The WHO Global Health Observatory Data Repository reports South Africa with 1.52 psychiatrists/100 000 of the population among other countries in Africa with 0.01 psychiatrists/100 000 (Chad, Burundi and Niger) to more than 30/100 000 for some countries in Europe. The overall situation, while being cognizant that mental health care is not only provided by specialist psychiatrists and that the current treatment gap may have to be addressed by strategies such as appropriate task sharing, suggests that there are actually too few psychiatrists to meet the country’s mental health care needs. To address the need to develop a strategy to increase the local specialist training and examination capacity, a situational review of currently practicing psychiatrists was undertaken by the [BLINDED] and the [BLINDED], using the South African Society of Psychiatrists (SASOP) membership database. The number, distribution and attributes of practicing psychiatrists were compared with international figures on the ratio of psychiatrists/100 000 population. In April 2019 there were 850 qualified psychiatrists actively practicing in the country and based on the national population figure of 55.6 million people (2016 Census), the psychiatrists/100 000 ratio was 1.53. This indicates no improvement between 2016 to 2019. From the SASOP database, we determined that about 80% of psychiatrists are working in the private sector - a much higher proportion than is usually quoted. As the vast majority of psychiatrists are practicing in urban areas in two provinces, Gauteng (n=350) and Western Cape (n=292), the ratio of psychiatrists/100 000 in these areas is relatively higher, at 2.6 and 5.0 respectively. Whereas rural areas in South Africa are largely without specialist mental health expertise, at a rate of 0.03/100 000 population. This investigation provides a discipline-specific situational review of the attributes and distribution of the current workforce of specialists in the country.
Many aromatic hydrocarbons assigned to the so-called high production volume chemicals (HPVCs) are frequently encountered constituents of wastewaters that end up in the sea. Although the pollutant-degrading capabilities of freshwater bacteria are well known, the catabolism of pollutants by marine bacteria has received limited attention. A marine bacterium with the ability to aerobically utilize phenol - an HPVC and common aromatic pollutant - as its sole source of carbon and energy, was isolated from water samples from Durban Harbour, South Africa. The isolate, designated strain KM2, was assigned to the genus Marinobacter based on a variety of phenotypic properties and by analysis of the 16S rRNA gene sequence. The isolate displays an absolute growth requirement for NaCl which cannot be offset by replacement of NaCl with other salts. In addition to 4-methylphenol and 3,4-dimethylphenol, it utilizes a range of aliphatic hydrocarbons such as butan-1-ol and hexadecane under aerobic conditions. The transient formation of an intermediate exhibiting the UV-Vis spectral characteristics for 2-hydroxymuconic semialdehyde in cultures growing on phenol suggests that the isolate catabolizes this compound via the meta cleavage pathway. These results indicate that members of the genus Marinobacter might participate in the elimination of aromatic pollutants in South African marine environments.
Background and aims: Moderate to severe postoperative pain complicates surgeries performed on children in upper-income countries. The successful management of postoperative pain in children requires a biopsychosocial approach. Situational anxiety and anxiety disorders among caregivers influence a child's perioperative experience. This study aims to determine whether there is an association between caregiver's preoperative anxiety and children's postoperative pain in a lower-middleincome country (LMIC) setting. Methods: In this cross-sectional, descriptive study, we recruited 76 children aged 4-12 years, undergoing elective ambulatory tonsillectomy or adenotonsillectomy. Primary caregivers completed validated measures of anxiety (the Beck Anxiety Inventory [BAI] and the Kessler Psychological Distress Scale [K10]) prior to the children undergoing surgery. Postoperative pain was measured using the Wong-Baker Faces Pain Rating Scale 4 hours after surgery. Results: Caregiver anxiety was found in 31.7% of participants using the K10 and in 42.1% using the BAI. Moderate to severe postoperative pain was reported by 51% of children. There was a statistically significant correlation of moderate strength between anxiety scores of caregivers and children's self-reported postoperative pain scores (r = .47 for K10, r = .44 for BAI, P < .001 for both). Two median quantile regression models confirmed that K10 was positively associated with caregiver anxiety (WBFS) with slope = 0.16 and pseudo R 2 = 0.25 (P = .002, 95CI: 0.06-0.26) as was BAI with slope = 0.12 and pseudo R 2 = 0.22 (P = .013 95CI: 0.03-0.22). Conclusions: This study showed that preoperative caregiver anxiety is significantly associated with postoperative pain in children undergoing elective, ambulatory surgery in a LMIC setting (correlation of moderate strength). Interventions aimed at reducing caregiver anxiety should become an important component of the biopsychosocial management of postoperative pain in children.
Background The World Health Organization’s action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa. Aim To describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015. Setting New Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting. Methods In this retrospective audit, we reviewed the medical records of all patients ( N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015. Results Most admissions were male ( n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New Beginnings. Conclusions These baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa.
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