Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals

Background: Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.Objective: To explore health care workers' perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.Methods: An explorative descriptive qualitative study was conducted. Four focus group discussions were held with 33 hospital staff (senior clinical and management staff, and junior clinical staff) using interview guide questions developed based on the findings from an epidemiological study that was conducted in the same hospitals. Qualitative data were analysed using the framework analysis.Findings: Most respondents believed that critical illness, which was related to early and high case fatality rates on admission, was linked to a web of factors including preference for traditional medicine over conventional care, gross negligence of the child at household level, misdiagnosis of severe malnutrition at the first point of care, lack of specialised skills to deal with complex presentations, shortage of patient beds in the hospital and policies to discharge patients before optimal recovery. The majority believed that the WHO guidelines were effective and relatively simple to implement, but that they do not make much difference among severe acute malnutrition cases that are admitted in a critical condition. Poor management of cases was linked to the lack of continuity in training of rotating clinicians, sporadic shortages of therapeutic resources, inadequate staffing levels after normal working hours and some organisational and system-wide challenges beyond the immediate control of clinicians.Conclusion: Findings from this study suggest that effective management of paediatric severe acute malnutrition in the study setting is affected by a multiplicity of factors that manifest at different levels of the health system and the community. A verificatory study is encouraged to collaborate these findings

PURE ifying Research on Chronic Non-Communicable Diseases in South Africa

Chronic non-communicable diseases (NCDs) such as diabetes; cardiovascular disease (CVD) and cancers are a major public health problem. In an effort to increase awareness about the behavioural risk factors for NCDs a community-based project was implemented in Khayelitsha. Informed by the results of this study the School of Public Health at the University of the Western Cape joined the Prospective Urban and Rural Epidemiology (PURE) study in January 2009. The study seeks to scientifically document the root-causes of the traditional risk factors for NCDs by following-up adults aged 30 to 75 years for 12 to 15 years and collecting individual-; household-; community- and national-level information. Responding effectively to the growing burden of NCDs incorporates addressing societal and biological pathways from environmental causes to primordial predispositions and adequately managing the primary risk factors

Pain as a Reason for Primary Care Visits: Cross-Sectional Survey in a Rural and Periurban Health Clinic in the Eastern Cape; South Africa

Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province.Method: A cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95 confidence interval (CI) of pain were estimated; and the relationship with demographic variables was determined at a significance level of P 0.05.Results: Seven hundred and ninety-six adult patients were interviewed; representing a response rate of 97.4. Almost three-quarters (74.6; 95 CI: 63.2-81.4) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4; 95 CI: 32.1-61.0) visits and was secondary in 201 (25.3; 95 CI: 12.8-33.7) visits. The common sites of pain were the head; back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain.Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province

Inclination towards a research career among first year medical students: an international study.

Introduction: The importance of fostering clinicians who are also scientists is well recognized. It is of value to assess medical students’ inclination towards and self-perceived readiness for a research career, as this has implications on the future development of such individuals. Methods: A questionnaire was self-administered to all consenting first year medical students from eleven universities in ten countries. Questions were asked pertaining to inclination towards research careers, confidence in research methodology and ability to understand medical literature. Results: A total of 1354 questionnaires were completed, with a mean response rate of 76.5%. While 24.8% students expressed an interest in pursuing a research career, 48.3% were undecided. Students with prior research experience and students who were attending graduate medical school programmes were more likely to have an interest in a research career after graduation. Males were more interested in learning about biostatistics than females, while the reverse was true for learning about research ethics. Discussion: Most students in their first year of medical school are not inclined towards a research career. This finding applies internationally, across different countries and medical school systems. Thus, the onus is on medical schools to help transform the perception and attitudes of their students during the course of their training, so that a greater proportion will be interested in and ultimately pursue research careers.

Perceptions of Body Size and Its Association with HIV/AIDS

Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS.Setting: Khayelitsha; an urban township in Cape Town.Subjects: 513 women aged 18-65 years.Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase; qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection; participants were shown eight body figures; ranging from thin to obese; and asked to choose a figure representing the ideal figure; a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed; focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV; or who had AIDS. Only 10.2 thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure; while 34.2 thought that normal weight symbolised health. Only 2 thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31 thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8 preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases; rather than being thin and stigmatised as a person infected with HIV or who had AIDS. Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women

Fear of Sexually Transmitted Infections among Women with Male Migrant Partners-Relationship to Oscillatory Migration Pattern and Risk-Avoidance Behaviour

Background. In South Africa; former apartheid lasw encouraged rural males seeking employment to migrate to urban areas; movig weekly; monthly or annually between their rural families and urban workplaces. The combination of the migrant labour system and long family separations caused an explosion of serious health consequences; among others sexually transmitted infections (STIs) in the migrant population. Objective. To describe some correlates of male migration patterns for the rural women left behind; especially the fear of STIs that this engendered in theem and their risk-aoidance Setting and subjects. In KwaZulu-Natal; 208 parentatal paients who were partners of oscillating male migrant workers were interviewed to determine their demographic and charactetistics; and their fear of STIs. Results. Thirty-six per cent of the rural women said that they were afraid of contracting STIs from thair returning migrant partners; Women who saw their partners infrequently were more fearful of STI transmission; and were less able to have sexual communication. However; almost none of the women protected themselves; while only 8used condoms; primarily for contraceptive purposes. Conclusions. These results reflect the gender-based-power relationships of South African male migrants and their rural partners; the social and economic dependency of the women on their migrant partners; and the women's social responsibility to bear children. The results point to the need to go beyond interventions that simply seek to modify behaviour without altering the forces that promote risk taking and discourage risk reduction; and the need to develop appropriate interventions to curb STIs and decrease HIV