Background: Tuberculosis (TB) remains a serious public health concern because it continues devastating communities. This survey was conducted in the sub-district 2 of the Tshwane health district, South Africa. It aimed at determining the influence of patients’ living conditions on TB treatment outcomes. Human immunodeficiency virus (HIV) status, food security and exposure to cigarette smoke were considered as living conditions; and cure, death, default, failure and relapse were considered TB treatment outcomes.Methods: Record review using the Aitahealth database, clinic registers as well as a piloted, structured and administered questionnaire.Results: Convenience sampling applied; 180 respondents were obtained. Tuberculosis respondents with negative HIV status had a cure rate of 67.3% whilst those with positive HIV status had 37%. Tuberculosis respondents with good food security had 45.9% of cure rate. Tuberculosis respondents exposed to cigarette smoke had a death rate of 65.2%, while respondents not exposed to cigarette smoke showed 75% of cure rate.Conclusion: HIV status, food security and exposure to cigarette smoke, as components of living conditions, showed an association with TB treatment outcomes in the selected sample; in the sense HIV infection reduced the cure rate, increased the death and default rates of TB patients in the same sample. Good food security increased the cure rate of TB patients, but exposure to cigarette smoke decreased the cure rate and increased the death rate amongst respondents having TB treatment in the current survey.

Isoniazid preventive therapy (IPT) can reduce the overall risk of active tuberculosis (TB) in people living with HIV/ AIDS (PLHIV) by up to 62%. As a result the World Health Organization (WHO) and the Joint United Nations Programme on HIV/ AIDS (UNAIDS) have recommended IPT provision as a global strategy to reduce the prevalence of TB for PLHIV. However, whilst there are 84 countries supporting the provision of IPT in their policies, less than 1% of PLHIV in those countries are currently receiving IPT. Approximately 65% of TB patients in South Africa are HIV co-infected. Despite this fact, doctors are hesitant to prescribe IPT to TB-negative HIV-infected patients. Many doctors are also unaware of the current IPT guidelines of South Africa. This study sought to determine the level of knowledge, attitudes and practices of doctors regarding IPT for patients infected with HIV at Odi Hospital in Gauteng. Methods: A cross-sectional descriptive study was undertaken with a standardised questionnaire administered to 51 doctors working at Odi Hospital. Results: There were 51 respondents, many doctors (43.1%) having an excellent knowledge of IPT. Although one-third of the doctors were dispassionate about IPT provision, the majority of respondents (54.9%) had positive attitudes towards IPT provision. On average the doctors had good practices regarding IPT provision (35.3%). There were 12 (23.5%) doctors who were trained for IPT implementation. Although training was not associated with doctors' knowledge or attitudes towards IPT, it was associated with the practice of IPT implementation. Conclusion: Irrespective of their position, doctors at Odi District Hospital need formal training on the implementation of IPT, as this increases their confidence in IPT and their implementation practices.

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

BackgroundEctopic pregnancy (EP) is a life-threatening condition; at Odi Hospital, approximately 7–10 EPs are managed weekly. Our study is the first to assess the management of this life-threatening condition at Odi Hospital.AimThis study aimed to determine the incidence of EP and to assess the profile of women who presented with EP at Odi District Hospital from 01 January 2010 to 31 December 2014.SettingThe study was conducted at Odi District Hospital, located in Mabopane, a township in Gauteng province, 45 km north of Tshwane, South Africa (SA).MethodsThis was a cross-sectional study.ResultsWe analysed 263 completed patient records. The incidence rate was 22 per 1000 live births. The mean age was 28.9 years (SD ± 6.09), 57% were within the age group of 25–34 years, 90.9% were single and 85.2% were unemployed. Abdominal pain was the most common presenting complaint (81.1%). Ninety-nine (37.8%) were in a state of haemorrhagic shock. Possible risk factors were not documented in the patient files for 95%. A third (34.2%) were operated on within 4 hours of consultation. Early management was associated with poor record-keeping (p = 0.02). There was a delay in confirming the diagnosis in 48.7%. It was associated with gestational age (p = 0.0017), previous abdominal surgery (p = 0.0026), normal haemoglobin level at the time of consultation (p = 0.0024), considerable haemoperitoneum at operation (p < 0.00001) and per vaginal bleeding (p = 0.003).ConclusionThe study highlighted the need to emphasise the importance of good record-keeping and documentation in patients, as well as the urgent need for ultrasound skills training among clinicians to implement the Essential Steps in Managing Obstetric Emergencies programme at this hospital to improve the management of EP and other obstetric emergencies.

