Complications following removal of oesophageal foreign bodies: a retrospective review of 349 cases.

AIM: To determine the incidence and types of complications associated with oesophageal foreign body (FB) removal in dogs, as well as to evaluate potential risk factors for the development of complications. METHODS: Clinical records were searched within Animal Emergency Service and Veterinary Specialist Services databases between July 2001 and March 2017. Data were collected regarding signalment, FB type, method of removal, medical management and complications. Follow-up records from the referring veterinarian were then obtained by either phone call or email. RESULTS: A total of 349 FB cases were reviewed. The majority of FBs were bones (77.4%), with Staffordshire Bull Terriers (12.3%) and West Highland White Terriers (9.8%) the most common breeds seen. Complications at the time of FB removal occurred in 20 cases (5.9%), with 14 cases of perforation. Persistent gastrointestinal signs were reported in 4.7% of cases within the initial 72-h period following FB removal and 11.9% cases outside this time period. Respiratory signs such as dyspnoea and coughing were also reported in 8 cases (2.3%), all of which occurred within 72 h after FB removal. Follow-up of at least 1 month was available in 151 cases. Delayed complications occurred in 11 cases (7.3%), with stricture occurring in 4 cases (2.6%); 16 animals were either euthanased (n = 14) or died (n = 2) post-FB removal, resulting in a case fatality rate of 4.6%. CONCLUSION: Use of antacid medications and FB type did not have a statistically significant relationship with complications following FB removal.

Serum cobalamin concentrations in healthy cats and cats with non-alimentary tract illness in Australia.

OBJECTIVE: To determine a reference range for serum cobalamin concentration in healthy cats in Australia using a chemiluminescent enzyme immunoassay and to prospectively investigate the prevalence of hypocobalaminaemia in cats with non-alimentary tract disease. DESIGN: Prospective study measuring serum cobalamin concentrations in clinically healthy cats and cats with non-alimentary tract illness. PROCEDURE: Blood was collected from 50 clinically healthy cats that were owned by staff and associates of Veterinary Specialist Services or were owned animals presented to Creek Road Cat Clinic for routine vaccination. Blood was collected from 47 cats with non-alimentary tract illness presented at either clinic. Serum cobalamin concentration was determined for each group using a chemiluminescent enzyme immunoassay. RESULTS: A reference range for Australian cats calculated using the central 95th percentile in the 50 clinically healthy cats was 345 to 3668 pg/mL. Median serum cobalamin concentration in 47 cats with non-alimentary tract illness (1186 pg/mL; range 117-3480) was not significantly different to the median serum cobalamin of the 50 healthy cats (1213 pg/mL, range 311-3688). Using the calculated reference range one sick cat with non-alimentary tract illness had a markedly low serum cobalamin concentration. CONCLUSION: Although hypocobalaminaemia is uncommon in sick cats with non-alimentary tract illness in Australia, its occurrence in this study warrants further investigation.

A district health service in Khayelitsha--panacea or pipedream?

Khayelitsha is an underserviced, largely informal urban settlement on the edge of Cape Town. It is home to some 350,000 people. This paper maintains that a district health service would be beneficial in Khayelitsha. Advantages include (i) the integration and co-ordination of services with coherent management of health care; (ii) the ability to prioritise and act on problems with the full range of preventive and curative measures as well as intersectoral support; and (iii) the accountability of health providers. Some of the steps taken towards the initiation of a district health service are illustrated in a discussion of the recent changes in health service structures in Khayelitsha. There are many obstacles to the implementation of a formal district health service and these are discussed briefly.

Botshabelo's vaccination survey.

This community-based survey evaluates vaccination coverage of small children and socio-economic status of their households in a randomly selected sample of a black South African township. It reveals a poverty-stricken community, where only 19% of the children surveyed were fully vaccinated. It is suggested that expansion of health infrastructures together with a co-ordinated strategy of immunisation would result in a spectacular increase in vaccination coverage.

Measuring environmental health status in Oukasie, 1987.

This article reports on some aspects of the physical environment and on environmental health services at Oukasie. The data were collected over a weekend in August 1987 by an interview and by direct inspection of the environment using a standard schedule. We had a 100% response rate on the interviews. There was a mean of 2.2 +/- 1.6 persons per room in the households, with brick houses being less crowded than non-brick houses. Private yards were generally kept very clean. Bucket latrines were unhygienic and used by an average of 4 families. No latrine was built to accepted standards. Garbage collection and emptying of the bucket latrines by the municipality seemed to be unsatisfactory. Our overall impression was that where responsibility for maintenance of hygiene is either undefined, such as the collection chambers of bucket latrines, or a responsibility of the public authorities, such as garbage collection and water drainage, there is an unsatisfactory state of hygiene. Where maintenance of cleanliness is clearly a private responsibility, such as the maintenance of the cleanliness of private yards, the general status of hygiene is good.

Community health survey of Oukasie, 1987.

