Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>The earth is flat, as are our journals and CPD</b>]]> <![CDATA[E<b>ditor's Choice</b>]]> <![CDATA[<b>Amiodarone-induced lung disease</b>]]> <![CDATA[<b>Non-seroidal anti-inflammatory drugs and cardiovascular risk</b>]]> <![CDATA[Chris Barnard and<b> </b>Hunterian Museums]]> <![CDATA[<b>Gaucher disease in South Africa</b>]]> <![CDATA[<b>Choice on Termination of Pregnancy Amendment Bill</b>]]> <![CDATA[<b>The art of medicine</b>: <b>Heart, head and hands</b>]]> <![CDATA[<b>HPCSA - computer burglars strike again</b>]]> <![CDATA[<b>Zimbabwe meltdown fuelling MDRTB?</b>]]> <![CDATA[<b>Malaria - now Limpopo and Mpumalanga suffer</b>]]> <![CDATA[<b>Multidisciplinary teams - the rural way forward</b>]]> <![CDATA[<b>Femur fractures in infants</b>]]> <![CDATA[<b>Acute haemorrhagic pancreatitis in HIV-positive patients</b>]]> <![CDATA[<b>Thirty years on</b>: <b><i>Plus ça change, plus c'est la même chose</i></b>]]> <![CDATA[<b>Willem Johannes Bam</b>]]> <![CDATA[<b>Sam Wayburne</b>]]> <![CDATA[<b>Tuberculous pericarditis and HIV infection in Africa</b>]]> <![CDATA[<b>Management of toxoplasmic encephalitis in HIV-infected adults - a review</b>]]> <![CDATA[<b>Stress during internship at three Johannesburg hospitals</b>]]> <![CDATA[<b>Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa</b>]]> <![CDATA[<b>Is the Western Cape at risk of an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage</b>]]> OBJECTIVE: To determine the routine immunisation coverage rates in children aged 12 - 23 months in the Western Cape. DESIGN: Cross-sectional Household Survey using an adaptation of the '30 by 7' cluster survey technique. SETTING: Households across the Western Cape. SUBJECTS: A total of 3 705 caregivers of children aged 12 - 23 months who had been living in the Western Cape for at least 6 months. OUTCOME MEASURES: Vaccination status (1 = fully vaccinated; 0 = partially vaccinated) as recorded on a Road-to-Health card or by history. Reasons for not vaccinating were established from a questionnaire. RESULTS: The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for those due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%), and lack of motivation (14%). Of the clinic factors cited, the two commonest ones were missed opportunities (34%) and being told by clinic staff to return another time (20%). CONCLUSION: While the coverage indicates that a great deal of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions, including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. It will need to be sustainably improved before introducing rubella vaccine as part of the Expanded Programme on Immunisations (EPI) schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused. <![CDATA[<b>Implementation of the Mental Health Care Act (2002) at district hospitals in South Africa</b>: <b>Translating principles into practice</b>]]> Legislation prior to 2002 tended to reinforce the alienation, stigmatisation and disempowerment of mentally ill patients in South Africa. In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles - human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation - are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the 'rock face', and offers solutions to the problem of translating principles into practice. <![CDATA[<b>Prevalence of sexually transmitted infections in women attending antenatal care in Tete province, Mozambique</b>]]> OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in pregnant women. METHODS: A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemagglutination (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique. RESULTS: Blood and urine samples were collected from 1 119 and 835 women, respectively. The prevalence of CT was 4.1%, and that of NG 2.5%. The RPR test was positive in 5.2% of the women, and 7.1% had a positive TPHA test. Active syphilis was found in 4.7%. In univariate analysis, CT was associated with having had any level of education (p<0.05), reactive RPR and TPHA were associated with illiteracy (p<0.05), and TPHA was associated with age &gt;25. Multivariate analysis did not show any significant association. In comparison with published data from 1993, a decline was observed for CT (p<0.05), NG and syphilis (p<0.001). CONCLUSIONS: Compared with available data, a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour, as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However, STI rates are still high, and the problem needs more concrete and sustained efforts for its control. <![CDATA[<b>Dr James Barry</b>: <b>The early years revealed</b>]]> The extraordinary story of Dr James Barry still excites interest and controversy over one hundred and forty years after her death.1-5 Dr Barry's army career has been well documented,6 but her early life has remained obscure and subject to speculation.7-9 This study advances some ideas previously presented,10-12 and from a substantial collection of contemporary manuscripts13 reconstructs an important part of Dr Barry's early life.