High seroprevalence of hepatitis E virus in the Free State province of South Africa.

The seroepidemiology of hepatitis E virus (HEV) in South Africa is limited. We investigated anti-HEV IgM and IgG, in residual hepatitis A, B, and C negative serology specimens, at our public sector Free State (FS) laboratory. Of 299 specimens (01 May-31 October 2020), 182/299 (60.9%) had anti-HEV IgG and 1/299 (0.33%) had anti-HEV IgM. High HEV seroprevalence across different age groups suggests a different epidemiology in the FS, necessitating further research. Contribution: The need for HEV research in South Africa is highlighted. Clinicians should consider HEV in their differential diagnosis of patients with hepatitis.

Healthcare providers' knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape.

Background: Clinicians are crucial in encouraging smokers to quit through behavioural or pharmacological smoking cessation interventions. Smokers quit better with professional help. The level of healthcare providers' (HCPs) knowledge, attitudes and counselling skills related to effective smoking cessation support in the study area remains uncertain. Aim: The study aimed to determine HCPs' knowledge, attitudes and practices (KAP) on smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape. Setting: Sol Plaatje's 13 district municipality clinics, Kimberley, Northern Cape. Method: A descriptive, cross-sectional analytical study involving healthcare workers in the above setting. Results: A total of 165 HCPs, including medical officers, professional nurses, enrolled nurses and assistant-enrolled nurses working in primary healthcare clinics, were invited to participate in the study, with 156 completing the questionnaires. About 53.9% had no knowledge of South African tobacco smoking cessation guidelines, while 87.2% knew the importance of counselling patients about smoking and its impact on quitting. The majority of them did not know the medicines recommended for tobacco treatment in South Africa. About 89.7% expressed that smoking cessation counselling is an important part of their jobs. However, less than half indicated that they make follow-up arrangements for those attempting to quit. Conclusion: The study revealed gaps in KAP regarding smoking cessation among the respondents, necessitating the need for continuing education on the existing smoking cessation guidelines among these HCPs. Contribution: The results of this study will help to improve smoking cessation intervention knowledge among health providers.

Medical registrars at the University of the Free State: Burnout, resilience and coping strategies.

BACKGROUND:  Burnout among doctors has been linked with decreased quality of patient care. The coronavirus disease 2019 (COVID-19) pandemic highlighted the need to protect doctors' mental health and well-being. This study aimed to investigate burnout, resilience and coping strategies among registrars in the MMed programme of the University of the Free State (UFS) in 2020. METHODS:  In this quantitative, cross-sectional study, a link to an online anonymous self-administered questionnaire with socio-demographic questions, perceived stress, Copenhagen Burnout Inventory (CBI), Connor-Davidson Resilience Scale and Brief Cope was emailed to all 278 registrars. RESULTS:  Sixty registrars responded (response rate 21.6%). More than half (55.0%) were male and 73.3% were married. There were 28.3% second- and third-year students, respectively. Most (58.3%) had 5-10 years' work experience. The CBI personal scale had the highest median value (58.3; interquartile range [IQR]: 43.3; 70.8) with 70% scoring ≥ 50. The median score for resilience was 78 of 100 (IQR: 69; 84). There were weak negative correlations between resilience and burnout scores (r = -0.31 to r = -0.37). Planning, positive reframing and acceptance were the most frequently used adaptive coping mechanisms; self-distraction was the most frequently used maladaptive coping mechanism. There was no association between gender and burnout and resilience scores. CONCLUSION:  Registrars were resilient with low levels of patient- and work-related burnout, and higher personal burnout, using mostly positive coping strategies.Contribution: This study gives insight into the well-being of registrars at the UFS during COVID-19. Continuous monitoring and support for this population are essential to foster mental health and well-being.

Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position.

Background: Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively. Objectives: This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a 'bubble test' to detect malposition and pneumothorax. Method: Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the 'bubble test' and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR. Results: Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3-6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18-56 min) (p < 0.0001). Conclusion: This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition. Contribution: Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.

Knowledge, attitude and practice on screening and early diagnosis of prostate cancer of primary health care providers in the Free State.

