Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 6 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Creeping mediocrity in public governance threatens the public health</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>An 'amnesty' for health professionals?</b>]]> <![CDATA[<b>Near-fatal TURP syndrome associated with similarities in irrigant fluid packaging appearance</b>]]> <![CDATA[<b>Oral fluids</b>: <b>How pseudoscience gulls the gullible</b>]]> <![CDATA[<b>Health care ideology clash costs patients dearly</b>]]> <![CDATA[<b>How (not) to handle doctors ...</b>]]> <![CDATA[<b>HPCSA fee amnesty for returnees fails dismally</b>]]> <![CDATA[<b>Incompetent maintenance/inept response - Eighty more Eastern-Cape babies die</b>]]> <![CDATA[<b>A review of the prevention of mother-to-child transmission programme of the Western Cape provincial government, 2003 - 2004</b>]]> <![CDATA[<b>Equity and quality of care through racial profiling</b>]]> <![CDATA[<b>A city of superlatives</b>]]> <![CDATA[<b>Brain contusion/sudden cardiopulmonary arrest syndrome in <i>A Painful Case</i> from James Joyce's <i>Dubliners</i></b>]]> <![CDATA[<b>Mental health is integral to public health</b>: <b>A call to scale up evidence-based services and develop mental health research</b>]]> <![CDATA[<b>Abandonment of antiretroviral therapy</b>: <b>A potential barrier to scale-up in sub-Saharan Africa</b>]]> <![CDATA[<b>Cryptococcosis in Gauteng: Implications for monitoring of HIV treatment programmes</b>]]> <![CDATA[<b><i>Candida</i></b><b> species: Species distribution and antifungal susceptibility patterns</b>]]> <![CDATA[<b>Pyruvate kinase deficiency in a South African kindred caused by a 1529A mutation in the PK-LR gene</b>]]> <![CDATA[<b>Prevention of mother-to-child transmission of HIV programme: Low vertical transmission in KwaZulu-Natal, South Africa</b>]]> OBJECTIVE: To describe the operational effectiveness of the prevention of mother-to-child transmission (PMTCT) of HIV programme at McCord Hospital during the period 1 March 2004 - 31 August 2005. DESIGN: Observational cohort study. SETTING: McCord Hospital, Durban, South Africa. SUBJECTS: Antenatal patients attending the PMTCT clinic. MEASUREMENTS AND RESULTS: During the 18 months all 2 624 women (100%) attending the antenatal clinic received HIV counselling, resulting in 91% (2 388) being tested for HIV. The prevalence of HIV in the total cohort was 13% (95% confidence interval (CI) 11.6 - 14.2). Of the HIV-positive mothers 302 (89%) completed their pregnancy at the hospital, and in this group there were 3 intrauterine deaths, 1 miscarriage, 1 maternal death (with the baby in utero) and 297 live births with 1 early neonatal death. Only 11% (36 out of 338) were lost to follow-up. A quarter (668) of the partners of all women attending the antenatal clinic were tested for HIV. Delivery in 70% (209) of live births was by caesarean section. Nevirapine was administered to 98% (290) of live babies and 75% (224) received zidovudine (AZT) as well. The 6-week polymerase chain reaction (PCR) baby test uptake was 81% (239 out of 296 live babies). Of those tested, 2.9% (95% CI 1.3 - 6.2) tested HIV positive. CONCLUSION: Despite challenges faced by PMTCT providers in a resource-constrained setting, this state-aided hospital provides a comprehensive and integrated service and has achieved outcomes that compare favourably with those in the developed world. <![CDATA[<b>Pneumococcal conjugate vaccine - a health priority</b>]]> Pneumonia is a major cause of childhood mortality and morbidity. Streptococcus pneumoniae is the most important bacterial pathogen causing pneumonia in children. The HIV epidemic has increased the burden and severity of childhood pneumococcal pneumonia and invasive disease fortyfold. Pneumococcal conjugate vaccine (PCV) is a highly effective intervention to reduce invasive pneumococcal disease and pneumonia. Studies evaluating a 9-valent PCV in South Africa and The Gambia reported a 72 - 77% reduction in vaccine-serotype-specific invasive disease in vaccinated children. As many of the pneumococcal serotypes associated with antibiotic resistance are included in PCV, vaccination has also been associated with a reduction in antimicrobial-resistant invasive disease. PCV may also reduce childhood mortality, especially in places with limited access to health care, as shown in Gambian study in which PCV reduced childhood mortality by 16%. In addition to the direct effects of PCV, there is a substantial reduction in disease burden through indirect protection of non-vaccinated populations. PCV is immunogenic in HIV-infected children and provides protection against invasive disease or pneumonia in a substantial number of children. Although the efficacy of PCV for prevention of invasive disease or pneumonia is lower in HIV-infected compared to -uninfected children, the overall burden of disease prevented is much greater in HIV-infected children because of the higher burden of pneumococcal disease in these children. Consequently, vaccine-preventable invasive disease is almost 60 times higher in HIV-infected compared to -uninfected children, while the reduction in pneumonia in HIV-infected children is 15 times greater. However, the long-term efficacy of PCV wanes in HIV-infected children who are not taking antiretroviral therapy, and booster doses are probably indicated. Although there is concern about the potential for replacement disease due to non-vaccine serotypes, a substantial and sustained reduction in invasive disease has occurred overall in populations with widespread childhood immunisation. Routine childhood