Trends in admissions, morbidity and outcomes at Red Cross War Memorial Children's Hospital, Cape Town, 2004-2013

Background. Routinely collected patient information has the potential to yield valuable information about health systems and population health, but there have been few comprehensive analyses of paediatric admissions at South African (SA) hospitals.Objectives. To investigate trends in hospitalisation and outcomes at Red Cross War Memorial Children's Hospital (RCWMCH), a major referral hospital for children in the Western Cape and SA.Methods. Using routinely collected observational health data from the hospital informatics system, we investigated admissions between 2004 and 2013. Clinical classification software was used to group International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes to rank causes during 2008 - 2013, when ICD-10 codes were widely available. Analyses examined trends in medical and surgical admissions over time. Results. There were 215 536 admissions over 10 years of 129 733 patients. Admissions increased by 9.3%, with increases in the general medical wards (5%), medical specialty wards (74%), the burns unit (73%), and the intensive care unit (16%). In contrast, admissions decreased in the trauma unit (21%) and short-stay medical wards (1%). In-hospital mortality decreased by 54% (p-trend <0.001) over 10 years. Diarrhoea and lower-respiratory tract illness were the most common causes for medical admissions, although admissions and deaths due to these conditions decreased between 2008 and 2013, which coincided with the national introduction of related vaccines. Similarly, tuberculosis admissions and deaths decreased over this period. These trends could be owing to a concurrent decrease in HIV comorbidity (p-trend <0.001). Trauma was the most common reason for surgical admission. Conclusion. Paediatric in-hospital mortality decreased consistently over a decade, despite an overall increase in admissions. Pneumonia and diarrhoea admissions decreased markedly over a 6-year period, but remain the most important causes of hospitalisation

HIV/AIDS and Mental Health Research in Sub-Saharan Africa: a Systematic Review

The relationship between mental illness and HIV/AIDS is complex and bidirectional. A significant amount of research has been performed in high-income countries but less is known about HIV and mental health in sub-Saharan Africa. The objectives of the review were to search the literature for quantitative studies conducted in sub-Saharan Africa on mental health and HIV and to critically evaluate and collate the studies in order to identify research needs and priorities. The databases Ovid; MEDLINE; PsycINFO and the Social Sciences Citation Index (SSCI) were searched for variations of search terms related to HIV/AIDS and mental health and studies limited to the populations of African countries. In addition; we hand-searched indexes of key journals and the databases of academic theses. We included 104 papers or research publications. The majority of these were published after 2005. The major topics covered were: mental-health-related HIV-risk behaviour; HIV in psychiatric populations; and mental illness in HIV-positive populations. The reported prevalence levels of mental illness among people living with HIV or AIDS (PLHIV) was high; with all but one study noting a prevalence of 19or higher. Neurocognitive changes in adults with HIV were also prevalent; with reported deficits of up to 99in symptomatic PLHIV and 33in non-symptomatic PLHIV. Research on HIV in relation to mental health is increasing; however; there is a need for good-quality prospective studies to investigate the bidirectional effects of mental illness and HIV on each other

Prevalence and correlates of atypical patterns of drug use progression: findings from the South African Stress and Health Study

Objective: Atypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans.Method: Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. Results: Overall; 12.2of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. Conclusion: Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common; especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research

Primary Health Eye Care: Evaluation of the Competence of Medical Students in Performing Fundoscopy with the Direct Ophthalmoscope

Background: To evaluate the skill of fifth-year medical students at the University of Cape Town in the performance of fundoscopy at the end of their ophthalmology rotation.Methods: The design was a prospective cohort study. The study was conducted at Groote Schuur Hospital in Cape Town. The ability of fifth-year medical students to perform fundoscopy on mannequin heads fitted with fundus photographs using direct ophthalmoscopes was evaluated. The outcome measures used were ability to see the fundus and ability to recognise fundus pathology. Results: The fundus photographs could be seen in 95of cases. The correct diagnosis could be made in only 57of cases. Conclusion: Medical students at the University of Cape Town need more than the current one week of practical ophthalmology training to improve their fundoscopy skills