Effect of the coronavirus pandemic on nutrition and health of adults in Calabar, Nigeria: A post-lockdown analysis

Background: The food security and nutrition of millions of people around the world is currently being threatened by the coronavirus disease 2019 (COVID-19) pandemic, an evolving health crisis. Aim: To evaluate the effect of the COVID-19 pandemic on nutrition and health of adults in Calabar, especially after the hard lockdown.Setting: Online cross-sectional survey in Calabar, Nigeria. Method: After sample size determination, an online questionnaire was designed, content-validated by nutrition experts and piloted on 20 respondents. The questionnaire link was circulated for 6 weeks (April­May, 2021). The questionnaire was structured to gather socio-economic data, lifestyles of the participants (especially younger adults) and changes in dietary intake and health. Descriptive statistics and Pearson's correlation were used to define the proportion of responses for each question and check for association. Results: No glaring nutrition or health problems was observed in the surveyed population (385 respondents), but many (50%) earned very low monthly income (< 50 000 naira). A drop in finances seemed to have indirectly caused a decrease in food consumption post-lockdown. A strong association between age and health risks was observed; similarly, alcohol intake was significantly affected by income and age. Conclusion: The pandemic caused many changes in people's dietary habits and lifestyles, including financial setbacks. Apparently, education and proper enlightenment play a major role in food choices (despite limited resources), thus ensuring adequate nutrition and reducing health risks in the face of a pandemic. Contribution: This study has affirmed the efficacy of nutrition education and proper awareness in ensuring healthy dietary choices, optimal health and reduced risks of diseases.

Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Oculocutaneous albinism in southern Africa: Historical background, genetic, clinical and psychosocial issues

Albinism is an inherited condition associated with significant depigmentation of the skin, hair and eyes. It occurs in every population with varying frequency, and narratives of people with albinism have been recorded since 200 BC. In southern Africa albinism is common, about 1 in 4000 people are affected, but it remains a poorly understood condition surrounded by myths and superstition. This article provides a historical background on oculocutaneous albinism (OCA) in southern Africa and presents relevant information from the literature regarding epidemiology, genetics and genetic counselling, health, psychosocial and cultural issues, and medical care. There are several recessively inherited types of OCA and a mutation, responsible for about 80%of South African variants, has been identified in OCA type 2. The physical characteristics associated with albinism, that is, sun-sensitive skin and low vision, can be managed. However, people with OCA in Africa also experience psychosocial issues, such as discrimination, because of the various superstitious beliefs and attitudes held in the community. Management should include medical care for health problems, appropriate adjustment of the schooling context and genetic counseling. In addition, widespread public awareness programs are required to increase the knowledge of the genetic causes of OCA and of the nature of genetic counselling, to address the negative attitudes in the community, to reduce the marginalization and stigmatization of people with albinism and to improve their quality of life.

Oculocutaneous albinism in southern Africa: Historical background, genetic, clinical and psychosocial issues

Albinism is an inherited condition associated with significant depigmentation of the skin, hair and eyes. It occurs in every population with varying frequency, and narratives of people with albinism have been recorded since 200 BC. In southern Africa albinism is common, about 1 in 4000 people are affected, but it remains a poorly understood condition surrounded by myths and superstition. This article provides a historical background on oculocutaneous albinism (OCA) in southern Africa and presents relevant information from the literature regarding epidemiology, genetics and genetic counselling, health, psychosocial and cultural issues, and medical care. There are several recessively inherited types of OCA and a mutation, responsible for about 80%of South African variants, has been identified in OCA type 2. The physical characteristics associated with albinism, that is, sun-sensitive skin and low vision, can be managed. However, people with OCA in Africa also experience psychosocial issues, such as discrimination, because of the various superstitious beliefs and attitudes held in the community. Management should include medical care for health problems, appropriate adjustment of the schooling context and genetic counseling. In addition, widespread public awareness programmes are required to increase the knowledge of the genetic causes of OCA and of the nature of genetic counselling, to address the negative attitudes in the community, to reduce the marginalisation and stigmatization of people with albinism and to improve their quality of life