BackgroundThe emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail.AimThe objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries.SettingThe emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa.MethodsThis was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries.ResultsFive different types of glass were reported to have caused the injuries, namely car glass (7.69%), glass ampoules (3.85%), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47%) and most victims were mostly young males (80.23%). The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%), between 18:00 and 04:00. The face (34.23%) and the scalp (26.84%) were the sites that were injured most often.ConclusionAssault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%).

Background: The most recommended type of anaesthesia by many obstetric guidelines for Caesarean section (CS) is spinal anaesthesia. This to achieve a higher level of pain and comfort control for the patient during and after CS. Little scientific research has assessed mothers' satisfaction with spinal anaesthesia. Methods: This was a cross-sectional study conducted at the maternity unit of Tembisa Hospital, South Africa in March 2014. Results: Overall satisfaction with spinal anaesthesia was 77.1%. The mean age (SD) was 27.9 (5.8) years. CS was mostly done as an emergency 63 (76.8%). The level of satisfaction varied greatly. There was a linear regression between age and answer scores regarding preoperative explanations (r = 0.2. R-squared = 0.05, p-value of 0.03. There was an association between preoperative explanations and gravidity (OR 13.1; CL 95%; CI 1.9-41.7; p = 0.0018). In perioperative time, elective CS was associated with verbal communication with the doctor administrating the spinal anaesthesia (OR 13.5; CL 95% CI 0.7-237.3; p = 0.0017). Pain at the injection site of lumbar puncture (OR 4; CL 95% CI 1.2-13; p = 0.025) and the atmosphere in the theatre (OR 4.1; CL 95% CI 1.1-15.5; p = 0.02) were determinant for future choice of spinal anaesthesia. Conclusion: Integrating pre-anaesthesia explanations in antenatal care and pre-anaesthesia counselling during labour and the use of adequate medication to reduce discomfort, pain and shivering may increase maternal satisfaction with spinal anaesthesia for CS.

BackgroundAccording to the South African Policy and guidelines for the implementation of the PMTCT programme of 2008, all pregnant women who tested HIV-positive also had to have their CD4 count measured in order to inform the option of Prevention of Mother-to-Child Treatment (PMTCT): to be put on lifelong treatment or to be placed on temporary PMTCT. They were required to return for the results within two weeks, but some did not return, implying that they did not benefit from the programme. This study was conducted to establish their reasons for not returning.ObjectivesTo explore the reasons given by women attending antenatal care for not returning for the results of their CD4 count done for PMTCT at Embhuleni Hospital and satellite clinics, Mpumalanga.MethodsThe study was a qualitative study using the free-attitude interview technique. Women who had not returned for their results were traced and interviewed on their reasons for not returning. Interviews were conducted in Siswati, audio-taped, transcribed verbatim and translated into English for analysis. Data saturation was reached by the eighth participant. A thematic analysis was conducted.ResultsThe themes that emerged were: participants were not informed about the PMTCT process; poor service delivery from the healthcare practitioners; unprofessional healthcare practitioners’ conduct; shortages of medication in the healthcare facilities; fear of social stigma; and poor patient socioeconomic conditions.ConclusionThe reasons for not returning were mainly based on participants’ experiences during consultations at the healthcare centres and their perceptions of the healthcare practitioners. Healthcare practitioners should adhere to the tenets of professionalism in order to address this problem.

Background: It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors’ misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions.Methods: A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty.Results: The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary health- care and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors’ level of surgical ability. Based on individual interviews, 11 themes were extracted and a ‘wheel’ model was created, depicting the core values of the FM discipline.Conclusion: The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills.