Patient satisfaction with peri-partum care at Bertha Gxowa district hospital, South Africa

Background: Patient satisfaction is one of the key outcome measures of healthcare services. Aim and Setting: To explore factors that influence women's satisfaction with peri-partum care at Bertha Gxowa district hospital, South African primary care. Methods: A cross-sectional study involving 260 women was conducted. A structured questionnaire collected information from participants on pain relief, health education provided by healthcare providers, privacy, cleanliness of the ward and their participation in decision-making about care received in the peri-partum period. Results: Most respondents were co-habiting with their partners (100, 38%) and had completed only secondary school education (119, 46%). The average participant age was 27 years, with an average parity of two children. Most participants were satisfied with the privacy (218, 84%) and the general cleanliness of the wards (233, 90%). However, large proportions of women were dissatisfied with the information given to them by doctors (104, 55%) and nurses (89, 37%), and the rest were unsure. About 189 (73%) participants were dissatisfied with the extent of their participation in decision-making about their own care. The study had a caesarean rate of 53 (20%). Compared to normal vaginal delivery, participants who had caesarean section were significantly more likely to report being satisfied with pain relief during labour (p < 0.001). Conclusion: The study findings showed varying levels of satisfaction with different aspects of peri-partum care and suggested the need for better pain relief during vaginal delivery, information sharing by doctors and patient emancipation for decision-making about their own care

Writing therapy

In the distant past I started to suggest to patients that they might like to write down their stories as a form of therapy.1 They could write me a letter or write a letter to some significant person in their lives that would help them coordinate their thoughts and emotions

The perceptions of general practitioners on National Health Insurance in Chris Hani district, Eastern Cape, South Africa

Background: National Health Insurance (NHI) intends to provide universal health coverage to all South Africans, with equity and quality as its tenets. The participation of private general practitioners (GPs) in NHI is essential. The aim was to explore perceptions of GPs on NHI in Chris Hani district, Eastern Cape, South Africa.Methods: A descriptive phenomenological qualitative study using semi-structured individual interviews of 12 GPs from six municipalities was undertaken. Data analysis used the framework method assisted by Atlas.ti software.Results: GPs in Chris Hani district felt that NHI would improve health and benefit society and be of particular benefit to poor andrural people as it will improve access to healthcare. Lack of governmental administrative capacity and a human resource plan were seen as barriers to implementation. They believed that NHI would benefit them through a single purchaser system and support more comprehensive care. GPs were concerned about a lack of information on primary care packages, accreditation,remuneration and patient allocation. They thought that NHI might disadvantage solo GPs. NHI implementation could be improved by actively engaging with GP organisations. Improvement of existing government health facilities and continued medical education were seen as possible ways to better implement NHI.Conclusion GPs in this study were generally positive about NHI and thought it would benefit both patients and providers.However, they had concerns regarding the capacity of government to implement NHI and the implications for solo GPs, and needed more information. Government needs to actively engage GPs

Sexually Transmitted Infections among Patients Attending the General Practice Clinic; Wesley Guild Hospital; Ilesa; Nigeria

Background: Sexually transmitted infections (STIs) are among the most common infectious diseases in the world today. There are few reliable statistics on the true prevalence of STIs in developing countries; especially in the general practice setting; hence the need to determine the prevalence in each locality. With the scourge and pandemicity of human immunodeficiency virus (HIV) and the fact that STIs are recognised as independent risk factors for its transmission; determining the risk profiles for STIs has become paramount. The aim of this study was to describe the pattern of STIs among patients attending a Nigerian general practice (GP) clinic. Methods: This was a descriptive; cross-sectional; hospital-based study. Consenting patients were recruited serially between February and April 2006 until the sample size of 415 was reached. Subjects' genital symptoms were considered according to the four common STI syndromes according to National AIDS/STD Control Programme guidelines. Results: The age range of the subjects was 15 to 95 years (mean 45.16 years; standard deviation 18.83 years; median 44 years). The median age at coitarche was 21 years while the median age at marriage was 25 years. The prevalence rates of current; past and lifetime STI were 18.8; 22.4and 32respectively. Only 28 (6.8) study subjects had laboratory evidence of STIs at the time of study. Previous sex with a commercial sex worker; previous history of STIs; premarital sex; first intercourse before or at 21 years of age and multiple sexual partners were significantly associated with STIs. Previous history of STIs was a strong predictor of current STI in this study while premarital sex and previous sex with a commercial sex worker were strong predictors of past STI. The frequency of HIV infection among subjects with STIs was more than double that of the control and a co-infection rate of 17.9was found. Conclusions: The findings of this study indicate a high prevalence of STIs in the study community in association with prevailing high sexual risk behaviours; hence the need for reliable control programmes targeting the latter

Sexually Transmitted Infections among Patients Attending the General Practice Clinic; Wesley Guild Hospital; Ilesa; Nigeria