A series of surveys were conducted at the request of the community of Oukasie to determine certain public health information in the township, a peri-urban black community. This article describes two of these surveys. The first, a census and partial demographic survey, showed that the total black population was around 6,300 with a mean household occupancy of 4.1. Some of the estimated vital statistics calculated were an infant mortality rate of 36.6/1,000, a crude birth rate of 28.0/1,000, a crude death rate of 6.5/1,000, and a general fertility rate of 99.3/1,000. The second survey into the nutritional and immunisation status of children aged under 5 years showed that 20% of children were underweight and nearly half were incompletely immunised at 1 year of age. These studies, involving local community and student volunteers, were rapidly and inexpensively done and provide basic public health information.

Life after death--mortality statistics and the public health.

The process by which mortality statistics are compiled in the RSA and the potential impact on public health are discussed. The use of the international death certificate is outlined; this is compared with the South African death certificate to illustrate the importance of establishing the chain of events leading to death. The distinction between underlying and direct causes of death in compiling mortality statistics and planning public health intervention is considered. The major part played by medical practitioners in the death certification process is emphasised, and some of the areas in which mortality data could be improved are highlighted.

Dispensing habits of Johannesburg pharmacists in treating acute infantile diarrhoea.

Sixty pharmacists in Johannesburg were randomly selected and questioned on their suggested treatment of acute infantile diarrhoea as well as their knowledge of oral rehydration therapy (ORT); 53 (88%) responded. Of 51 pharmacists who had treated diarrhoea in children, 8 (16%) had never heard of ORT, while 20 (39%) treated this condition with antidiarrhoeal drugs. These findings are perturbing, because acute diarrhoeal disease is the biggest cause of mortality of children aged 1-4 years in South Africa and ORT is recognised as an effective means of prevention of death.

Awareness of oral rehydration at well-baby clinics in Johannesburg.

A questionnaire regarding knowledge about oral rehydration therapy (ORT) was administered to 1087 adults bringing Asian, black, coloured and white children to under-5 clinics in Johannesburg. Although 54% had heard about ORT, misconceptions existed in this group and half thought that ORT stops diarrhoea. There were no significant differences in awareness of ORT between the different population groups. Awareness increased with age of the child, the birth order of the child and the educational level of the adult. These three factors were associated with statistically significant differences in awareness. Of these, educational level was the most important. The main first source of information about ORT was clinic sisters (54%), although when a child has diarrhoea a doctor is most commonly consulted (43%). Less-educated mothers of newborn first children appear to be in most need of health education, and recommendations to involve this group and health professionals in Johannesburg are discussed.

Notification of five of the EPI target diseases in South Africa. An assessment of disease and vaccination reporting.

The incidence of 5 of the 6 EPI target diseases, diphtheria, tetanus, poliomyelitis, measles and tuberculosis, in South Africa is examined. Incidence is linked to vaccination coverage and an assessment of municipal vaccination coverage and programme monitoring is made. Diphtheria incidence has decreased sharply and this is probably due to vaccination. A change in the cyclical pattern of polio incidence may be due to improved vaccination. No influence of vaccination could be detected with respect to measles, tetanus and tuberculosis. Vaccination programmes report results as 'total doses given' and not as coverage rates. Improvements in three major areas, i.e. vaccination coverage, programme monitoring and evaluation and programme co-ordination are proposed.

Mass immunisation campaigns--do they solve the problem?

Mass immunisation campaigns have been successfully used for vaccine delivery in countries such as Brazil and Turkey as well as in a number of instances locally. Although in some circumstances mass campaigns have been advantageous, they are not recommended as a basic policy for South Africa. Immunisation services should be incorporated into routine primary health care delivery as part of maternal and child services. If these services are adequately delivered there would be no need for mass campaigns.

Alexandra township--is immunisation adequate?

In this study we assessed immunisation coverage and identified some of the factors that are predictive of non-immunisation in Alexandra township. A cohort of 348 babies delivered through the Alexandra clinic system in March and April 1986 were followed up for 4-5 months to see whether they returned for the first DPT and poliomyelitis immunisation. Two hundred and twenty-eight of the eligible babies (66%) received the first DPT and polio immunisation. Of the 120 who were not immunised, 54 (16% of the total) were not traced, 46 (13%) were transferred to another area and 20 (6%) were traced defaulters. Babies born to mothers who had not attended antenatal clinics and who lived outside Alexandra had children with significantly lower immunisation coverage than those born to other mothers. the sex of the baby, maternal age, previous sibling death, maternal parity and paternal support were not associated with any difference in immunisation coverage. In this paper some of the reasons for the low immunisation coverage are discussed and suggestions as to how this can be improved are given.

Age-related patterns of alcoholism among veterans in ambulatory care.

In a survey of 342 outpatients in two urban Veterans Administration medical centers, 10.2 percent of the patients aged 65 and over and 8.4 percent of those aged 55 to 64 were found to be alcoholic on the Veterans Alcoholism Screening Test. The younger age groups (under age 35, age 35 to 44, and age 45 to 54) were two and a half to three times more likely to be alcoholic than the 65-and-over group. The oldest group was most likely to have never been alcoholic, and least likely to have been formerly alcoholic. Although several authors have proposed that the elderly may increase their intake of alcohol in response to the stresses of aging, study data indicated that half of the 65-and-over alcoholics were longstanding alcoholics. However, while the study suggests that the older groups have proportionately fewer alcoholics, the growing size of the aging population means that in the next few decades there will be greater absolute numbers of elderly chronic alcoholics.