Determinants of occupational health hazards among roadside automobile mechanics in Sokoto Metropolis, Nigeria

Roadside automobile mechanics are in the course of their work exposed to several hazards that put them at risk of severe debilitating health challenges. This group of workers, however, is reported not to know much about such hazards and to have little or no training on workplace safety. Aim: The study aimed to identify the determinants of occupational health hazards among roadside automobile mechanics in Sokoto Metropolis. Methodology: This was a descriptive, cross-sectional study, and using a two-stage sampling technique, a total of 205 roadside mechanics were recruited for the study. A semi-structured interviewer-administered questionnaire was used, and the data were imputed into and analyzed using IBM SPSS. Results: The mean age of the respondents was 31.10 ± 10.19 years, and over one-third of them (38.1%) were general vehicle repairers. Majority of the respondents had good knowledge of and attitude toward workplace hazards. However, a good proportion (91.0%) of the mechanics felt that their occupation was a risky one and 80.1% ate and 86.1% drank while working. Type of training and job description were the predictors of knowledge of workplace hazards. Job description was the only predictor of attitude. Burns, bruises, headache/dizziness, and cuts were the most reported work-related illnesses and injuries. Conclusion: Although most of the auto-mechanics were aware and had good knowledge of workplace hazards, they did not adhere to safety practices in the workplace, mostly due to nonavailability of protective apparels. There is, therefore, need for continuous health education under the platform of the auto-mechanics association so that they can voluntarily adopt safety practices in their workplace

Exploring factors influencing integration of traditional and medical male circumcision methods at Ingquza Hill Local Municipality, Eastern Cape: A socio-ecological perspective

Background: Medical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods. Aim: This study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels.Setting: The study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province. Methods: An explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model. Results: Four main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These included: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices. Conclusion: Male circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods

Modern health-seeking behaviour and associated factors among mothers having under 5-years old children in Shire town, Tigray, Ethiopia: a cross-sectional study 2018

Background: The practice of appropriate health care-seeking is important to reduce severe and life-threatening childhood illnesses. In Shire town, little is known about the mother's health care-seeking behaviour on childhood illness. Aim: To assess modern health-seeking behaviour and associated factors of mothers having under 5-years old children in Shire town. Setting: The study setting was Shire town, northwest Tigray, Ethiopia. Methods: A community-based cross-sectional study was conducted to interview 504 mother-child pairs by systematic random sampling technique. Data were collected through interviewer-administered semi-structured questionnaires. Data were coded, entered, cleaned and edited using EPIDATA version 3.1 and export to Statistical Package for Social Science (SPSS) Version 22.0 for analysis. To identify the significant variables, binary logistic regression was employed. Variables with p-value < 0.05 at 95% CI (confidence interval) in multivariate logistic regression were considered statistically significant. Results: In this study, around 76.2% (72.1, 80) of mothers sought modern health care. In a multivariate logistic regression analysis at a p-value of < 0.05, caregivers with age of ≥ 28 years (AOR [adjusted odds ratios]: 1.65; 95% CI [1.02, 2.68]), educational level of secondary school and above (AOR: 0.44; 95% CI [0.23, 0.86]), child feeding per day < 8 times (AOR: 2.77; 95%CI[1.75, 4.38]) and perceived severity of illness (AOR: 2; 95% CI [1.07, 3.82]) were statistically associated with modern health care-seeking behaviour. Conclusion: Strengthen healthcare services is recommended at the community level through information, education and communication/behavioural change strategies to improve the mother's health care-seeking behaviour

Health and educational achievement of school-aged children: The impact of anaemia and iron status on learning

