Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420160003&lang=en vol. 106 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The Age of the Acquisitors - girls and women beware</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300001&lng=en&nrm=iso&tlng=en <![CDATA[<b>CME: Cardiology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300002&lng=en&nrm=iso&tlng=en <![CDATA[<b>SANS 444:2014: A new standard for small-ampoule labelling and a chance to reduce drug administration errors in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Barber as infectious agent</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300004&lng=en&nrm=iso&tlng=en <![CDATA[<b>The burden of drug overdose on critical care units in East London, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300005&lng=en&nrm=iso&tlng=en <![CDATA[<b>SA professor and US engineer transform disabled babies' lives</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Arnold Waldemar Wiid, MB ChB (1950 - 2013)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Is South Africa at risk for Zika virus disease?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Could we offer mitochondrial donation or similar assisted reproductive technology to South African patients with mitochondrial DNA disease?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300009&lng=en&nrm=iso&tlng=en <![CDATA[<b>Cardiovascular medicine in primary healthcare in sub-Saharan Africa: Minimum standards for practice (part 3)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Approach to chest pain and acute myocardial infarction</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300011&lng=en&nrm=iso&tlng=en Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable angina pectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention (PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring. <![CDATA[<b>An approach to the patient with a suspected tachycardia in the emergency department</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300012&lng=en&nrm=iso&tlng=en Patients present to the emergency department with either an ongoing tachycardia or a history suspicious of a tachycardia. Either way, the tachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardia is not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If a tachycardia is confirmed on an ECG, the clinician needs to classify it according to two variables: (i) regularity of the rhythm; and (ii) QRS width. This will allow a differential diagnosis to be made. <![CDATA[<b>Recommendations pertaining to the use of influenza vaccines and influenza antiviral drugs, 2016</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300013&lng=en&nrm=iso&tlng=en Vaccination is the most effective strategy to prevent influenza. It is recommended that influenza vaccine be administered each year before the influenza season, i.e. from March to June, although for individuals at increased risk of severe influenza in whom vaccination was missed, vaccine may be administered later. For a review of the 2015 influenza season and ongoing real-time updates of the 2016 influenza season when it starts, refer to the website of the National Institute for Communicable Diseases of the National Health Laboratory Service (www.nicd.ac.za). In this article we provide recommendations for the use of influenza vaccines in anticipation of the 2016 southern hemisphere influenza season. Guidance is based on available evidence to assist clinicians in making decisions regarding influenza vaccination. It should be noted that this article includes general recommendations for vaccination with influenza vaccines available in South Africa and may differ from groups targeted in specific vaccination programmes, e.g. the National Department of Health Programme. <![CDATA[<b>Digitotalar dysmorphism: Molecular elucidation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300014&lng=en&nrm=iso&tlng=en Dominantly inherited digitotalar dysmorphism (DTD), which is characterised by flexion contractures of digits and 'rocker-bottom' feet due to a vertical talus, was first described in a South African family of European stock in 1972. We review the clinical manifestations and document the molecular basis for DTD in this prototype family. This family was restudied in 1995 and 2006 and biological specimens were obtained for molecular studies. Since the distal arthrogryposes (DAs) are genetically heterogeneous, an unbiased approach to mutation identification was undertaken through whole-exome next-generation sequencing of DNA from a single DTD-affected female. Venous blood specimens were obtained for DNA banking and subsequent molecular studies. Analysis of the nine genes that had previously been shown to cause DAs revealed a pathogenic mutation in exon nine of TNNT3. The presence of the p.