Adherence to hypertension treatment guidelines in state facilities in KwaZulu-Natal, South Africa.

Rationale, aims and objectives The province of KwaZulu-Natal, South Africa, embarked on the Essential Drugs Programme (EDP) consisting of standard treatment guidelines (STGs) and essential drugs lists in May 1999. The use of these tools was aimed at promoting rational drug use. This study sought to determine the percentage of compliance to the STGs of the EDP in the treatment of hypertension in patients in the district of eThekwini. Methods A retrospective cross-sectional randomized sampling of 100 prescriptions for hypertension per 21 health facility was conducted for the period of 3 months in 2007. Each prescription was assessed against modified World Health Organization indicators to determine compliance to STGs. Results The mean age of the sample was 55.235 years (+/-0.62). Hypertension featured as the most common diagnosis in the sample (57.5%). The mean result of compliance to the STGs for the eThekwini District was 22.05% (+/-20.03). The results of the multiple linear regression equation suggest that the variables selected in this study explain 86.79% of the variables impacting on treatment guideline adherence. Conclusion The low mean results for compliance to the STGs was due mainly to the absence of a diagnosis recorded on the prescription, and the addition of a new drug for each symptom without due consideration of polypharmacy, drug-disease and drug-drug interactions.

A model for selecting assessment methods for evaluating medical students in African medical schools.

Introduction of more effective and standardized assessment methods for testing students' performance in Africa's medical institutions has been hampered by severe financial and personnel shortages. Nevertheless, some African institutions have recognized the problem and are now revising their medical curricula, and, therefore, their assessment methods. These institutions, and those yet to come, need guidance on selecting assessment methods so as to adopt models that can be sustained locally. The authors provide a model for selecting assessment methods for testing medical students' performance in African medical institutions. The model systematically evaluates factors that influence implementation of an assessment method. Six commonly used methods (the essay examinations, short-answer questions, multiple-choice questions, patient-based clinical examination, problem-based oral examination [POE], and objective structured clinical examination) are evaluated by scoring and weighting against performance, cost, suitability, and safety factors. In the model, the highest score identifies the most appropriate method. Selection of an assessment method is illustrated using two institutional models, one depicting an ideal situation in which the objective structured clinical examination was preferred, and a second depicting the typical African scenario in which the essay and short-answer-question examinations were best. The POE method received the highest score and could be recommended as the most appropriate for Africa's medical institutions, but POE assessments require changing the medical curricula to a problem-based learning approach. The authors' model is easy to understand and promotes change in the medical curriculum and method of student assessment.