The Mortality of Serving African Presidents: A Lesson for the Health Profession and the Lay Public

Although Africa has the worst mortality data in the world; the picture painted by the high mortality rate of serving Africa leaders in the last five years suggests reasons and causes far beyond poor socio-economic conditions. This study examined the causes and age at death of serving African leaders; in the last five years; and draws out the lessons; for the health profession and the general public.Material and methods: An internet search of creditable websites was carried out to determine the number; causes and age at deaths of the leaders; within the study period of 2008 to 2012. The life expectancy rates of the bereaved countries were also considered.Results: A total of 13 presidential mortalities took place in the world during the study period; with 10 (76.92) involving serving African leaders. The leaders died at an average age of 66.9 +/- 7.22 years; an average of 12.1 years above the life expectancy rate of their respective countries; but less than the world average of 68 years. Most (80.00) of the leaders died from non-communicable diseases; 3 died from cardiovascular diseases; 3 died from cancer; while two were known diabetics. The remaining two leaders were killed in a violent change of government.Conclusion: The African leaders died mainly from non-communicable diseases; at an age that is below the world average. Public enlightenment campaigns and greater emphasis on patient-centered chronic care of non-communicable diseases are hereby recommended

Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa

Objective: The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards deinstitutionalisation. This article investigates patient and social work factors related to successful community placement; in the context of limited community care facilities. Method: Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions; and the most common type of interventions. Results: The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse; verbal or physical aggression; uncontrolled sexual activity); and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female; in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support. Conclusion: The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients; limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments

A qualitative Exploration of Resilience in Pre-Adolescent AIDS Orphans Living in a Residential Care Facility

This article presents the findings of a study among a small group of South African AIDS orphans living in a residential care facility; Lebone Land. The research was conducted between June and September 2006. A qualitative; exploratory study consisting of in-depth; semistructured interviews with eight children and seven key informants aimed to identify and investigate developmental assets operating in the children's lives to help them cope amid exposure to adversities. The findings indicate that the developmental assets that facilitate coping and foster resilience in these children relate to four main components: external stressors and challenges; external supports; inner strengths and interpersonal and problem-solving skills. Emerging key themes relate to the experience of illness; death; poverty and violence; as well as the important roles of morality; social values; resistance skills; religion and faith in assisting these children in defining their purpose in life. To this end; constructive use of time; commitment to learning; goal-setting; problem-solving ability and self-efficacy are fundamental in the children's attainment of their future projections. Therefore; qualities such as optimism; perseverance and hope seem to permeate the children's process of recovery. Strong networks of support; particularly friendships with other children; also seem to contribute to developing and sustaining resilience

Chronic patient care at North West Province clinics

Introduction: Chronic illnesses are a significant burden to the health services in South Africa. There is a specific national health plan whereby chronically ill patients who are acceptably controlled should be managed at clinic level. The perception has emerged that the management of primary care has not been optimal in the Southern District of the North West Province. This provided the motivation to initiate this research, namely consideration of chronic patient care at clinics in the North West Province of South Africa. Method: A cross-sectional descriptive study was carried out at four randomly selected clinics covering four sub-districts in the Southern District (North West Province). This was done using charts and registers at the clinics. Inclusion criteria were patients older than 18, and presenting with the following chronic illnesses: asthma/chronic obstructive airways disease(COAD), hypertension, diabetes and epilepsy. The major focus areas were the regular assessment of the patients, the level of control of the illness and the use of the Essential Drugs List and Standard Treatment Guidelines (EDL/STG). Results: In the cases of all the chronic illnesses it was found that regular assessments were poorly done, with asthma (peak flow measurements) being the most poorly done. Control was generally less than 50% for all the illnesses, although the EDL was followed fairly well by the personnel at the clinics. Conclusion: In the light of the burden of chronic illness the results give cause for great concern about the quality of care for chronically ill patients, and reasons were sought for some of the poor results. A subsequent decision was taken to carry out comprehensive quality improvement projects on each of the illnesses over the following five years

Long-term Care of Children and Adolescents with Intellectual Disabilities and Severe Physical Abnormalities

Objective: This study sets out to review the clinical profile and treatment program of children and adolescents with intellectual disability in Waverley Care Center (WCC). Method: A retrospective review was done of users from January to December 2004. Reviewed parameters included age; gender; length of stay; DSM IV diagnoses; current medical treatment; and level of functioning and mobility according to the Therapeutic Classification System for Children (TCS). Results: A total of 179 users were receiving care. Although the mean age of users was 14 to 15 years; their ages ranged from 3 to 34 years. The gender ratio of users was 1 (female) to 1.6 (male). The average length of stay was 6.73 years and the range of stay from 0.5 to 29 years. Attention deficit hyperactivity disorder was diagnosed in eight children and pervasive disorders were suspected in some. Intellectual impairment ranged from severe to profound. Specific interventions with regard to severe physical impairments were made by occupational therapy and physiotherapy

Long-Term Care of Children and Adolescents with Intellectual Disabilities and Severe Physical Abnormalities

Objective: This study sets out to review the clinical profile and treatment program of children and adolescents with intellectual disability in Waverley Care Center (WCC). Method: A retrospective review was done of users from January to December 2004. Reviewed parameters included age; gender; length of stay; DSM IV diagnoses; current medical treatment; and level of functioning and mobility according to the Therapeutic Classification System for Children (TCS). Results: A total of 179 users were receiving care. Although the mean age of users was 14 to 15 years; their ages ranged from 3 to 34 years. The gender ratio of users was 1 (female) to 1.6 (male). The average length of stay was 6.73 years and the range of stay from 0.5 to 29 years. Attention deficit hyperactivity disorder was diagnosed in eight children and pervasive disorders were suspected in some. Intellectual impairment ranged from severe to profound. Specific interventions with regard to severe physical impairments were made by occupational therapy and physiotherapy. Conclusion: Due to the extent of their physical disabilities requiring full-time nursing care; discharge and placement back in the community remained a rare option for most users in the study group