Health Risk Behaviors of High School Learners and their Perceptions of Preventive Services offered by General Practitioners

"Background: Adolescence spans nearly a decade in which young people may initiate health risk behaviors like unsafe sexual practices and alcohol; tobacco and other drugs use (ATOD use). Most adolescent mortality and morbidity; attributable to such health risk behaviors; are preventable. Managing the consequences of health risk behaviors is costly and does not reduce the number of young people initiating these unhealthy lifestyle choices. The emphasis needs to shift towards the provision of adolescent primary and secondary preventive services. Overseas efforts involve national health risk behavior screening; the application of national guidelines for primary health care workers in all contexts and continuing evaluation so that appropriate region specific policies can be instituted. With the completion of our second South African National Health Risk Behavior survey and the implementation and evaluation of the National Adolescent Friendly Clinic Initiative in government clinics; we lack national guidelines for the primary health care worker to administer adolescent preventive services. Furthermore; the NAFCI initiative does not involve the general practitioner in the private sector. The aim of the research is to assess how the economically disadvantaged youth from public schools access the private sector general practitioner for preventive services related to health risk behaviors. Methods: This cross-sectional descriptive study was conducted among senior high school learners (Grades 10; 11 and 12) from 18 randomly selected secondary public; co-educa -tional schools with an ordinary curriculum in the Johannesburg educational districts; during the first three school terms of 2002. A self administered research questionnaire was used to ascertain learners self reported involvement in health risk behaviors and their interaction with their GP in dealing with these health risk behaviors. Results: 1139 learners completed the research questionnaires. 1. Learners reported a high prevalence of health risk behaviors: 65for alcohol use; 57for sexual activity; 39for tobacco use and 15for drug use. 2. The predominant pattern of substance use was the experimental pattern of having tried these substances: 40for cigarette use; 53for alcohol use; 54for injected drug use and 57for other drug use. The majority of sexually active adolescents were practicing unsafe sex (55had multiple partners; 52without condoms and 28without family planning). 3. Learners reported a high prevalence of coexisting health risk behaviors: 44for alcohol use and sexual activity; 36for tobacco and alcohol use and 26for tobacco use and sexual activity. 4. Risk perception was lower for sexual activity (25felt in danger and 5felt affected) than for substance use (an average of 82felt in danger and 40felt affected). Of the 1139 learners; only 271 learners (24) had a GP in private practice. 1. The adolescent-GP interaction was favorable for preventive service delivery: 70of learners had medical aid cover; 41were seeing their GP for more than five years; 92were the ""family?? doctor; 80had visited their GP in the past 6 months and 60had consulted on their own at least once. 2. Primary preventive service delivery to those not involved in health risk behaviors was poor: 28for sexual activity; 24for drug use; 23for alcohol use and 19for tobacco use. 3. Uncovering of health risk behaviors occurred to varying degrees: 40for sexual activity; 18with alcohol use; 18with tobacco use and 11with drug use. 4. Secondary preventive service delivery to those involved in health risk behaviors was better: averages of 89for sexual activity; 84for drug use; 54for tobacco use and 38for alcohol use. Statistically significant learner and general practitioner demographics highlighted the complex dynamics involved in this interaction. Conclusions: The study showed that adolescents from economically disadvantaged backgrounds have a high prevalence of health risk behaviors but utilize the general practice resource to a limited degree. Despite the interaction between adolescent and general practitioner being conducive to the receipt of primary and secondary preventive services; this was not optimal"

Efficacy of quinine for falciparum malaria according to previous chloroquine exposure. [short report]

Chloroquine has been reported to antagonize the anti-parasitic action of quinine against Plasmodium falciparum in vitro. The authors looked for evidence of any such antagonism in vivo. In 123 Malawian children with cerebral malaria treated with parenteral quinine; the likelihood of survival and the rate of recovery were much the same in patients who had taken chloroquine and those who had not. In these circumstances there was no evidence of chloroquine/quinine antagonism