Home therapy for inherited bleeding disorders in south Africa: results of a modified delphi consensus process

Background. Optimal care of patients with inherited bleeding disorders requires that bleeding episodes are treated early, or still better prevented, through extension of patient care beyond hospital-based treatment to home-based therapy. In South Africa (SA), adoption of home therapy is variable, in part owing to lack of consensus among healthcare providers on what constitutes home therapy, which patients should be candidates for it, how it should be monitored, and what the barriers to home therapy are.Objectives. To conduct a modified Delphi process in order to establish consensus on home therapy among haemophilia healthcare providers in SA.Methods. Treaters experienced in haemophilia care were invited to participate in a consensus-seeking process conducted in three rounds. In round 1, provisional statements around home therapy were formulated as questions and collated in a structured list. In rounds 2 and 3, evolving versions of the questionnaire were administered to participants. Consensus was defined as ≥70% agreement among the participants.Results. The panel composition included an equal number of physicians and non-physicians. The participation rate was 100% through all three consensus rounds. The group reached consensus for 92% of the statements. Consensus of 100% was reached on starting home therapy in paediatric patients, requiring all patients on home therapy to sign informed consent and indemnity, and providing round-the-clock support for patients on home therapy.Conclusions. The home therapy consensus statements in this report have the potential to translate to policy on home therapy and to guide the initiation, practice and evaluation of home therapy programmes in SA

Emerging Trends in Non-Communicable Disease Mortality in South Africa; 1997 - 2010

OBJECTIVES:National trends in age-standardised death rates (ASDRs) for non-communicable diseases (NCDs) in South Africa (SA) were identified between 1997 and 2010.METHODS:As part of the second National Burden of Disease Study; vital registration data were used after validity checks; proportional redistribution of missing age; sex and population group; demographic adjustments for registration incompleteness; and identification of misclassified AIDS deaths. Garbage codes were redistributed proportionally to specified codes by age; sex and population group. ASDRs were calculated using mid-year population estimates and the World Health Organization world standard.RESULTS:Of 594 071 deaths in 2010; 38.9% were due to NCDs (42.6% females). ASDRs were 287/100 000 for cardiovascular diseases (CVDs); 114/100 000 for cancers (malignant neoplasms); 58/100 000 for chronic respiratory conditions and 52/100 000 for diabetes mellitus. An overall annual decrease of 0.4% was observed resulting from declines in stroke; ischaemic heart disease; oesophageal and lung cancer; asthma and chronic respiratory disease; while increases were observed for diabetes; renal disease; endocrine and nutritional disorders; and breast and prostate cancers. Stroke was the leading NCD cause of death; accounting for 17.5% of total NCD deaths. Compared with those for whites; NCD mortality rates for other population groups were higher at 1.3 for black Africans; 1.4 for Indians and 1.4 for coloureds; but varied by condition.CONCLUSIONS:NCDs contribute to premature mortality in SA; threatening socioeconomic development. While NCD mortality rates have decreased slightly; it is necessary to strengthen prevention and healthcare provision and monitor emerging trends in cause-specific mortality to inform these strategies if the target of 2% annual decline is to be achieved