Background: Anaemia is a common blood disorder in children and is known to cause complications such as lethargy and stress on bodily organs. Children from disadvantaged communities often fail to achieve their age-related potential with iron deficiency anaemia stated as a risk factor through causing inattentiveness and learning problems. Limited evidence exists for the adverse effects of iron deficiency anaemia on the developing child's brain from South African studies. Aim: The objective of this study was to determine the local prevalence of anaemia and iron deficiency and to examine their association with psychomotor development and school performance in school-aged children. Setting: This study was conducted in a peri-urban disadvantaged community from KwaZulu-Natal, South Africa. Methods: Children aged 6 to 8 years from KwaZulu-Natal were enrolled (n = 184). Three parameters of assessment were used: clinical data, biochemical data (haemoglobin levels and iron studies) and school performance (interviews with caregivers, teachers and the children). Anaemia presence and iron deficiency were the hypothesised mediating variables through which growth, development and school performance were influenced. Results: A high point prevalence of anaemia (23.4%), iron deficiency anaemia (4.9%) and helminth infection (27.1%) was identified. Impaired cognitive assessment scores (20.7%) were prevalent in the children sampled. Behavioural problems (4.3%), poor memory function (4.3%) and impaired attention (1.1%) were of low prevalence. Anaemia and iron deficiency were both associated with impaired fine motor skills (p < 0.05). Anaemia was significantly associated with low cognitive scores (p = 0.01). Neither anaemia, iron status nor helminth infection significantly predicted school performance in the children sampled. Conclusions: The point prevalence of anaemia and iron deficiency among the sampled children was higher than the national prevalence. The sample size was however inadequate for drawing statistical conclusions about psychomotor development and school performance because of the low prevalence of the different outcomes that were examined. Practical challenges faced in conducting this investigation in rural South African schools were discussed

Self-managing individual wellness for the health professional: a somatology perspective

Background: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. Aim: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. Setting: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. Method: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. Results: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. Conclusions: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness

Sense of coherence in Chinese and German students

Background: Mental health and salutogenesis are important topics at universities in China and Germany where heightening stress levels in students can be observed. Aim: The aim of this article is to determine the profile of the salutogenic concept, sense of coherence (SOC), in Chinese and German students to provide new insights into SOC and mental health in Chinese and German students in higher education institutions (HEIs). Setting: The study was carried out at universities in China and Germany. Method: A non-experimental, cross-sectional, survey-based research design and convenience sampling was utilised to obtain the sample (n = 356). The sample was derived at a selected Chinese (n = 255) and a selected German university (n= 101). Data were gathered using the 7-point Likert SOC dimension scales based on the Life-Orientation Questionnaire (LOQ) research instrument. The internal consistency levels of the SOC sub-scales were of acceptable levels. Descriptive and inferential statistics were used to analyse the data. Cronbach's alpha coefficients were calculated to determine the reliability of the LOQ research instrument. General linear modelling techniques. Results: The results showed the Chinese students scored significantly lower in all three SOC scales than the German students, with the largest practical significant difference in the sub-score of meaningfulness. In general, female Chinese and German students scored higher than their male counterparts. No significant differences could be found between German female and male, and Chinese female and male students. Conclusion: Conclusions and recommendations for future research and HEI practice are provided

Awareness of the ward based outreach team and the services offered by the programme in the tshwane health district, South Africa

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on theprinciples of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households.Methods: The study assessed the awareness of the WBOT and the servicesoffered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data werecollected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers. Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, 'Yes' and 'No'. A summary of the responses showed that the number of 'yes' responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) 'yes' responses and 698 (11.1%) 'no' responses.Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%

Patients' knowledge of health rights and satisfaction with outpatient services at the tertiary hospitals in Enugu state, Nigeria

