Surgical infections at a regional hospital in Gauteng: reasons for delay to care and profile of pathology

Background: Present on arrival infection is a common indication for admission of surgical patients initially managed at primary care level. We aimed to describe the demographic and disease profile of patients presenting with infection requiring surgical management, describe determinants of patients' health-seeking behaviour, and identify barriers to care.Methods: A prospective descriptive questionnaire-based study was conducted at Edenvale General Hospital between February 2014 and October 2016. Minors were excluded. Results: Eighty-nine patients participated. Abscesses (26%), diabetic foot (22%), and cellulitis (16%) were the commonest categories of infection necessitating admission. The majority of patients were South African (88%), Black African (82%), males (58%), without medical aid (99%), who were not formally employed (58%), were from poor households (74%), inhabited some form of formal housing (90%), were in charge of decisions regarding personal health (80%), and first sought help at the primary care level (71%). Delay to presentation was noted in 69% of patients, and delay to referral in 46%. Age, race, history of diabetes, and main source of monthly income were significant variables in delayed presentation (p<0.05), and age and level of care on first contact in delayed referral (p<0.05) in the study sample. The most common reason for delay to presentation (84%) and referral (61%) was patients' belief that their problem would resolve spontaneously. Conclusions: Patients' socio-economic status, past medical history, demographics, level of first contact with the health care system, and perceptions of their own health contributed to delays in seeking and receiving care in the study sample. These delays may be addressed by interventions that target the availability, accessibility, acceptability and affordability of health care services

Intimate Partner Violence at a Tertiary Institution

Background. Intimate partner violence (IPV) is actual or threatened physical; sexual; psychological; emotional or stalking abuse by an intimate partner. Despite the high prevalence of IPV in South Africa (SA); there is a paucity of data on university students training in fields where they are likely to have to manage the after-effects of such events in their personal capacity in the future. Objectives. To ascertain the prevalence of IPV in an SA tertiary institution population with a diverse demographic profile.Methods. Students from the faculty of health sciences and the faculty of humanities; social work department; completed an anonymous questionnaire. Students were made aware of psychological counselling available to them.Results. Responses were obtained from 1 354 of 1 593 students (85.0%) (67.8% female; 45.9% black; 32.7% white; 16.6% Indian; 4.8% coloured). Of the respondents; 53.0% indicated that they were in a relationship. The prevalence of any type of IPV (sexual; physical or emotional abuse) among all respondents was 42.6%. Emotional abuse was reported by 54.9% of respondents; physical abuse by 20.0% and sexual abuse by 8.9%. Thirty-five females (6.5% of respondents who had suffered IPV) indicated that they had been emotionally; physically and sexually abused. Fourteen percent identified themselves as perpetrators of abuse; but only three perpetrators of sexual abuse reported having also been victims of sexual abuse. Most respondents (58.7%) knew where to get help.Conclusion. The extent of IPV among the medical and social work students sampled was found to be unacceptably high; both as victims and as perpetrators. As a result of their exposure to IPV; these individuals may have difficulty in managing patients who have been subjected to abuse

Lavage Drain Extension for Local Anaesthetic Instillation into Abdominal Wounds

BACKGROUND. A new device made by ThebeMedicare allows efficient local anaesthetic washout of wound areas; by utilising an attachment to an existing drain. The aim of this trial was to explore 'proof of concept' in patients undergoing abdominoplasty procedures. PATIENTS AND METHODS. Thirty-one patients who had undergone abdominoplasty procedures were selected for instillation of a local anaesthetic preparation; ropivacaine (Naropin; AstraZeneca) into the wound site on day 1 and 2 after surgery; followed by early mobilisation. Efficacy of the system; patient comfort and mobilisation were documented. RESULTS. The abdominoplasty patients experienced no discomfort from the procedure and claimed effective relief of pain for an average of 12 hours following instillation of local anaesthetic. All mobilised effectively. The device worked well; with no technical problems. CONCLUSION. The lavage drain extension has proved to be a cost-effective and efficient way of providing postoperative pain control and promoting early mobilisation in this patient group