - successful conservative management. SA J Radiol 2006. [DOI: 10.4102/sajr.v10i4.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
A patient with a spontaneously acquired hernia along the inferior lumbar triangle commonly referred to as lumbar triangle of Petit is presented. This was confirmed on CT scan and successfully treated surgically. A review of the literature relevant to this condition is presented. It is likely that with advances in imaging techniques and a wider clinical usage of these investigative modalities there will be further recognition of this uncommon condition.
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Affiliation(s)
- M Naidoo
- Department of Surgery, Nelson R Mandela School of Medicine, University of Natal, PO Box 17039, Congella, 4013 South Africa
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Madala ND, Naicker S, Singh B, Naidoo M, Smith AN, Rughubar K. The pathogenesis of membranoproliferative glomerulonephritis in KwaZulu-Natal, South Africa is unrelated to hepatitis C virus infection. Clin Nephrol 2003; 60:69-73. [PMID: 12940606 DOI: 10.5414/cnp60069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Idiopathic membranoproliferative glomerulonephritis (MPGN) is a well-defined clinicopathological entity with a poor prognosis, with 50% of patients progressing to end stage renal disease (ESRD) within 10 years. It was reported in about 36% of adult Black patients with nephrotic syndrome in our center previously [Seedat et al. 1988]. Hepatitis C virus (HCV) infection has been shown to be associated with cryoglobulinemic as well as non-cryoglobulinemic (or idiopathic glomerulonephritis). The aim of this study was to determine whether an association exists between HCV infection and idiopathic MPGN in a population with a relatively high prevalence of MPGN. We studied adult patients referred with glomerular disease over a two-year period, 104 patients had primary glomerulonephritis. All 23 (22%) patients with idiopathic MPGN were enrolled, as well as 32 age-matched patients presenting with other primary glomerular diseases. We examined serum from all 55 patients for evidence of HCV antibodies and HCV RNA. None of the 55 patients showed evidence of HCV infection. Chronic renal failure was present in 82.6% of the patients with idiopathic MPGN and it was advanced in 52,2%, who either were dialysis-requiring at presentation or progressed to ESRD soon thereafter; 30.4% had moderate chronic renal failure, while only 17.4% had normal renal function. HCV infection is not associated with idiopathic MPGN in our patients. Idiopathic MPGN remains an idiopathic disease, possibly with a poor prognosis in our population.
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Affiliation(s)
- N D Madala
- Department of Medicine, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.
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Hochart L, Naidoo M, Thomson SR. Small-bowel strictures and perforation in tuberculosis. S Afr Med J 2002; 92:519-20. [PMID: 12197190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- L Hochart
- Nelson R Mandela School of Medicine, Department of Surgery, Addington Hospital, Durban
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Abstract
OBJECTIVE To evaluate whether cardiac responses to a level of hypoxic hypercapnia that may be observed in rebreathing studies are altered with infant sleep position. METHODOLOGY Eighteen healthy term infants (< 5-days-old) were studied. Heart rate (HR) and HR variability were monitored during air breathing and during 3 min exposure to a mixture of 15% O2/3% CO2 in both the prone and supine positions. Power spectral analysis of HR was performed. RESULTS Heart rate was the only measured variable to be significantly changed in response to 15% O2/3% CO2. Hypoxic hypercapnia elicited no significant responses in power spectral HR variables. There was no effect of sleeping position on any of the measured variables. CONCLUSIONS There are no significant differences in cardiac responses to mild hypoxic hypercapnia between sleep positions and power spectral indices of the autonomic control of HR are not altered by sleep position in newborn babies.
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Affiliation(s)
- M Naidoo
- Perinatal Research Centre, University of Queensland, Royal Women's Hospital, Brisbane, Australia
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