BACKGROUND: Patient satisfaction is a key indicator for measuring the success of the health system goals, delivery quality care that is safe, equitable, patient-centered, evidence-based, timely and efficient, through interprofessional collaborative team work. Equally, patient's knowledge of their health rights will enhance better provider-patient's relationship, patient satisfaction, and effective care management. OBJECTIVES: The aim of this study was to compare patients' knowledge of health rights, satisfaction with the physicians' conducts and outpatient services across three tertiary hospitals in Enugu, Nigeria. METHODS: A descriptive cross-sectional study of 304 patients selected from the outpatient clinics of the University of Nigeria Teaching hospital (UNTH), National Orthopaedic Hospital (NOHE), and Enugu State University of Science and Technology Teaching Hospital (ESUTH), from October to December, 2015 was conducted. A four point Likert scale, dissatisfied (1), very dissatisfied (2), moderately satisfied (3), and very satisfied (4) was applied. Knowledge of health rights were scored as follows, 0-5 poor knowledge, 6-10 good knowledge, 11 and above very good knowledge. A minimum sample size of 91 patients was calculated for each of the study hospital, but increased to100 each, to enhance precision, reduce error margin, and to contend possible nonresponses and incompleteness. A multi-stage sampling technique was applied. The data were analyzed using SPSS version 16.0.RESULTS: Knowledge of health rights was poor in 5.9%, 20.8%, and 14.9% of patients (X2 =9.61, p=0.000), and very good in 70.6%, 2 46.5% and 59.4% patients (X2 =12.14, p=0.000) from UNTH, NOHE, and ESUTH respectively. The mean knowledge scores were 10.50 ±3.240 for UNTH; 8.72±2.953 for NOHE; and 9.93±3.151 for the ESUTH. The overall mean knowledge scores of the patients across the three hospitals was not statistically significant (F=0.000, P =1.000). Patients' overall mean satisfaction with physicians' conduct and services was 3.63±0.525 for UNTH, 3.45±0.741 for NOHE, and 3.47±0.609 for ESUTH, with no statistically significant difference (F=0.000, P =1.000). Overall mean satisfaction scores for the general outpatient services were 3.19±0.728, 3.15±0.713, and 3.00±0.721 for UNTH, NOHE, and ESUT respectively. The observed differences in the overall mean satisfaction for the general services provisions across the hospitals was not statistically significant (F=0.000, P=1.000). Patients' mean knowledge scores were statistically (p=0.000) associated with mean satisfaction with the physicians' conduct and services provision across hospitals. CONCLUSION: Patients knowledge of health rights and satisfaction with physicians' conducts and outpatient services across the hospitals were generally good and satisfactory, but differed statistically in-between hospitals

The relationship between thyroid function and bone health in euthyroid healthy adult Nigerians

There is a dearth of reports on variation in thyroid function within the reference range on bone health in euthyroid healthy adults in Nigeria This study evaluated the variation in thyroid function within reference range on biochemical bone markers and bone mineral density in healthy adults. This prospective study was carried out among 40 healthy participants above 21 years of age but less than 50 years by systematic random sampling. Exclusion criteria included subjects with acute or chronic disease states, previous fractures, any drug use, history of alcohol or smoking. Interviewer ­questionnaire was administered. Anthropometric indices determined. Blood samples for thyroid function tests included triiodothyronine (FT3), thyroxine(FT4), Thyroid Stimulating Hormone(TSH-thyrotropin), osteocalcin (OC), and Alkaline phosphatase (ALP), serum calcium adjusted for albumin, inorganic phosphorus, and urine sample for calcium and creatinine were collected after 10 - 12 hours fast. 24 hour calcium excretion was calculated (CaE). Bone mineral Density determined by Dual X - ray Absorptiometry scan. Statistical analysis done,< 0.05 set as level of significant. The mean age 34.10 years (7.8), with BMI 26.32kg/m2 (4.02),waist circumference 76.60cm (17.07). The mean levels of bone markers were osteocalcin 17.68ng/ml (10.67), alkaline phosphatase70.60 IU/L (16.56) and 24hour calcium excretion 396.10mg/dl (101.89). OC and ALP inversely correlated with age but CaE did not. TSH positively correlates OC( r =0.35,p=0.029), but not CaE, p > 0.05. FT4 correlates bone formation markers OC,ALPand CaE p <0.05. Neither FT3,FT4 or TSH neither correlates with zscore BMD. Normal variation in the levels of ft4 and TSH has an early impact on biochemical bone markers compared to bone mineral density. Biochemical bone markers are thus suggested as screening tools for early detection of metabolic bone diseases in euthyroid healthy adults