BACKGROUND: Prostate cancer is topmost in terms of incidence and mortality among men in sub-Saharan Africa, including South Africa. Prostate cancer screening is beneficial only to certain categories of men, making a rational screening approach necessary. AIM: This study aimed to assess the knowledge, attitudes and practice (KAP) regarding prostate cancer screening among primary health care (PHC) providers in the Free State, South Africa. SETTING: Selected district hospitals, local clinics and general practice rooms. METHODS: This was a cross-sectional analytical survey. Participating nurses and community health workers (CHWs) were selected through stratified random sampling. All available medical doctors and clinical associates were approached to participate, totalling 548 participants. Relevant information was obtained from these PHC providers using self-administered questionnaires. Both descriptive and analytical statistics were computed using Statistical Analysis System (SAS) Version 9. A p-value 0.05 was considered significant. RESULTS: Most participants had poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%). Female PHC providers, lower cadre nurses and CHWs had lower mean knowledge scores. Not participating in prostate cancer-related continuing medical education was associated with poor knowledge (p 0.001), negative attitudes (p = 0.047) and poor practice (p 0.001). CONCLUSION: This study established appreciable KAP gaps relating to prostate cancer screening among PHC providers. Identified gaps should be addressed through the preferred teaching and learning strategies suggested by the participants.Contribution: This study establishes the need to address KAP gaps regarding prostate cancer screening among PHC providers; therefore necessitating the capacity-building roles of district family physicians.

Clinical review of stroke care at National District Hospital, Bloemfontein.

BACKGROUND: Stroke is a leading cause of morbidity and mortality affecting sub-Saharan Africa. Studies show that dedicated stroke units improve patient outcomes. National District Hospital (NDH) manages strokes, with the potential of becoming a dedicated stroke unit in Bloemfontein, South Africa. The study aimed to describe the clinical characteristics, management and outcomes of patients presenting with stroke at NDH. METHODS: In this retrospective descriptive study, emergency department registers were used to identify patients presenting with symptoms of a stroke between 01 January 2019 and 31 March 2019. Relevant data were extracted from hospital files. RESULTS: Of the 106 identified patients, 53 were included in the study. The median age was 61 years (range 28-89 years), with an almost equal split between genders. The most common risk factor was hypertension (81.3%). The median time from symptom onset to presentation at NDH was 9 h. No patient received thrombolysis. One patient received neurosurgical intervention. The most prescribed secondary preventative drugs were antihypertensive medication, statins, anticoagulation and antiretroviral therapy. Half (52.8%) of the patients received rehabilitation as in-patients. Final diagnoses were ischaemic strokes (26/53, 49.0%), transient ischaemic attacks (10/56, 22.7%) and haemorrhagic strokes (6/56, 13.6%). The 6-month post-infarct mortality rate was 37.5%. CONCLUSION: Patient outcomes were comparable to similar South African studies. Time delays in stroke management remain a major obstacle. Identified action points include community education, improving emergency medical services and establishing a dedicated stroke unit.Contribution: This study underlines the importance of stroke and cardiovascular disease prevention and stresses the value of establishing dedicated stroke units.

Knowledge, beliefs and intentions of African men in the Free State about prostate cancer screening.

Background: African men are less likely to participate in prostate cancer (PCa) screening, which may be beneficial to some of them. Gaps in knowledge, cultural factors and beliefs are associated with their screening intentions. Aim: To determine the knowledge, cultural factors and screening intentions of African males regarding PCa screening. Setting: The study was conducted among African men attending randomly selected primary healthcare clinics in the Free State province. Methods: An analytical, cross-sectional survey using self-administered questionnaires developed in line with the Theory of Planned Behaviour constructs. Results: Of the 389 respondents, 18.3% had ever been screened for PCa with prostate-specific antigen (PSA) testing and 6.2% by digital rectal examination (DRE). About a quarter (24.4%) of the respondents had knowledge scores ≥ 50%. Factors associated with greater intent to screen for PCa were lower degree of fear/apprehension of PCa screening (mean score = 2.03; p < 0.001), higher perceived benefits of PCa screening (mean score = 2.69; p = 0.002), lower perceived situational barriers to PCa screening (mean score = 2.03; p = 0.006) and higher perceived risk of getting PCa (mean score = 2.66; p = 0.024). Conclusion: The observed low level of knowledge and practice of PCa screening among the respondents could be enhanced through PCa awareness strategies targeted at these men or those that could influence their decision making, especially healthcare providers. Factors that enhance screening intentions should be promoted. Contribution: This study improves on the scarce literature on factors associated with African men's PCa screening intention.

