Health-service utilization by pregnant women in the greater Mafikeng-Mmabatho district.

Since the implementation of free maternity services in South Africa from 1994, more maternity services were provided (SA, 1994: 73). These services are however inaccessible to many pregnant women in the rural areas, leading to sub-optimal antenatal health service utilization. Another problem that emerged, is deterioration in antenatal health service rendering throughout the country, as well as a lack of guidelines for the mobilization of pregnant women in order to promote optimal antenatal health service utilization (ANHSU) in the North West Province. The mentioned problems were the reasons for undertaking this research. The aims formulated for this research were: To determine the composition of the infrastructure of the antenatal health services and the efficacy of the antenatal health-service rendering in the greater Mafikeng-Mmabatho District; To undertake a survey of the ANHSU by pregnant women attending the mentioned services; To explore and describe the perceptions of these pregnant women regarding ANHSU; To formulate recommendations for antenatal health service providers working in the greater Mafikeng-Mmabatho District for the mobilization of pregnant women to promote optimal ANHSU. A qualitative survey design was followed within the context of the greater Mafikeng-Mmabatho District in the North West Province. Data-collection was managed through completion of structured questionnaires by chief professional nurses and puerperal women and by holding semi-structured interviews with puerperal women who were selected using non-probable, voluntary and purposive sampling. The findings that emerged were, that the composition of the infrastructure of the majority antenatal health services in the greater Mafikeng-Mmabatho District were insufficiently equipped indicating the provision of ineffective antenatal health service rendering. Pregnant women were utilizing the antenatal health services sub-optimally and the exploration and description of their ANHSU, revealed factors promoting and preventing utilization. Recommendations have been formulated for nursing education, nursing research and nursing practice with specific reference to the formulation of guidelines for antenatal health service providers to promote optimal ANHSU by pregnant women.

Vertical tripod fixation (VTF) simplifies transscleral approaches.

Transscleral fixation of intraocular lenses (IOL) is an accepted procedure today. Following Malbran's initial approach, new techniques have been developed in various ophthalmic centers; many, however, are time-consuming and difficult, as reflected by complications, most commonly hyphema and IOL tilt. We present here a simple method of transscleral fixation, which was performed in 24 patients in our department. It involves fixating the IOL vertically, on a three-point configuration, using standard 10-0 prolene stitches. Performing it is easy and time-saving. VTF ensures a stable transscleral fixation of an IOL.

Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations.

The management of congenital cataracts is still challenging, especially in developing nations, where surgical facilities are limited. Congenital cataracts were extracted from 22 patients (26 eyes): a procedure consisting of a star-shaped anterior capsulectomy and wash-out of lens material (STARWO) was performed in 16 of them (18 eyes) (group A); a procedure consisting of a star-shaped anterior capsulectomy, wash-out, anterior vitrectomy through the posterior capsulotomy, and repeated tearing of remnants of the anterior capsule (STARWAR) was performed in six patients (eight eyes) (group B). Intraocular lenses were implanted in both groups. In group A, secondary membranes (27.7%) developed in five eyes, postoperative uveitis in four (22.2%), and a late Elschnig pearl in 1 (5.5%). In group B, there was one case of secondary membrane formation (12.5%), and one of postoperative uveitis; neither required subsequent intervention. The inexpensive instrumentation used and the low rate of perioperative complications encountered in these patients make these two techniques attractive alternatives for managing congentital cataracts in developing nations.

[Diffuse corneal pigmentation--a new sign in neurofibromatosis].

Neurofibromatosis is an autosomal dominant disease affecting many organs. It is known for the characteristic pigmented skin spots and various neurofibromas. We present a 79-year old man who underwent elective cataract extraction. The surgery was complicated by the presence of diffuse, deep, intracorneal pigmentation. To our knowledge, this sign has not as yet been described in neurofibromatosis.

[Eye trauma in southern Africa].

The population of southern Africa living in South Africa, Swaziland, Lesotho and Mozambique is 50 million. Because of intertribal hostility, the particular family structure, and the widespread use of alcohol and cannabinoid drugs, violence is very common. Trauma results mainly from "cold" weapons, which are an essential part of the traditional accoutrements of the African male. 202 patients (31.86% of those who underwent eye surgery in 2 years) needed surgery for severe ocular trauma in Mbabane, Swaziland. In a similar period, 100 patients (19.49%) required similar surgery in Boksburg, South Africa.

Left paraduodenal hernia with acute abdominal symptoms. A case report.

A 22-year-old man with an incarcerated left paraduodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.

[Gas gangrene: A discussion of 3 cases and review of the literature]. / Gasgangreen. 'n Bespreking van 3 gevalle en literatuuroorsig.

Three patients with gas gangrene of the lower limbs are presented. In 2 of the 3 patients gas gangrene developed after lower-limb amputation, indications for amputation being atherosclerotic and diabetic gangrene. In the third patient associated leukaemia was diagnosed. All 3 patients presented with the typical clinical manifestations of gas gangrene. Clostridium perfringens was isolated from the affected leg in each patient. The current application of surgery and hyperbaric oxygen therapy in the treatment of gas gangrene is discussed.