Socioeconomic status and health shocks; analysis of coping strategies in rural households of Enugu State, Nigeria

Background: Health burden in rural areas of developing countries is worsened by the limited coverage of health insurance. With constrained access to quality healthcare and constituting two thirds of Nigeria's poor, this study investigates how rural households cope with health shocks consequent on their socioeconomic status. Method: Data was collected from 600 households in Enugu using a questionnaire. Cross-tabulation, chi square and multiple regression statistical techniques were employed for data analysis. Findings: About 53% of the respondents were male household-heads while borrowing (47.65%), sales of assets (43.85%), diversion of funds (2.00%) and reduced expenditure (6.48%) were the main coping strategies. Education, occupation, and income statistically influenced the coping strategies (P < 0.005) and jointly accounted for 26.5% (R2 = 0.265, P < 0.001) of the variations in coping strategies. Conclusion: Having a rural healthcare policy and mainstreaming the informal sector into the national health insurance scheme will am

Family environment, socioeconomic conditions and childhood health and wellbeing in informal settlements in Mozambique

Background. A possible relationship between slum residence and children's health and wellbeing in sub-Saharan Africa has been relatively under-researched.Objective. To investigate the relationship between the type of area of residence and children's and adolescents' health and wellbeing in urban Mozambique.Methods. Descriptive and logistic regression techniques were employed on data from 1 913 children and 798 adolescents, to analyse several key outcomes.Results. The descriptive findings indicate that children in slum areas are the most disadvantaged, followed by those in quasi-slum areas,in terms of school enrolment, health and the type of care received in the home. Similar descriptive results were found for the adolescents'outcomes. Multivariate analyses showed that compared with children in slum areas, those in non-slum areas were more likely to be attending school (odds ratio (OR) 4.22; confidence interval (CI) 1.73 - 10.31), less likely to be typically sick (OR 0.26; CI 0.14 - 0.47) and less likely to be left alone in the household (OR 0.29; CI 0.18 - 0.48). Adolescents in non-slum areas tended to have completed ≥6 years of education (OR 3.01; CI 1.78 - 5.07), to be aware of HIV/AIDS programmes (OR 4.29; CI 2.43 - 7.55), to believe that HIV/AIDS may be transmitted through unprotected sex (OR 13.01; CI 3.76 - 45.02) and to have parents or caregivers who had ever talked to them about matters related to sex (OR 3.15; CI 1.76 - 5.65). Family structure and sowcioeconomic characteristics, together, account for most of the differences between slum and quasi-slum areasparticularlchildren's outcomes.Conclusion. The health and the wellbeing of children and adolescents in slums is negatively affected, compared with other urban places in Mozambique. However, for children, family structure and other socioeconomic factors remove most slum/quasi-slum effects

Registrar wellness in Botswana: Measuring burnout and identifying ways to improve wellness

Background. Burnout during registrar training is high, especially in resource-limited settings where stressors are intensified. Burnout leads to decreased quality of life for doctors, poor job and patient satisfaction, and difficulty retaining doctors.Objectives. Primary: to measure burnout among registrars working at Princess Marina Hospital in Gaborone, Botswana. Secondary: to determine factors contributing to burnout and identify potential wellness interventions.Methods. The validated Maslach Burnout Inventory was used to measure the degree of emotional exhaustion, depersonalisation and personal accomplishment. Work-related difficulties and potential wellness interventions were explored through multiple-choice and open-ended questions.Results. Of 40 eligible registrars, 20 (50%) completed the survey. High levels of burnout were reported for emotional exhaustion in 65% (13/20), depersonalisation in 45% (9/20), and personal accomplishment in 35% (7/20) of registrars. A high degree of burnout was reported by 75% (15/20) of registrars in one or more domains. In the previous 7 days, registrars worked an average of 77 hours, took 1.5 overnight calls, slept 5.7 hours per night, and 53% (10/19) had ≥1 of their patients die. Five (25%) registrars considered leaving Botswana to work in another country, which correlated with those with the highest degree of burnout. The most common frustrations included insufficient salary and limited medical resources. Suggested interventions included improved mentorship and wellness lectures.Conclusions. There is a high degree of burnout, especially emotional exhaustion, among registrars. Encouragingly, most registrars have a desire to work in Botswana after training. Future research on improving registrar wellness in low-resource settings is urgently needed

