A cross-sectional analysis of the association between age and gender and prescribed minimum benefit chronic disease list conditions among South Africans with concomitant hypertension, diabetes and dyslipidaemia

BACKGROUND

Prescribed Minimum Benefit Chronic Disease List (PMB CDL) conditions are a regulated list of conditions most common to South Africa.

OBJECTIVES

To investigate the prevalence and association between PMB CDL conditions and age and gender among patients with concomitant hypertension, diabetes and dyslipidaemia.

METHODS

The study population consisted of patients (n = 17 866) with a prescription containing at least one co-prescribed antilipemics, antihypertensive and antidiabetic (identified using the MIMS Desk Reference). ICD-10 codes on claims for PMB CDL conditions were counted.

RESULTS

39.5% of patients had a PMB CDL condition. Women had higher odds for hypothyroidism (OR 6.30, 95% CI; 5.52, 7.19, p < 0.001) and lower odds for coronary artery disease (CAD) (OR 0.63, 95% CI; 0.55, 0.72, p < 0.001) than men. In combination with hypothyroidism the odds for CAD were reversed and strongly increased; 3.54 (95% CI; 2.38, 5.25, p < 0.001). The odds for females having cardiac failure (CF) was insignificant and low (OR 0.87, 95% CI; 0.75, 1.01, p = 0.063); however combined with hypothyroidism, the odds increased to 5.35 (95% CI; 3.52, 8.13, p < 0.001).

CONCLUSION

Hypothyroidism was an important discriminating factor for co-morbidity in women with concomitant hypertension, diabetes and dyslipidaemia, in particular with cardiovascular disease.

Assessment of the Appropriateness of Antibiotic Prescriptions in Lesotho Public Hospitals: A Novel Methodology Based on Principles of Antibiotic Prescribing

The study primarily aimed at assessing the appropriateness of antibiotic prescriptions in a section of public health institutions in Lesotho using an assessment tool formulated from principles of antibiotic prescribing. Relevant data on procedures of infection diagnosis and prescribed antibiotics were collected from both inpatient and outpatient case reports for a one-month period in five public hospitals in Lesotho. These were analyzed for the appropriateness of the prescribed antibiotics. Prescription appropriateness assessment was based on conformities of prescribed antibiotics to criteria developed from pertinent principles of antibiotic prescribing. Assessed prescriptions, 307 inpatient and 865 outpatient prescriptions in total, were classified into categories of appropriateness based on extents to which they satisfied conditions defined by combinations of criteria in the assessment tool. Antibiotic prescriptions from inpatient and outpatient departments of study site hospitals were categorized into groups of different degrees of appropriateness. A total of 32.2% inpatient prescriptions and 78.4% outpatient prescriptions assessed were appropriately written for the empiric treatment of infections for which bacterial pathogens were considered absolute or possible etiologies. The use of prescription assessment tools based on principles of antibiotic prescribing is a feasible option of assessing the appropriateness of antibiotic prescriptions, particularly in low-income countries where expert panels cannot be formed.

The Impact of Appropriate Antibiotic Prescribing on Treatment Evaluation Parameters

The therapeutic impact of inappropriate prescribing of antibiotics is debatable, particularly in situations where infections are treated empirically with multiply prescribed antibiotics. Prescribers may remain under the illusion that such prescriptions are appropriate on the basis of any observed positive treatment outcomes, even though an antibiotic prescribed in such combination therapy may actually be infective against infecting pathogens. This, inevitably, promotes inappropriate antibiotic prescribing. Prescribers may be motivated to make more conscious attempts to prescribe antibiotics appropriately if it is proven that judicious prescribing of antibiotics has positive impacts on treatment outcomes. The objective of this study was to determine the impact of appropriate prescribing of antibiotics on treatment outcomes, days of patient hospitalization and costs related to antibiotic treatment. Observational data on antibiotic treatment were collected for a one-month period from case notes of all inpatients (n=307) and outpatients (n=865) at five government and mission hospitals in Lesotho. Prescriptions were classified into categories of appropriateness based on extents to which antibiotics were prescribed according to principles. Treatment success rates, mean days of hospitalization and costs of antibiotic treatments of inpatients treated with specified prescription categories were determined. Appropriate prescribing of antibiotics for inpatients had positive impacts on treatment outcomes, patients' days of hospitalization for infections and costs of antibiotic treatments. In outpatient settings, appropriate prescribing of antibiotics failed to show any significant impact on costs of antibiotics. Appropriate prescribing of antibiotics had a positive impact on patients' recovery and costs of antibiotic treatments in inpatient settings.

Cognitive and linguistic profiles of specific language impairment and semantic-pragmatic disorder in bilinguals

This study explored the notion that the extent to which language-impaired children can become bilingual depends on the type of language impairment. Single-case studies were conducted on two 7-year-old bilingual children, who had both been exposed to English and Afrikaans consistently and regularly from an early age. The subjects presented with specific language impairment (SLI) and semantic-pragmatic disorder (SPD), respectively. They were assessed on a battery of cognitive and linguistic tests in both their languages. Results indicate that the SLI subject, who presented with a deficit in successive processing on the Cognitive Assessment System, had difficulty in acquiring the surface features of both languages. She developed much better proficiency in English than in Afrikaans, despite substantial exposure to the latter. The SPD subject, whose cognitive profile was characterised by planning and attention deficits, but a strength in successive processing, presented with equal proficiency in both languages. The theoretical and clinical implications of this research are discussed.