(Arg63His) missense mutation at position 63 of TNNT3 was confirmed through direct cycle sequencing of genomic DNA in six affected family members for whom DNA had been archived. <![CDATA[<b>Amendments to the Sexual Offences Act dealing with consensual underage sex: Implications for doctors and researchers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300015&lng=en&nrm=iso&tlng=en In terms of the Sexual Offences and Related Matters Amendment Act, consensual sex or sexual activity with children aged 12 - 15 was a crime, and as such had to be reported to the police. This was challenged in court in the Teddy Bear case, which held that it was unconstitutional and caused more harm than good. In June 2015, the Amendment Act was accepted by both the National Assembly and the National Council of Provinces, and came into operation on 3 July 2015. This article looks at the amendments to sections 15 and 16 of the Act and what the reporting obligations for medical professionals and researchers are in light of the amendments, as well as the duty to provide medical services and advice to adolescents. <![CDATA[<b>The value of internal medicine outreach in rural KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300016&lng=en&nrm=iso&tlng=en BACKGROUND: Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)'s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care. OBJECTIVES: Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014. METHODS: Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories. RESULTS: During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged &gt;40 years, but over half of inpatients seen were aged <40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%. CONCLUSIONS: The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised. <![CDATA[<b>A subepidermal blistering disorder</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300017&lng=en&nrm=iso&tlng=en BACKGROUND: Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)'s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care. OBJECTIVES: Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014. METHODS: Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories. RESULTS: During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged &gt;40 years, but over half of inpatients seen were aged <40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%. CONCLUSIONS: The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised. <![CDATA[<b>Breast cancer in high-risk Afrikaner families: Is <i>BRCA </i>founder mutation testing sufficient?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300018&lng=en&nrm=iso&tlng=en BACKGROUND: Germline pathogenic mutations in cancer susceptibility genes result in inherited cancer syndromes. In the Afrikaner population of South Africa (SA), three founder mutations in the BRCA genes that lead to hereditary breast and ovarian cancer syndrome (HBOCS) have been identified. OBJECTIVES: To investigate the uptake and type of molecular testing performed on patients for HBOCS, to determine the prevalence of the three Afrikaner founder BRCA mutations as well as non-founder BRCA mutations in the study population, and to analyse the utility of two mutation prediction models (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) and Manchester scoring method) in assisting with the decision for the most cost-effective testing option. METHODS: A retrospective file review was performed on counsellees of self-reported Afrikaner ancestry from Johannesburg, SA (2001 -2014), with a personal or family history of breast and/or ovarian cancer. Demographic and family history information was recorded and Manchester and BOADICEA scores were calculated for each patient. RESULTS: Of 86 unrelated counsellees whose files were reviewed, 54 (62.8%) underwent BRCA genetic testing; 18 (33.3%) tested positive for a mutation, and 14 of these (77.8%) for an Afrikaner founder mutation. Twelve counsellees had the BRCA2 c.7934delG mutation. Four non-founder mutations were identified. BOADICEA scores were significantly higher in counsellees who tested positive for a mutation than in those who tested negative. CONCLUSIONS: Founder mutation testing should be performed as a first-line option. BOADICEA is very useful in identifying counsellees at high risk for a BRCA mutation and also assists with the decision to pursue further testing following a negative founder mutation result. These findings assist in guiding an informed genetic counselling service for at-risk individuals with an Afrikaner background. <![CDATA[<b>Knowledge regarding basic concepts of hereditary cancers, and the available genetic counselling and testing services: A survey of general practitioners in Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300019&lng=en&nrm=iso&tlng=en BACKGROUND: In families with hereditary cancer, at-risk individuals can benefit from genetic counselling and testing. General practitioners (GPs) are ideally placed to identify such families and refer them appropriately. OBJECTIVE: To assess the