Is South Africa Advancing towards National Health Insurance? The Perspectives of General Practitioners in One Pilot Site

Background. The launch of the National Health Insurance (NHI) White Paper in December 2015 heralded a new stage in South Africa's advancement towards universal health coverage. The 'contracting in' of private sector general practitioners (GPs); though only one component of the overall reformed system; is nevertheless crucial to address staff shortages and capacity; and also to realise the broader vision of a single unified; integrated system.Objective. To report on the views and experiences of GP providers tasked with implementing the reforms at one pilot site; Tshwane District in Gauteng Province; providing an insight into the practical challenges the NHI scheme faces in implementation.Methods. The study was qualitative in nature; using a combination of convenience and purposeful sampling to recruit participants. A thematic analysis of the data was conducted using Nvivo 10 software.Results. The overall experiences of the GPs exposed a number of problems with the pilot.These included frustration with lack of appropriate infrastructure and equipment in NHI facilities; difficulties integrating into the facilities and lack of professional autonomy; as well as unhappiness with contracting arrangements. Despite strong support for the idea of NHI; there was general scepticism that private doctors would embrace the scheme on the scale required.Conclusion. The study suggests that the current pilots are still a long way from the vision of a single; integrated health system. While it may be argued that the pilots are not themselves the completed NHI; the findings suggest that it will take much longer to establish than the timeline envisaged by government

Tonsillectomy Rates in the South Africa Private Healthcare Sector

Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this; there exists considerable international (190 - 850/100 000 people =19 years of age) and regional variation in rates. This cannot be accounted for by differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African (SA) private healthcare sector and regional variations thereof. To compare local rates with international rates and assess trends in adeno-/tonsillectomy practice. Methods. Analysis of 2012 and 2013 adeno-/tonsillectomy data provided by the largest SA private healthcare funder; accounting for 30% of the medical scheme market. Rates are expressed per 100 000 people =19 years of age. Results. The tonsillectomy rate in the SA private healthcare sector was 1 888/100 000 people =19 years of age in 2012. In 2013; the rate dropped significantly (p0.001) to 1 755/100 000. This is more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in this rate within SA. Discussion. The SA tonsillectomy rate is very high when compared with international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather; it is differences in training and clinical practice of clinicians; as well as social and family factors; that have been implicated.Conclusion. The adeno-/tonsillectomy rate in the SA private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration

Health; Nutritional and Socio Cultural Status of the Nilotic Population in the Southern Sudan

This book presents the results of a large study realised between 1979 and 1984; in the Upper Nile State; on a significant sample of a southern Sudanese population belonging to three Nilotic tribes (Dinka; Nuer and Shilluk). In 1979; these populations still lived in a very traditional way and were subject to rapid changes due to the construction of the 365 km long Jonglei canal. The study was interrupted by the civil war; in February 1984. This book is divided into four distinct parts: The population and the environment are described in the first part. The objectives of the studies and their methodology are presented in the second part. The results of a cross-sectional study (300 children; men and women) and of a longitudinal study of 400 pregnant women and their newborn child until the age of three years are presented in the third part. The anthropometrical; clinical; biological and nutritional data are included.The traditional way of life; beliefs as well as the socio-cultural aspects (customs; social activities; magic; dreams; death; relationship and freedom; libido or sexual desires; diseases; and collective activities) are described in the fourth part. Genealogical trees of two families; one a Dinka and another Shilluk (from the 13th century); are presented in Annexe. This book can serves as a guide for medical doctors; public health workers; epidemiologists; NGO-s... and for comparatives studies in Africa