South African Family Practice最新文献

Background: Treatment success rate is a critical indicator for monitoring the progress of tuberculosis (TB) treatment programmes at both the patient and population levels. It informs decisions about resource allocation and the effectiveness of TB control strategies. This study aimed to determine the level of TB cure rates and the factors associated with treatment success among TB patients receiving TB care in the Collins Chabane municipality, Limpopo province, South Africa.

Methods: Medical records from April 2020 to March 2021 of 289 patients attending primary health care facilities, initiated on anti-TB treatment were reviewed. Descriptive statistics were used to analyse data and modified Poisson regression was used to determine factors associated with treatment success. Statistical software Epi Info was used for analysis.

Results: Of the 289 TB cases, 282 (97.6%) were newly initiated on TB treatment. Of these, 37.0% were cured, followed by 29.0% who defaulted treatment, 22.3% who completed the treatment and 11.7% who died during treatment. The likelihood of successful treatment outcomes was significantly associated with marital status, supervised treatment and distance travelled to a health facility. A higher likelihood of success was observed among patients who were single and 27.0% of those had supervised treatments.

Conclusion: Tuberculosis patients continue to die in the course of treatment. Supervised treatment is a predictor of successful treatment outcomes.Contributions: This study highlight the need for heightened advocacy for supervised TB treatment and increased effort to combat the death of patients while on TB treatment.

Background: To evaluate the effects of coronavirus disease 2019 (COVID-19) and the preventative measures taken, especially how they affect forensic pathology services in rural South Africa.

Methods: This retrospective analysis includes referred post-mortem cases from all forensic pathology services in Limpopo province, comparing the period before the COVID-19 pandemic (01 January 2019 to 31 December 2019) with the pandemic period (01 January 2020 to 31 December 2020). Data analysis was performed using STATA 16.0 software (StataCorp; College Station, TX). Chi-square test was employed for comparison, with a p-value 0.05 deemed statistically significant.

Results: Approximately 9319 cases were submitted for post-mortem examinations, with 4857 occurring before the pandemic and 4462 during it, marking an 8.1% decrease. There was a decrease in the number of unnatural death cases, while the instances of natural deaths rose. Cases under investigation saw a notable increase. There was a marked decrease in referrals for forensic examinations across all districts. In addition, except for one facility, there was a decline in the number of cases sent for autopsies at all facilities.

Conclusion: In conclusion, forensic pathology services in this province had been severely disrupted by the COVID-19 outbreak and the lockdown that followed, especially in the tertiary hospital. It has led to new challenges for case management and necessitated changes to operating procedures.Contribution: It has required modifications to operational procedures and has introduced various challenges in case management.

Despite the strides made in healthcare, many countries still struggle to meet citizen healthcare needs, leading to global and regional health inequalities. The complex interactions between healthcare systems and disciplines present challenges for primary care providers and family physicians. Primary care providers must be equipped with tools and resources to effectively fulfil their duties, such as clinical governance, leadership and capacity building. This article focusses on various thinking approaches that primary care providers can employ, namely systems thinking, complexity science thinking and learning health systems thinking. We appreciate that individual styles and preferences, organisational culture and systemic realities influence multiple modes of thinking and decision-making. A range of modes of thinking and mental models will assist with tackling challenges and opportunities in the primary healthcare system. We hope this brief overview encourages readers to experiment with different ways of thinking to help facilitate innovative solutions.

Background: Integrated primary care (IPC) is a final-year medical subject at the University of the Witwatersrand, Johannesburg, South Africa. It focusses on primary health care training. The coronavirus disease 2019 (COVID-19) pandemic exacerbated existing decentralised training challenges, including standardisation and patient exposure. This study explored IPC students' experiences and perceptions of online learning during the COVID-19 pandemic.

Methods: This explanatory-sequential mixed-methods study was informed by the technology acceptance model, community of inquiry model and self-regulated learning theory. A cross-sectional online survey was followed by focus group discussions (FGDs) (n = 2 and n = 3, respectively). All 316 medical students in the 2021 cohort were eligible to participate. Closed-ended survey responses were analysed using descriptive and inferential statistics. Open-ended responses were analysed using content analysis. The FGDs were thematically analysed.

Results: The survey response rate was 52% (n = 164/316). Most students found the online content easily accessible (93.3%) and logically organised (80.0%). The course structure and organisation, and the range of online activities offered were the main features that supported learning. The main challenges included the content not being comprehensive and the difficulty of learning patient management from online content. Suggested improvements related to the course design and ways students and instructors can maximise the affordances of the online course.

