Mastering your fellowship: Part 3, 2022

The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination.Keywords: family physicians; FCFP (SA) examination; family medicine registrars; postgraduate training; national exit examination; infectious diseases.

Mastering Your Fellowship: Part 4, 2022

The 'Mastering Your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa examination. The series is aimed at helping family medicine registrars prepare for this examination.

Factors influencing the use of intermittent preventive treatment of pregnant women seeking care at primary healthcare facilities in the Bwari Area Council, Abuja, Nigeria

Background: The use of intermittent preventive treatment-sulphadoxine­pyrimethamine (IPT-SP), adapted by Nigeria, is one key preventive strategy recommended by the World Health Organization. Because antenatal clinics serve as the usual entry point for IPT-SP implementation, this study explored healthcare workers' knowledge and practice, which are key to optimal IPT-SP coverage. Aim: This study aimed to explore the knowledge and practices of healthcare workers on the direct observation of IPT-SP amongst pregnant women attending antenatal care (ANC) in the Bwari Area Council (BWAC) of the Federal Capital Territory, Abuja, Nigeria. Setting: The study took place at five different wards of Bwari Area Council and eight Antenatal care facilities in Abuja, Federal Capital Territory, Nigeria. Methods: In-depth interviews and indirect observations were conducted among purposively selected healthcare workers in charge of the ANC of the eligible facilities. The study explored the knowledge and practices of healthcare workers on intermittent preventive treatment. Data were transcribed, translated and manually coded, and thematic analysis was conducted. Results: Healthcare workers' knowledge of IPT-SP, mode of administration and the rationale behind the use were poor. They all agreed that IPT-SP is supposed to be administered as a directly observed therapy at the clinic, but this practice was non-existent. Conclusion: The findings indicate that factors such as adequate technical skill, accessibility and availability of logistics influence knowledge and practice of IPT service delivery. Therefore, measures should be put in place to address gaps identified by this study

A description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe

Background: Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities.Aim: The aim of this project was to improve the community's knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes.Setting: The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe.Methods: We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group.Results: There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community's confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established.Conclusion: The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes

Mastering your fellowship

The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online

Mastering your Fellowship

The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Background: Diabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal. Methods: A retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients' demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.Results: One hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.Conclusion: The prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM

The Profile and Frequency of Known Risk Factors or Comorbidities for Deep Vein Thrombosis in an Urban District Hospital in KwaZulu-Natal

Background: Although deep vein thrombosis (DVT) is a preventable disease; it increases the morbidity and mortality in hospitalised; patients; resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality.Aim and setting: The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal.Methods: A retrospective review of clinical notes of all medical patients (age = 13 years) admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013.Results: The median age was 40 years (interquartile range 32-60 years) and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors; accounting for 51.85% and 35.80%; respectively. Other risk factors observed were recent hospitalisation (34.57%); smoking (25.93%); previous DVT (19.75%) and congestive cardiac failure (18.52%).Conclusion: DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore; HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered

Patients with Type 2 Diabetes and Difficulties Associated With Initiation of Insulin Therapy in a Public Health Clinic in Durban

Objectives: Many patients with type 2 diabetes are uncontrolled on maximum oral treatment. The early introduction of insulin can lower diabetes-related complications. The purpose of this study was to explore the reasons behind a perceived reluctance of patients with type 2 diabetes to commence insulin therapy despite objective evidence for the augmentation of oral treatment with insulin. Secondary objectives were to review the demographic data of these patients; to review the patients' knowledge of their disease and of insulin and to compare the knowledge and difficulties of those who agreed to be initiated on insulin with that of those who refused.Design: The study used an observational analytical design. All uncontrolled patients with type 2 diabetes on maximum oral therapy were interviewed using face-to-face interviews with open- and closed-ended questions.Setting and subjects: The study was conducted over a three-month period at the Phoenix Community Health Centre; a state-run institution; in Durban; KwaZulu-Natal.Outcome measures: The education level of the patients; their knowledge of the disease; understanding of insulin; family support and fear of needles and pain were notable outcome measures.Results: Fifty-nine patients were enrolled in the study. The mean haemoglobin A1c was 9.6. Level of academic education was not associated with a willingness to start insulin therapy (p-value = 0.426). Forty-seven per cent of the patients had no understanding of insulin. Forty-four per cent of the patients were willing to initiate insulin therapy and 55 refused. There was no significant difference in knowledge score between those who accepted and refused insulin therapy (p-value = 0.554). Seventy-nine per cent of patients were afraid of the pain associated with injections.Conclusion: As a fear of injections and needles was the only significant factor that was associated with the refusal to initiate insulin therapy (p-value 0.001); health professionals need to address this during patient education; so as to initiate insulin treatment successfully and timeously