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2.
S Afr Med J ; 111(6): 515-516, 2021 04 09.
Article in English | MEDLINE | ID: mdl-34382555

ABSTRACT

Letter by Venter et al. on editorial  by Schoub (Dial down the rhetoric over COVID-19 vaccines. S Afr Med J 2021;111(6):522-523. https://doi.org/10.7196/SAMJ.2021.v111i6.15740).


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , SARS-CoV-2 , South Africa
3.
S Afr Med J ; 108(6): 506-510, 2018 May 25.
Article in English | MEDLINE | ID: mdl-30004332

ABSTRACT

BACKGROUND: Ureteral stenting is generally a theatre-based procedure that requires a multidisciplinary team and on-table imaging. Limited hospital bed numbers and theatre time in our centre in Cape Town, South Africa, have led us to explore an alternative approach. OBJECTIVES: To see whether outpatient insertion of ureteric stents under local anaesthesia without fluoroscopy was a possible and acceptable alternative to theatre-based ureteral stenting. METHODS: Ureteral stenting (double-J stents and ureteric catheters) was performed with flexible cystoscopy under local anaesthesia and chemoprophylaxis, but without fluoroscopic guidance, in an outpatient setting. Every patient had an abdominal radiograph and an ultrasound scan of the kidney after the procedure to confirm stent position. RESULTS: Three hundred and sixteen procedures (276 double-J stents and 40 ureteric catheters) were performed in 161 men and 155 women. The overall success rate for the procedures was 85.4%, independent of gender (p=0.87), age (p=0.13), type of device inserted (p=0.81) or unilateral/bilateral nature of the procedure (p=1.0). Procedures with a successful outcome were performed in a significantly (p<0.0001) shorter median time (10 minutes (interquartile range (IQR) 5 - 15)) than failed procedures (20 minutes (IQR 10 - 30)). Patients with a pain score of >5 experienced a significantly (p=0.02) greater proportion of failure (27.3%) than patients with a pain score of ≤5 (12.5%). Difficulties were encountered in 23.7% of procedures, with a significantly higher proportion being registered in failed interventions compared with successful ones (82.6% v. 13.7%; p<0.0001). CONCLUSIONS: The procedure was easily mastered and technically simple, and represents savings in cost, time and human resources in our setting.

4.
S Afr Med J ; 106(12): 1192-1210, 2016 Dec 01.
Article in English | MEDLINE | ID: mdl-27917765

ABSTRACT

BACKGROUND: Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants. OBJECTIVES: To review design and operational features of pregnancy support programmes, highlighting features that promote their effectiveness and efficiency, and implications thereof for SA. METHODS: Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries. RESULTS: Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support. CONCLUSIONS: Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.

6.
S Afr Med J ; 88(7): 838-40, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9698708
7.
Health Econ ; 7(4): 281-9, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9683089

ABSTRACT

This paper discusses some of the trends, debates and policy proposals in relation to the financing of the private health sector in South Africa. The public and private sectors in South Africa are of equivalent size in terms of overall expenditure, but cover substantially different population sizes. Within this context the government has reached the unavoidable conclusion that the private sector has to play some role in ensuring that equity, access and efficiency objectives are achieved for the health system as a whole. However, the private sector is some way off from taking on this responsibility. Substantial increases in per capita costs over the past 15 years, coupled with a degree of deregulation by the former government, have resulted in increasing instability and volatility. The development of a very competitive medical scheme (health insurance) market reinforced by intermediaries with commercial interests has accelerated trends toward excluding high health risks from cover. The approach taken by the government has been to define a new environment which leaves the market open for extensive competition, but removes from schemes the ability to compete by discriminating against high health risks. The only alternatives left to the private market, policy makers hope, will be to go out of business, or to survive through productivity improvements.


Subject(s)
Health Care Reform , Private Sector , Costs and Cost Analysis , Delivery of Health Care/economics , Delivery of Health Care/trends , Financing, Government , Financing, Personal , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Health Policy , Insurance, Health/economics , Insurance, Health/trends , Managed Care Programs , Private Sector/economics , Private Sector/trends , Public Sector/economics , Public Sector/trends , Risk Management , South Africa
11.
S Afr Med J ; 69(5): 297-300, 1986 Mar 01.
Article in English | MEDLINE | ID: mdl-3961609

ABSTRACT

Phases II and III of the human in vitro fertilization programme at Tygerberg Hospital are presented. In phase II, 42 laparoscopies were performed and oocytes were obtained from 76% of the follicles aspirated, but with a fertilization rate of only 37%. The viable pregnancy rate per embryo transfer was 4%. Important changes took place in the programme, which led to a fertilization rate of 77% in phase III. Of the 78 patients subjected to laparoscopy, 65 (83%) reached the embryo transfer stage, resulting in a clinical pregnancy rate per embryo transfer of 23%, and with a 19% pregnancy rate per laparoscopy. The changes, methods and results of phases II and III are discussed.


Subject(s)
Fertilization in Vitro , Embryo Transfer/instrumentation , Evaluation Studies as Topic , Female , Fertilization in Vitro/methods , Humans , Pregnancy , South Africa
12.
S Afr Med J ; 67(19): 751-4, 1985 May 11.
Article in English | MEDLINE | ID: mdl-3158086

ABSTRACT

Phase I (3 June - 31 October 1983) of the in vitro fertilization (IVF) programme at Tygerberg Hospital is outlined in this article. This programme led to the birth of the first IVF baby in South Africa after fertilization and embryo transfer (ET) took place at this institution. The baby was born on 29 April 1984; a second baby was born on 20 June 1984. During phase I 24 laparoscopies were performed; 32 oocytes were obtained from 56 follicles, of which 62,5% were fertilized. Eleven ETs were performed, which led to 3 pregnancies. An ongoing pregnancy rate of 18% per ET and a pregnancy rate of 12,5% per laparoscopy were achieved.


Subject(s)
Embryo Transfer/methods , Fertilization in Vitro/methods , Adult , Female , Humans , Laparoscopy , Ovulation Induction , South Africa
13.
S Afr Med J ; 54(9): 359-61, 1978 Aug 26.
Article in English | MEDLINE | ID: mdl-715632

ABSTRACT

Sera of 184 patients were examined to determine the incidence of hepatitis B surface antigen (HBsAg). Ninety-two patients had primary liver cancer (PLC) and there were 92 matched controls. Thirty-one of the 92 patients with PLC and 8 of the 92 patients with no clinical evidence of liver disease had radio-immunoassay-positive tests for HBsAg. The difference was significant (P less than 0,01). In 56 of the patients with PLC it was possible to assess the nature of associated liver disease histologically. HBsAg was found in the sera of 66,6% of patients with postcollapse cirrhosis and in 22,2% of patients with chronic Budd-Chiari syndrome. It is likely that the role played by hepatitis B infection in the pathogenesis of PLC varies according to local circumstances in different geographical areas.


Subject(s)
Budd-Chiari Syndrome/complications , Hepatitis B Surface Antigens/blood , Adolescent , Adult , Aged , Female , Humans , Infant , Liver/analysis , Liver Neoplasms/epidemiology , Liver Neoplasms/immunology , Male , Middle Aged , South Africa
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