Conclusion: Acknowledging the limitations of learning clinical content online, the participants felt the course supported their learning. Our findings suggest that well-designed online content can augment clinical learning.Contribution: This study contributes to the discourse on the value of online learning for clinical teaching.

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination.

Background: Many serious adverse events associated with gestational diabetes mellitus (GDM) can be mitigated by timely glucose control during pregnancy, achieved through education and lifestyle choices. The aim of this study was to translate and cross-culturally adapt and test the preliminary internal consistency and test-retest reliability of the South African English, Afrikaans and isiXhosa versions of the GDM Knowledge Questionnaire (GDMKQ).

Methods: A prospective, observational study was conducted at a high-risk antenatal clinic in South Africa. Pregnant women ≥ 18 years with GDM were consecutively sampled. Semantic equivalence between the original and adapted versions was assessed. Face and content validity, internal consistency and test-retest reliability were evaluated.

Results: The three SA-GDMKQ versions demonstrated good face and content validity. For internal consistency, Cronbach's alpha values were 0.534 for the Afrikaans version, 0.434 for the English version and 0.621 for the isiXhosa version. Test-retest reliability found kappa (standard error [s.e.]) values ranged between -0.03 (0.18) and 0.89 (0.13) for the English version, between -0.07 (0.18) and 0.53 (0.13) for the Afrikaans version and between 0.28 (0.18) and 0.87 (0.17) for the isiXhosa version. All versions of the SA-GDMKQ had a statistically significant (p  0.001) positive linear correlation between the total scores.

Conclusion: The English, Afrikaans and isiXhosa SA-GDMKQ versions were found to be feasible and easy to comprehend, although lower internal consistency and test-retest reliability were displayed. Further validation of the psychometric properties of the English, Afrikaans and isiXhosa versions of the SA-GDMKQ among larger sample groups is however warranted.Contribution: This study adds to the knowledge around developing and using culturally appropriate questionnaires and outcome measures in research and clinical practice.

Background: Burn injuries cause significant morbidity and mortality, with prevalence in developing countries such as South Africa. This study aimed to determine the characteristics and referral patterns of burn injuries.

Methods: A retrospective observational study was conducted in a single emergency centre, Kalafong Provincial Tertiary Hospital, from 01 January 2021 to 31 December 2021. The study included patients 13 years with burn injuries.

Results: A total of 266 patients were identified. Males (n = 144, 54.1%) had a higher prevalence of incurring burn injuries. The majority of injuries were secondary to scald burns (n = 237, 89.1%). A total of 208 (78.2%) patients had a percentage of total body surface area (%TBSA) of 10%, and 257 (96.6%) had superficial partial-thickness burns. Only 77 (28.9%) cases were from referral centres and there was no relationship between referral pattern and %TBSA. Majority (n = 248, 93.2%) received no pre-hospital wound care. Only 108 (40.6%) patients were admitted and the median length of hospital stay (interquartile range [IQR]) was 7 days (2 to 9). There was a significant relationship between the length of hospital stay and %TBSA burns (p  0.001).

Conclusion: The pattern of burn injuries in patients is similar to previous studies carried out predominantly in townships in South Africa. Most referrals were found to be appropriate and complied with institutional burn injury admission protocol, although pre-hospital wound care was inadequate.Contribution: Primary burn injury care is vital to reduce morbidity and mortality, and development of programmes for public awareness of burn injuries remains crucial.

Violence manifests in various ways in healthcare, including trauma from an undifferentiated patient, psychosomatic illness, substance abuse or dependency and mental health challenges. Different forms of violence exist, such as intimate partner violence, gender-based violence, domestic violence, child abuse, neglect, elder abuse, sexual violence, self-directed violence and collective violence. These may be included in domestic violence or exist as standalone forms. Health practitioners play a pivotal role in managing incidents of domestic violence. This article highlights the definitions in the Amended Domestic Violence Act of 2021 and suggests screening options for domestic violence. The authors also suggest screening tools, a management flow diagram and contact numbers for resources. Domestic violence can be a generational curse that compromises biopsychosocial wellbeing. To break the perceived culture of violence, healthcare workers play a pivotal role in screening and management, as well as the mandatory reporting of domestic violence when children and the elderly are sharing such a household.