Background Hypertension contributes significantly to cardiovascular and renal diseases. It can be controlled by lifestyle modifications, however in poor communities there is lack of awareness, and treatment and control of hypertension is often poor. The aim of this study was to determine hypertension knowledge, attitudes and practices in a disadvantaged rural community in Matebeleland South province of Zimbabwe. Methods We conducted a descriptive cross-sectional survey on hypertensive patients in the community. A pre-tested and validated interviewer-administered questionnaire was used to collect demographic, awareness, treatment and control data among consenting hypertensive patients. Results 304 respondents were enrolled into the study (mean age, 59 years), and a majority were women (65.4%). The treatment default rate was 30.9%, and 25% of respondents on medication did not know their blood pressure control status. Knowledge on hypertension was poor, with 64.8% of respondents stating that stress was its main cause, 85.9% stated that palpitations were a symptom of hypertension and 59.8% of respondents added salt on the table. The more education respondents had received, the more likely they were knowledgeable about hypertension (odds ratio for secondary education, 3.68 [95% CI: 1.61–8.41], and for tertiary education, 7.52 [95% CI: 2.76–20.46], compared to those without formal education). Those who believed in herbal medicines (50.7%) and those who used traditional medicines (14.5%) were 53% (95% CI: 0.29–0.76) and 68% (95% CI: 0.29–0.76) less likely to be knowledgeable about hypertension compared to those who did not believe in or use traditional medicines, respectively. Conclusion Members of the community had poor knowledge on hypertension. This was associated with a lack of education and with strong beliefs in herbal and traditional medicines in the community, which influenced attitudes and practices on hypertension. Dietary risk factors were linked to poor knowledge. Hypertensive medicine shortages at the clinic resulted in worsened hypertension care and poor hypertension outcomes in the community.

BackgroundThe prevalence of hypertension in South Africa has been estimated to be 20% of the adult population with over six million people being affected. Poor adherence to treatment plans lead to inadequate blood pressure control and high morbidity. Many studies have looked at factors contributing to poor blood pressure control in South Africa but few studies actually focus on district hospitals in Kwazulu-Natal in particular, despite the fact that the province has the most heterogeneous population in South Africa.MethodThe study was a descriptive cross-sectional study conducted at the chronic outpatient clinic of an urban district hospital involving 370 participants aged 18–90 years.ResultThe study showed poorly controlled blood pressure in 58% of the participants. Only 35% knew their blood pressure results on the day of interview and 19.2% were aware of their target blood pressure. Good adherence was self-reported by 95% of the participants, whist 51.4% reported significant side-effects to medication.ConclusionThe majority of patients had poor knowledge about blood pressure and little awareness of their blood pressure reading. These may be precursors to poor blood pressure control and this needs further investigation. A high level of self-reported adherence to medication did not translate into effective blood pressure control. A significant number reported medication side-effects which may have contributed to the poor blood pressure control. The high adherence rate may therefore have been over reported. An objective way to measure adherence will be necessary for future research.

Background Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities. Aim The aim of this project was to improve the community’s knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes. Setting The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe. Methods We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group. Results There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community’s confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established. Conclusion The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes.

Background. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. Objective. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. Methods. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZuluNatal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and softtissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. Results. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Conclusion. Children are particularly vulnerable to snakebite, and the consequences can be devastating. While the majority of patients in this study were shown to have secondary bacterial infection, debridement and subsequent wound management is considered the mainstay of treatment. Common organisms are Enterobacteriaceae and enterococci. There appears to be a role for antibiotics in the management of these patients. A good antibiotic policy is strongly advocated.

BackgroundDiabetic foot disease (DFD) is a major challenge for the healthcare system, with enormous economic consequences for people living with diabetes, their families, and society, affecting both quality of life and quality of care. The study aim was to assess the level of awareness of DFD amongst patients with type 2 diabetes mellitus (T2DM).MethodsAn observational descriptive cross-sectional study was conducted at the chronic outpatients department of a regional hospital in Durban, South Africa.ResultsTwo hundred participants with T2DM participated in the study. Ninety-one per cent of participants were either overweight or obese. Ninety-two per cent of participants had concomitant hypertension (57.5%), dyslipidaemia (26.7%) and eye disease (7.2%). Seventy-six per cent reported altered sensation in their lower limbs, and 90% reported having no previous DFD education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. Participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI) 4.2–4.7) and practice (mean 11.09, s.d. 2.233, CI 10.8–11.5) on diabetic foot care (DFC). Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p <0.05).ConclusionThe study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimise the burden of DFD, improved screening and prevention programmes as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.