practices, knowledge and attitudes of GPs regarding common hereditary cancers. METHODS: An exploratory research design was used. An existing questionnaire was adapted, piloted and mailed to 196 GPs in Johannesburg, South Africa. The 61 GPs (31.1%) who completed and returned the questionnaire constituted the final sample. Data were analysed using descriptive statistics. RESULTS: The GPs obtained some information on cancer family history from their patients, but not enough to assess the risks. Altogether 22 (36.1%) of the GPs referred patients to appropriate facilities for assessment and testing, while 32 (52.5%) were aware of genetic testing services. Most (38/61, 62.3%) were not familiar with the genetic counselling facilities available, but they felt patients should have counselling before testing. Less than half knew about possible paternal inheritance, or the low rate of hereditary mutations and their penetrance. Overall, the majority of GPs (53/61, 86.9%) were interested in learning more about cancer genetics and available services, and they expected to play an increasing role in the field in the future. CONCLUSIONS: Many of the GPs in this study had limited knowledge about inherited cancers, cancer risk management and genetic services. Appropriate education needs to be increased so that they are better equipped to identify and refer families at risk. <![CDATA[<b>A clinical and molecular investigation of two South African families with Simpson-Golabi-Behmel syndrome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300020&lng=en&nrm=iso&tlng=en BACKGROUND: Simpson-Golabi-Behmel syndrome (SGBS) is an X-linked recessive overgrowth syndrome manifesting primarily in boys and characterised by macrosomia, distinctive facial features and multiple congenital abnormalities. Although this rare condition is thought to be underdiagnosed, making a diagnosis is important as affected boys have a 7.5% risk of developing visceral tumours and surveillance is warranted. Mutations in GPC3 are found in up to 70% of boys affected with SGBS. OBJECTIVES: A clinical and molecular investigation of two boys with SGBS, probands B and S, and their mothers. Documentation of the clinical phenotype could assist with diagnosis in affected boys and will lead to early initiation of tumour surveillance. METHODS: Hospital folders were reviewed and clinical consultations arranged for both probands and their mothers. Molecular investigations initially searched for whole-exon deletions in GPC3 followed by gene sequencing. RESULTS: The clinical phenotype of both probands was consistent with that previously reported in the literature. The main features pointing towards the diagnosis were macrosomia, coarse facial features and macroglossia with a midline groove in the tongue. Proband B developed a Wilms tumour. He was found to have a novel mutation causing a premature stop codon. CONCLUSIONS: This research represents the first published report of SGBS in South Africa. Early recognition and confirmation of this condition is important in order to institute tumour surveillance and assist families with accurate recurrence risks. <![CDATA[<b>Alpha-thalassaemia trait as a cause of unexplained microcytosis in a South African population</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300021&lng=en&nrm=iso&tlng=en BACKGROUND: Red cell microcytosis is a common abnormality detected in a full blood count, which often prompts clinicians to investigate further for a cause. In the absence of iron deficiency and anaemia of chronic disease, the differential diagnosis includes β-thalassaemia trait and α-thalassaemia trait. METHODS: We investigated the contribution of α-thalassaemia trait in South African subjects with unexplained microcytosis. Iron studies, haemoglobin subfractionation and multiplex polymerase chain reaction (PCR) analysis for α-globin gene deletions were performed on 97 controls and 86 patients. RESULTS: After excluding iron deficiency, anaemia of chronic disease and β-thalassaemia trait, 78.0% of subjects with unexplained microcytosis were confirmed on PCR analysis to have α-thalassaemia trait. CONCLUSION: Alpha-thalassaemia trait accounts for the majority of unexplained microcytosis. <![CDATA[<b>Validation of the CoaguChek XS international normalised ratio point-of-care analyser in patients at Charlotte Maxeke Johannesburg Academic Hospital, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300022&lng=en&nrm=iso&tlng=en BACKGROUND: Measurement of the international normalised ratio (INR) is essential in the management of patients on long-term warfarin therapy. The CoaguChek XS portable coagulometer is a point-of-care test for INR measurement. It offers the advantage of improved patient accessibility, particularly in peripheral clinics. OBJECTIVES: To evaluate the clinical utility of the CoaguChek XS for monitoring of patients on standard warfarin therapy (INR 2 - 3) as well as those with mechanical heart valve replacements (INR 2.5 - 3.5). METHODS:We compared the performance of the CoaguChek XS device with that of the STAGO laboratory analyser with regard to accuracy and precision in 304 patients referred for routine testing. RESULTS: The mean INR value of the CoaguChek XS of 2.75 (standard deviation (SD) 1.18) was comparable to that of the STAGO (2.65 (SD 1.04)). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was small, and the imprecision was within acceptable limits. Within the target range (2.0 - 3.5), 93.9% of the CoaguChek XS INR readings were within 0.5 units of the standard laboratory method result. There was, however, an increase in the variability of the differences between the two test methods when the INR was >3.6. CONCLUSION: The CoaguChek XS point-of-care device can be used to provide accurate and precise INR measurements over a wide range for monitoring of valvular and non-valvular patients on long-term warfarin therapy. <![CDATA[<b>High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix Lifestyle Project</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300023&lng=en&nrm=iso&tlng=en BACKGROUND: Previous studies show a high prevalence of cardiovascular (CV) risk factors in South African (SA) Asian Indians, with the emergence of premature coronary artery disease in young Indian subjects. OBJECTIVE: To determine the prevalence of CV risk factors in this population. METHODS: This was a cross-sectional study of randomly selected adults aged 15 - 64 years from the suburb of Phoenix in Durban, KwaZulu-Natal Province, SA. All participants had demographic, anthropometric and biochemical measurements using the modified World Health Organization (WHO) STEPwise survey methods. Hypertension, obesity, lipid abnormalities and diabetes mellitus (DM) were diagnosed using WHO criteria. Age-standardised frequencies for glycaemic indices were calculated according to the WHO standard world population distribution. RESULTS: Of the 1 428 subjects who responded (response rate 72.1%), complete data for analysis were available on 1 378 (1 001 women). The mean age was 45.5 (standard deviation 13) years. There were high prevalences of hypertension (47.5%), DM (20.1%), total body obesity (raised body mass index) (32.4%) and increased waist circumference (73.1%). The 'thin-fat' Asian phenotype (isolated abdominal obesity) was found in only 4.8% of participants. High prevalences of total body obesity (32.1%), increased waist circumference (31.3%) and insulin resistance (28.2%) were documented in the youngest age group. Over half of the males and 14.6% of females were current smokers. Diabetic dyslipidaemia was found in 61 subjects (4.4%). In multivariate analysis, age, triglycerides and waist circumference measurement were significant independent risk factors associated with DM and, together with fasting glucose, also predicted hypertension. CONCLUSION: Compared with Asian Indian subjects with similar environmental exposure in previous studies, the magnitude of change in risk factor prevalence over the past two decades has been of epidemic proportions. <![CDATA[<b>Comorbidity of respiratory and cardiovascular diseases among the elderly residing close to mine dumps in South Africa: A cross-sectional study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300024&lng=en&nrm=iso&tlng=en BACKGROUND: Pollution arising from mine dumps in South Africa (SA) has been a source of concern to nearby communities OBJECTIVE: To investigate whether comorbidity of respiratory and cardiovascular diseases among elderly persons (>55 years) was associated with proximity to mine dumps. METHODS: Elderly persons in communities 1 - 2 km (exposed) and >5 km (unexposed) from five preselected mine dumps in Gauteng and North West provinces in SA were included in a cross-sectional study. RESULTS: Exposed elderly persons had a significantly higher prevalence of cardiovascular and respiratory diseases than those who were unexposed. Multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma + hypertension (odds ratio (OR) 1.67; 95% confidence interval (CI) 1.22 - 2.28), asthma + pneumonia (OR 1.86; 95% CI 1.14 - 3.04), emphysema + arrhythmia (OR 1.38; 95% CI 1.07 - 1.77), emphysema + myocardial infarction (OR 2.01; 95% CI 1.73 - 2.54), emphysema + pneumonia (OR 3.36; 95% CI 1.41 - 7.98), hypertension + myocardial infarction (OR 1.60; 95% CI 1.04 - 2.44) and hypertension + pneumonia (OR 1.34; 95% CI 1.05 - 1.93. CONCLUSION: Detrimental associations between comorbidity of the health outcomes and proximity to mine dumps were observed among the elderly in SA. <![CDATA[<b>A cohort study of elderly people in Bloemfontein, South Africa, to determine health-related quality of life and functional abilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300025&lng=en&nrm=iso&tlng=en BACKGROUND: An ageing population has become an issue of global importance. According to statistics, the number of people aged &gt;60 years will outnumber children <5 years by 2020. OBJECTIVE: To identify chronic and comorbid diseases that contribute to reduced quality of life (QoL) and functional ability in elderly people living in nursing homes in Bloemfontein, Free State, South Africa (SA). METHODS: This study used utility- and capability-based questionnaires EQ-6D and a modified ICECAP-O to identify chronic and comorbid diseases that contribute to reduced QoL and functioning in the elderly. An information leaflet was supplied to respondents, along with an informed consent form that each signed and dated. The respondents participated voluntarily and anonymously. Structured interviews were conducted. No algorithm for the EQ-6D or ICECAP-O is available for the SA population. Statistical Package for the Social Sciences version 16 was used to perform the sum score calculations. Data were presented using standard descriptive statistics (frequencies, medians, means, standard deviations and standard errors. RESULTS: The total sample comprised 104 elderly respondents, 72.1% females and 27.9% males (mean age 77 years). Most suffered from at least two of the following diseases: hypertension (68.8%), joint disease (46.2%), heart disease (22.1%), cancer (19.2%) and psychological disorders (18.3%). The EQ-6D indicated that 'pain' (48.3%) and 'mobility' (36.2%) were the domains chiefly affected. Elderly subjects with extreme problems reported all domains to be equally affected, with the exception of 'cognition' (29.1%). CONCLUSIONS: Our results confirm that diseases result in pain and affect mobility and cognition in old age. Access to healthcare and services for older people involves recognition of the importance of health promotion and activities that will help prevent disease, and there should be a focus on maintaining independence, prevention and delay of disease, and disability treatment. This includes improving QoL in elderly people with existing disabilities. Reform of medical care services is essential to improve healthcare for the elderly and thus improve their QoL. <![CDATA[<b>Children with disabling chronic conditions in the Western health subdistrict of Cape Town, South Africa: Estimating numbers and service gaps</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300026&lng=en&nrm=iso&tlng=en BACKGROUND: Children with disabling chronic conditions often have extensive, complex and unmet healthcare and educational needs. They can be defined as a subset of the group of children with chronic health conditions whose condition results in some degree of functional or activity limitation. There is limited information in South Africa and other low- and middle-income countries with regard to the percentage of such children that access specialist health and special educational services, particularly in an urban setting, and what services exist for them. OBJECTIVES: To count the number of children with disabling chronic conditions who were accessing specialist health and special educational services in the Western health subdistrict of Cape Town, and to briefly describe the access to services outside of hospital-based specialist services. METHODS: A cross-sectional observational study was conducted between January 2010 and December 2011. The target population included all children <19 years of age with disabling chronic conditions, living in the Western subdistrict of Cape Town, who were accessing specialist health and special educational services. Such children were identified from the relevant referral hospitals, educational institutions, and private and non-profit organisations in the area RESULTS: A total of 1 138 children with disabling chronic conditions were identified. In the context of an under-19 population of 112 249, this corresponds to a rate of 10 per 1 000, whereas the expected rate of children with disabling chronic conditions would be about 50 per 1 000. Only 14% of children in special educational institutions attended specialist paediatric services during a 2-year period. Allied health and medical services for children outside of hospitals were very limited. CONCLUSIONS: There are a significant number of children with disabling chronic conditions who do not access health and special educational services in the Western health subdistrict of Cape Town. Medical and allied health support for children in institutions is very limited. Current information systems are inadequate to describe the need. <![CDATA[<b>Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000300027&lng=en&nrm=iso&tlng=en BACKGROUND: In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. OBJECTIVE: To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. METHODS: We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. RESULTS: Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. CONCLUSION: Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.