immunisation is now the standard of care in most developed countries. However, PCV is much less accessible to children in developing countries due to cost and availability. Cost-effectiveness analysis indicates that use of PCV is potentially highly cost-effective, at tiered pricing, even in very low-income countries. Widespread availability and vaccination with PCV is urgently needed for all children under 2 years of age in South Africa. In addition, the use of PCV for all HIV-infected children under 9 years should be prioritised. <![CDATA[<b>The evolving impact of HIV/AIDS on outpatient health services in KwaZulu-Natal, South Africa</b>]]> BACKGROUND AND OBJECTIVE: The high HIV prevalence in KwaZulu-Natal (KZN) places immense pressure on the health system. The burden of HIV/AIDS on health services is evolving as the epidemic progresses and as antiretroviral treatment becomes more widely available. For health policy makers and managers, timely and appropriate information is needed to facilitate adaptive management of health services. Through longitudinal research covering outpatient health services in KZN we examined the dynamics of the evolving HIV/AIDS burden and the resource implications of this burden, necessary for resource allocation decisions. METHODS: Data were collected between 2004 and 2005 in outpatient services across six health facilities in the province. The burden of HIV/AIDS was measured by assessing the proportion of outpatients presenting as HIV positive, determined by a clinical diagnosis (and test result where available). The burden was also measured by looking at the types of diseases presenting at outpatient facilities. Moreover, the study assessed the burden experienced by health care workers and financial implications for health facilities. RESULTS AND CONCLUSIONS: The study demonstrates that the burden on outpatient services is significant but has not been increasing over time, suggesting that people are not accessing care if and when they need it. However, in terms of resources, this burden has been increasing and shifting from tertiary services to more primary services. In order to accommodate the demands of HIV/AIDS, our focus therefore needs to turn towards outpatient services, in particular at the primary care level. <![CDATA[<b>Depression and anxiety in multisomatoform disorder: Prevalence and clinical predictors in primary care</b>]]> OBJECTIVE: Multisomatoform disorder (MSD) is characterised by >3 medically inexplicable, troublesome physical symptoms, together with a >2-year history of somatisation. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample MSD, and to compare demographic and clinical outcomes in those patients with and without co-morbidity. METHODS: Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropole. Participants were assessed for the presence of co-morbid depressive and anxiety disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity, disability, reported sick days and health care visits, pain experience, patient satisfaction with health services, and clinician-experienced difficulty. RESULTS: A current co-morbid depressive disorder was present in 29.4% (N=15) of patients, and a current co-morbid anxiety disorder in 52.9% (N=27). MSD patients with a co-morbid depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinician-reported difficulties, and more dissatisfaction with health care services than those without the disorder. A larger number of co-morbid disorders was associated with greater overall disability. CONCLUSION: High rates of co-morbid depressive and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had co-morbidity, which is consistent with the view that MSD should be viewed as an independent disorder. However, co-morbid depressive disorders were associated with increased symptom severity and functional impairment, consistent with previous reports from developing countries, emphasising the importance of co-morbidity in MSD. <![CDATA[<b>Homicide trends in the Mthatha area between 1993 and 2005</b>]]> BACKGROUND: Absolute poverty and gross income inequity can foment violence through various and multiple mechanisms. Poor people are highly prone to exploitation and manipulation by those who are wealthy and more powerful. The poor are as susceptible to being victims as being perpetrators of crime. OBJECTIVE: To study the trends in homicides in the Mthatha area. METHOD: A review of records of 5 583 medico-legal autopsies in Mthatha General Hospital of murder victims between 1993 and 2005. RESULTS: During the 13-year period, 12 063 autopsies were performed on people who died following trauma and other fatal injuries. Of this total, 5 583 (46%) were homicides. The average annual homicide rate during this period was 108/100 000 population. The rate increased from 94/100 000 in 1993 to 133/100 000 in 2005. Firearm-related deaths averaged 48/100 000, stab wounds 35/100 000, and blunt trauma (assault) 25/100 000 per year. Gunshot-related homicides increased from 27/100 000 in 1993 to a peak of 68/100 000 in 2001, decreasing to 42/100 000 in 2005. Stab-related homicides ranged from 42/100 000 in 1993 to a 'low' of 26/100 000 in 1995, then rose to 53/100 000 in 2005; assault with blunt objects increased from 25/100 000 to 38/100 000 in the same period. Murdered males (82%) outnumbered females in the proportion of 5:1, although there was an increasing incidence of females. About half of these deaths were in the 21 - 40-year-old range. CONCLUSION: There has been a progressive increase in homicides in the Mthatha area. To a certain extent, poverty has contributed to the causation of these deaths.