Type 2 diabetes mellitus patients' knowledge, attitude and practice of lifestyle modifications.

Background: Type 2 diabetes mellitus (T2DM) is a significant health burden globally, with uncontrolled DM often resulting in short- and long-term complications. Unfortunately, healthcare providers have little control over patients' necessary lifestyle modification practices outside the consultation room. Aim: To determine the level of knowledge, attitude and practice (KAP) of lifestyle modifications among patients with T2DM attending the National District Hospital Outpatient Department, Bloemfontein, and identify possible barriers to lifestyle modifications experienced by patients. Setting: Outpatient Department at a Free State hospital. Methods: Using a cross-sectional study, patients with previously diagnosed T2DM were invited to participate. Respondents completed a structured questionnaire to assess their KAP regarding lifestyle modifications. Results: Of the 149 respondents, 64.4% (n = 94) were obese and 24.0% (n = 35) overweight despite good knowledge of lifestyle modifications. Respondents displayed a positive attitude toward physical exercise but less so to adjusting their diets. In practice, 63.4% (n = 83) claimed to exercise regularly, but two-thirds irregularly monitored their weight. The practice of a controlled and planned diet was poor. Perceived barriers to lifestyle modifications included being too busy to engage in physical exercise, bad weather and financial constraints. Conclusion: Despite displaying good knowledge regarding lifestyle modifications, the attitude and practice thereof remain poor. It is essential to re-emphasise to patients why it is crucial to engage in lifestyle modification practices and assess whether they are doing so correctly. Contribution: It highlights the importance of lifestyle considerations of T2DM patients in the clinical context.

Clinical review of the clinical necessity of lumbar punctures performed on adults at National District Hospital Emergency Department.

BACKGROUND: Previous studies have found that indications for lumbar punctures (LPs) are managed differently, which raises the question of whether all LPs performed are clinically necessary. This study aimed to determine whether unnecessary (clinically not indicated) LPs were being performed at a district hospital in the Free State, South Africa. METHOD: This was a retrospective descriptive study. A list from the National Health Laboratory Service (NHLS) was used to identify all patients on whom an LP was performed in the adult emergency department of National District Hospital (NDH) in Bloemfontein, from 1 January 2018 to 30 June 2018. Data were captured on a data sheet and included demographic information, clinical signs and symptoms the patients presented with and the cerebrospinal fluid results. RESULTS: A total of 364 patients fit the inclusion criteria. Of these patients, 97 files (26.6%) could not be found, patient gender and LP results could be retrieved from the NHLS barcodes. After reviewing the presenting symptoms and signs captured on the 267 files, the primary researcher considered 150 (56.4%) of the LPs performed to have been carried out unnecessarily. From the total population of 364 patients, 246 (67.6%) of the LP results were normal. Only 118 (32.4%) of the LPs performed showed some form of central nervous system pathology. Of the 150 LPs assessed to have been unnecessarily performed, 124 (84.0%) were normal. CONCLUSION: This retrospective review indicates that a high percentage of LPs that were clinically not indicated were performed at NDH during the study period.

The epidemiological profile of meningitis among adults in a South African district hospital.

Introduction: understanding the epidemiological profile of a disease in a particular region allows for proper planning of public health resources for prevention, early diagnosis and treatment. In this present study, we describe the epidemiological profile of viral, fungal, tuberculous and bacterial meningitis among adults at National District Hospital (NDH), Free State province, over three years period (January 2017 to December 2019). Methods: a retrospective, observational study of all adult meningitis cases, managed at the National District Hospital (NDH) Bloemfontein, Free State Province, South Africa between January 2017 and December 2019. Results: of the 236 case files reviewed, majority (93.2%; n=220) of the patients managed for meningitis were black, as well as males (55.5%; n = 131). Higher incidence was found between the ages 20 to 49 (81.7%). Of those who died, the majority (n = 14; 63.6%) were males, in the age group 40-49 (n = 7; 31.8%), had TB meningitis (n = 12; 54.5%), were HIV positive (n = 20; 90.9%), and had cell count <100 cells/mm3 (n = 10; 45.5%). Conclusion: our study suggests that combining information on patient demography, co-morbidities, clinical presentation, and examination findings can substantially contribute to raising clinical suspicion, leading to swift identification, diagnosis, and treatment of patients.