Sexually transmitted infections (STIs) are among the most common infectious diseases in the world today. There are few reliable statistics on the true prevalence of STIs in developing countries; especially in the general practice setting; hence the need to determine the prevalence in each locality. With the scourge and pandemicity of human immunodeficiency virus (HIV) and the fact that STIs are recognised as independent risk factors for its transmission; determining the risk profiles for STIs has become paramount. The aim of this study was to describe the pattern of STIs among patients attending a Nigerian general practice (GP) clinic. Methods: This was a descriptive; cross-sectional; hospital-based study. Consenting patients were recruited serially between February and April 2006 until the sample size of 415 was reached. Subjects' genital symptoms were considered according to the four common STI syndromes according to National AIDS/STD Control Programme guidelines. Results: The age range of the subjects was 15 to 95 years (mean 45.16 years; standard deviation 18.83 years; median 44 years). The median age at coitarche was 21 years while the median age at marriage was 25 years. The prevalence rates of current; past and lifetime STI were 18.8; 22.4 and 32 respectively. Only 28 (6.8) study subjects had laboratory evidence of STIs at the time of study. Previous sex with a commercial sex worker; previous history of STIs; premarital sex; first intercourse before or at 21 years of age and multiple sexual partners were significantly associated with STIs. Previous history of STIs was a strong predictor of current STI in this study while premarital sex and previous sex with a commercial sex worker were strong predictors of past STI. The frequency of HIV infection among subjects with STIs was more than double that of the control and a co-infection rate of 17.9was found. Conclusions: The findings of this study indicate a high prevalence of STIs in the study community in association with prevailing high sexual risk behaviours; hence the need for reliable control programmes targeting the latter

Superficial Skin Infections and the Use of Topica and Systemic Antibiotics in General Practice

Superficial bacterial infections of the skin are very common. With the increasing burden of human immunodeficiency virus (HIV); this is likely to worsen. Examples of such infections include impetigo; erysipelas; cellulitis; ecthyma; furuncles; carbuncles and subcutaneous abscesses. Common causative organisms are staphylococci and streptococci. Generally; Staphylococcus aureus infections tend to spread locally; causing abscesses and carbuncles; while streptococci are apt to spread along tissue planes; and give rise to either cellulitis or erysipelas. However; this is not always the case. These infections cause a significant morbidity; and have to be diagnosed and treated promptly. Some result in serious complications

Migraine-Associated Vertigo and Dizziness as Presenting Complaint in a Private General Medical Practice

Migraine-associated vertigo (MV) remains a developing entity because accepted diagnostic criteria are unavailable. Patients present with debilitating dizziness without experiencing headache; and are often misdiagnosed as anxious. The condition is manageable in primary care without the need for neurological referral. The aim of this study was to investigate the prevalence of MV and migraine-associated dizziness (MD) as presenting complaints. Methods: Patients presented with dizziness probably or definitely associated with migraine history based on the criteria of the International Headache Society. Patients with other vestibulopathies and medical conditions were excluded. Patients were evaluated over a period of nine months. Seven hundred and seventeen patients were examined. The numbers of patients were recorded as a percentage of the population visiting a general practitioner. Response to migraine prophylactic medications was regarded as supporting evidence of the diagnosis. Response was regarded as a complete resolution of symptoms. Results: Of the 717 patients seen; 12 were identified as having probable or definite MV. Five patients were treated with migraine prophylactic medications; namely amitriptyline 25 mg nocte and/or sodium valproate CR 300 mg bd; and all showed a response to the treatment. Conclusions: We conclude that the prevalence of MV as presenting complaint may be as high as 1.67. This figure does however not reflect the total patient population that suffers from the condition - this figure may be much higher. Of those patients treated for MV the response was 100; further supporting the diagnosis. MV is a relevant complaint that is often misdiagnosed as psychogenic in origin

A Cross-Sectional Study of Blood Pressure Control in Hypertensive Patients in General Practice (the I-TARGET Study) : Cardiovascular Topics

Introduction: Despite the availability of multiple effective antihypertensive drugs; hypertension control rates remain poor. The reasons for this are complex; but increasingly; physician inertia has been identified as a crucial factor. In this study we attempted to define the level of blood pressure (BP) control and reasons for not achieving control in a survey of selected general practices within South Africa. Methods: This was a multi-centre; cross-sectional disease study involving 15 selected general practices throughout South Africa. Treated hypertensive patients over 18 years old were eligible for inclusion. The study was approved by Pharma Ethics; and after informed consent; consecutive hypertensive patients at the participating general practice centres were included; with each centre enrolling 30 patients. Results: A total of 451 patients; from 15 sites in South Africa; were entered in the study. The mean age of the patients was 60.7 years; 56.3were female and 15.7were current smokers. The BP was reduced by 26.4/17.6 mmHg (p 0.001) in 220 patients with a documented initial BP. Co-morbidities were present in 322 (71.4) patients and overall; 37.9had more than one co-morbidity. Lifestyle modification was not uniformly applied; with only 46.1; 59.6 and 56.8receiving advice about weight loss; exercise and diet; respectively. Less than a third (30.7) of patients were on monotherapy; 42.8were on two drugs (25.9on fixed-drug combination and 16.9on free combination) and 26.5were on more than two agents. Most (86.9) practitioners used either international or local guidelines to determine target BP. Overall; 61.2of patients were at goal (BP 140/90 mmHg). If a stricter target BP (BP ? 130/80 mmHg) is applied to patients with co-morbidities; as recommended by the guidelines; 60.6of patients did not reach goal. Of the 175 patients not at target BP; there was no action plan in 22.9; while 39.4were advised to undertake lifestyle changes only. Conclusions: Control rates were quite good in comparison with other surveys within and outside South Africa. However we were able to define several important deficiencies: there was evidence of physician inertia and also practitioners need to be more cognisant of local and international guidelines to optimise treatment