Secondary health conditions in people with spinal cord injury in South Africa: Prevalence and associated factors.

BACKGROUND: People with spinal cord injury (SCI) experience preventable secondary health conditions (SHCs) that worsen the disability, reduce the quality of life and affect health and wellbeing. There is limited information on the prevalence of SHCs and the associated factors to inform planning and practice in South Africa (SA). OBJECTIVES: To identify the prevalence of SHCs and the associated factors in people with SCI. METHODS: We conducted a retrospective review of patients' medical records at a tertiary academic hospital and a rehabilitation hospital in Gauteng Province, SA. Data collected included demographic data, injury profile, SHCs and associated factors. Data were summarised using descriptive statistics of frequency and percentages. Fisher's exact test was used to determine the association between SHCs and sociodemographic and clinical variables. The Mann-Whitney U-test was used to determine the associated risk factors for SHCs. Multinomial regression was used to determine the predictors of the frequency of SHCs. RESULTS: A total of 425 records were reviewed, 68.0% of patients were male, and the median (interquartile range) age was 45 (35 - 56) years. The majority (93.7%) of the patients had SHCs, and 78% had ≥2 SHCs. Significant predictors of having >3 SHCs were the duration of SCI (p=0.01), site of injury in the upper (p=0.03) and lower (p=0.01) thoracic spine, being unemployed (p=0.04), and public hospital income classification (H0 = social grant/unemployed, H1 = earning ZAR0 - 70 000 per annum single income/ZAR0 - 100 000 per annum household income, and Road Accident Fund; p=0.03, p=0.03 and p=0.01, respectively). CONCLUSIONS: Secondary health conditions were prevalent among patients with SCI. People with SCI experience multimorbidity that requires multiple management strategies. These findings point to the need for prevention strategies to minimise the occurrence of SHCs.

Developmental status of preschool children receiving cART: a descriptive cohort study.

BACKGROUND: HIV is known to cause neurodevelopmental problems in infants and young children. The impact of HIV on the development of preschool-age children has been less well described. METHOD: The study was conducted at an urban paediatric HIV clinic in Johannesburg, South Africa. A sample of convenience was used. Sixty-eight medically stable children between the ages of 3 and 5 years were assessed with the Griffiths Scales of Mental Development. Children were excluded from the study if they had severe HIV encephalopathy, which made it impossible for them to participate in the items on the Griffiths Scales of Mental Development. RESULTS: The children had started combination antiretroviral treatment (cART) at a mean age of 8.1 months. The majority of the children were virologically suppressed and did not present with wasting or stunting. Severe overall developmental delay (z-scores < -2SD) was detected in 55.88% of children. Developmental facets related to speech, cognition and perception were the most severely affected. Personal-social development was the least affected with only 13.4% of the children demonstrating severe delay. CONCLUSION: Despite having early access to cART, children infected with HIV are still at risk for severe developmental delay across a number of facets. Very early initiation of cART may help alleviate this problem. All preschool children infected with HIV should have routine developmental screening.

Socio-economic and clinical factors predictive of paediatric quality of life post burn.

Burns represent the second most common cause of non-intentional death in children under the age of five. Burns are amongst the most traumatic injuries and may impose significant psychological, educational, social and future occupational limitations to the young child. This cross-sectional study aimed to determine the socio-economic and clinical factors which predict quality of life in children with burn in a burns unit in South Africa. The Paediatric Quality of Life Inventory (PedsQL) and the Household Economic and Social Status Index (HESSI) questionnaires were administered to children and their caregivers one week and three months post discharge from the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Hospital, Soweto. The improvement in the PedsQL scores suggests that the quality of life for children three months after discharge is good despite being burnt. The severity of the burn was found to be a significant predictor of quality of life (p=0.00). Poor socio-economic status was clearly evident in demographic data of the subjects. The findings from this study are particularly important in identifying areas for further research that would be beneficial to developing countries. Furthermore, the results are important in the move towards more holistic care for paediatric burn survivors.

Parenting stress of caregivers of young children who are HIV Positive.

