Knowledge of final-year medical students at the University of KwaZulu-Natal about family medicine, and long-term career choices

Background: While international experience suggests that well-trained primary care physicians improve the quality and cost effectiveness of health care, family medicine (FM) as the discipline of the specialist primary care physician appears to not be an attractive career for medical graduates in South Africa (SA). The aim of this study was to establish final-year medical students' knowledge about FM and its relevance to the healthcare system, explore their perceptions of the discipline's relevance, and identify their specialty preference.Methods: This was a descriptive study conducted amongst final-year medical students at the University of KwaZulu-Natal (UKZN) in 2017 attheconclusion of their seven-week FM module. Data were collected using a self-administered questionnaire and results were analysed descriptively.Results: The response rate of completed questionnaires was 80.2% (157/196). Students reported limited exposure to FM in their early undergraduate years and low levels of awareness about essential public health programmes. Students showed good awareness of the six roles of family physicians (FPs), but FM was only the sixth most popular choice for specialisation. Conclusions: In general, students had favourable views concerning FM and its role in the future of healthcare delivery in SA,although their knowledge of essential health programmes was poor. The majority of students had limited interest in pursuing a career in FM. A key recommendation to address these issues is to introduce FM into the curriculum earlier, to cover the key roles of the FP, and provide teaching that highlights the relevance of FM to health system programmes

A review of the management and outcome of patients admitted with cryptococcal meningitis at a regional hospital in KwaZulu-Natal province

Background: South Africa has 7.06 million people who are HIV-positive, with those having a low CD4 count being susceptible to cryptococcal meningitis (CCM), which has an estimated mortality of 30­50%. This study aimed to establish the outcome of patients admitted with CCM to a regional hospital in Durban between June 2015 and May 2016, and the extent to which the National Department of Health (NDoH) protocol was adhered to in managing their condition. Method: This retrospective observational descriptive study reviewed the records of patients ≥ 12 years old admitted with CCM between June 2015 and May 2016, from which their demographic and medical data were extracted.Results: Seventy-six complete records were found of which 49 were men and 27 were women. The average CD4 count was 55.9 cells/mm3, 85.5% were treated with intravenous amphotericin B and high-dose oral fluconazole, 6.7% received only amphotericin B and 5.2% received only fluconazole. There was an in-hospital mortality of 31.6%, and the NDoH protocol was adhered to in 72.4% (55/76) of patients. There was, however, no significant difference in outcome between those who were and were not managed as per the protocol (p = 0.177).Discussion and conclusion: In-hospital mortality for CCM continues to be significant despite high rates of adherence to the NDoH protocol in the majority of patients. For this to be addressed, early diagnosis of HIV and initiation of ART to prevent the profound immunosuppression is essential

Description of Surgical and Anaesthetic Services Provided at Two District Hospitals in KwaZulu-Natal in Relation to the Surgical Norms and Standards Outlined in the Service Package for District Hospitals

Background: Provision of surgical services at district hospitals (DHS) is cost effective and important. The District Hospital Service Package for South Africa (package of services) specifies the services that a district hospital should provide. The aim of this study was to document the surgical services provided at two DHS in KwaZulu-Natal and to compare this with the recommendations in the package of services. Methods: In a retrospective quantitative study; data from 2008 were collected from the theatre register at two DHS. Data were analysed and results compared with the norms and standards in the package of services. Results were presented to staff at the hospitals; who then commented on the challenges of providing surgical services at DHS. Results: Only 60and 30respectively of procedures listed in the package of services were being carried out at the two hospitals. In total; 3 900 procedures were carried out over the year. Dundee Hospital offered a broader range of surgical procedures and anaesthetics than the Church of Scotland Hospital (COSH). COSH has a large obstetric burden; with 3 666 deliveries each year. A large number of procedures were being carried out by a single operator. Conclusions: Many surgical procedures are being carried out even though neither hospital provides the full complement of surgical services as specified in the package of services. The wide variation between the surgical services offered reflects the surgical and anaesthetic skills at the respective hospitals. Potential medico-legal hazards that require urgent attention were identified. A review of the package of services is essential to identify core procedures that must be provided at DHS