OBJECTIVE: Paediatric HIV remains a major challenge in Sub-Saharan Africa. Paediatric HIV is a multi-generational disorder with far-reaching implications for the whole family. Parenting stress in caregivers of HIV infected children has been studied in developed countries but never in South Africa. The aim of this study was to determine the extent of parenting stress in caregivers of children infected with HIV in South Africa. Further objectives were to monitor the levels of stress over one year after caregivers started attending a paediatric HIV clinic and to ascertain what factors were predictive of a decrease in parenting stress over that time. METHOD: One hundred and twenty two caregiver and children dyads were recruited into this study. Caregivers completed the Parenting Stress Index/ Short form at baseline and after six and 12 months. Demographic information was collected and the children's heights, weights and CD4 counts were recorded at each visit. RESULTS: The families that participated in this study came from very poor socio-economic backgrounds. Eighty five percent of the children were still being cared for by their biological mothers. The parenting stress levels of the caregivers in this study were extremely high at baseline. Although the parenting stress levels did come down significantly over the study period (p< 0.001) they remained high and warrant further investigation and management. A better level of education, better housing facilities and fewer adults living in the household were the three most important factors predicting a decrease in parenting stress over a one year period. CONCLUSION: Parenting stress of caregivers of young children infected with HIV is extremely high and warrants further investigation and long term management.

Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer.

Contrast enhanced magnetic resonance imaging (CE MRI) is the most sensitive tool for screening women who are at high familial risk of breast cancer. Our aim in this study was to assess the cost-effectiveness of X-ray mammography (XRM), CE MRI or both strategies combined. In total, 649 women were enrolled in the MARIBS study and screened with both CE MRI and mammography resulting in 1881 screens and 1-7 individual annual screening events. Women aged 35-49 years at high risk of breast cancer, either because they have a strong family history of breast cancer or are tested carriers of a BRCA1, BRCA2 or TP53 mutation or are at a 50% risk of having inherited such a mutation, were recruited from 22 centres and offered annual MRI and XRM for between 2 and 7 years. Information on the number and type of further investigations was collected and specifically calculated unit costs were used to calculate the incremental cost per cancer detected. The numbers of cancer detected was 13 for mammography, 27 for CE MRI and 33 for mammography and CE MRI combined. In the subgroup of BRCA1 (BRCA2) mutation carriers or of women having a first degree relative with a mutation in BRCA1 (BRCA2) corresponding numbers were 3 (6), 12 (7) and 12 (11), respectively. For all women, the incremental cost per cancer detected with CE MRI and mammography combined was pound28 284 compared to mammography. When only BRCA1 or the BRCA2 groups were considered, this cost would be reduced to pound11 731 (CE MRI vs mammography) and pound15 302 (CE MRI and mammography vs mammography). Results were most sensitive to the unit cost estimate for a CE MRI screening test. Contrast-enhanced MRI might be a cost-effective screening modality for women at high risk, particularly for the BRCA1 and BRCA2 subgroups. Further work is needed to assess the impact of screening on mortality and health-related quality of life.

Diagnostic ultrasound: a primary care-led service?

BACKGROUND: A training programme has been proposed for general practitioners (GPs) to perform ultrasound in primary care. This has generated considerable concern among radiologists as to the adequacy and appropriateness of such training. AIM: To assess the current provision of ultrasound services to primary care in the former Northern health region of England, the level of interest among GPs in undertaking recommended training, and the willingness or ability of radiology departments to provide it. METHOD: Postal questionnaires were sent to GPs (n = 334), their practice managers (n = 281) and all clinical directors/heads of radiology departments (n = 19) in the region. RESULTS: Altogether, 67% of GPs, 59% of practice managers, and 68% of radiologists returned questionnaires. Overall, 48% of GPs have open access to obstetric/gynaecological ultrasound compared with 77% for general diagnostic requests. A total of 73% of GPs would prefer an open access service and 15% a practice-based service. Some 48% of GPs were not interested, 36% moderately interested, and 16% very interested in participating in the training programme. Only two out of 13 radiology, departments were willing to provide such training. CONCLUSION: Despite recommendations from the Royal College of General Practitioners, around half the respondents in this survey do not have direct access to ultrasound for obstetric referrals, and a quarter for non-obstetric referrals. Interest shown by GPs in a primary care-led service is not mirrored by their radiology colleagues. Open access to ultrasound was considered the optimum service, suggesting that resources be targeted at improving hospital services rather than transferring facilities to primary care.