A comparison of the effectiveness of QCPR and conventional CPR training in final-year medical students at a South African university.

INTRODUCTION: High-quality cardiopulmonary resuscitation (CPR) saves lives. Training on basic first aid manikins allows students to practice manoeuvres and provides realistic resistance to chest compressions. Conventional CPR has no real-time feedback to observe the quality of CPR. Quality cardiopulmonary resuscitation (QCPR) is technology using wireless sensors embedded in the manikin to measure the effectiveness of core CPR components. This study compared the effectiveness of CPR training of final-year undergraduate medical students using electronic-feedback QCPR adult manikins and conventional adult manikins. The effectiveness of compressions was compared and return on investment was investigated. METHODS: In an experimental study, 53 students were divided into two groups using simple random sampling. The QCPR group practised CPR on the QCPR manikins. The CPR group practised on conventional CPR manikins. Both groups were allowed to practice for approximately 10 minutes. After the training session, both groups were tested using the QCPR manikin. Only chest compression performance in adult-sized manikins were measured, recorded and compared. RESULTS: The median flow fraction for the QCPR group was 78.0% (interquartile range (IQR) 63-89%) and for the CPR group 80.0% (IQR 74-85%). The median number of compressions for the QCPR group was 104 (IQR 101-109) and for the CPR group 107 (IQR 79-124). Both groups achieved a 100% compression rate with adequate depth. The maximum total effectiveness of both groups was 99%. No statistically significant difference was seen for the overall percentage of compression effectiveness between the groups. CONCLUSION: Participants achieved acceptable scores on most CPR compression metrics and complied with CPR guidelines in most cases. Efficacy of CPR training on conventional and QCPR manikins was comparable. CPR training in low resource settings can be just as effective on conventional manikins. Immediate feedback technology adds value to the training experience, allowing for individuals to adjust for deviations to set standards.

Knowledge, attitudes and practices of men in a South African rural community in relation to exclusive breastfeeding.

BACKGROUND: Several lifelong maternal, child and societal health benefits have been associated with exclusive breastfeeding (EBF). However, despite all the potential advantages, EBF rates have been consistently low in developing countries, including South Africa. It has been suggested that the knowledge, attitudes and practices of male partners in relation to EBF are amongst the important factors that contribute to the success of EBF practices. Hence, the aim of this study was to determine the knowledge, attitudes and practices of men in Botshabelo, Free State province, South Africa, regarding EBF. METHODS: This study was designed as a cross-sectional analytical study that utilised a structured questionnaire administered to 200 adult men attending the outpatient department of a district hospital, in the Free State province, South Africa. RESULTS: The majority (n = 83; 41.5%) of participants had poor knowledge of EBF but reported positive attitudes (n = 153, 76.5%) and good practices (n = 151, 75.5%) towards EBF, respectively. Age, levels of education, employment status, marital status and whether the participant accompanied his partner to the antenatal clinic were associated with adequate knowledge, positive attitudes and good practices in relation to EBF (p  0.05). CONCLUSION: The study revealed a suboptimal level of knowledge on EBF in men in Botshabelo. Most men had positive attitudes and reported good practices in relation to EBF. Our findings highlight the need for targeted community-based intervention programmes directed to educating and promoting positive social and cultural change in relation to EBF amongst men in Botshabelo.

A framework for the use of biological medicines in the free state province, South Africa.

PURPOSE: The use of biological medicines (BM) has increased worldwide owing to their effectiveness in the treatment of many chronic diseases. However, in South Africa, access to BM remains limited, hence, there is a need to develop strategies that will enable timely access to BM by all patients who need them. OBJECTIVE: To develop a framework for the use of BM in South Africa. METHODS: Using a Delphi questionnaire that was developed by integration of the opinions of newly qualified doctors (<2 years practice), prescribing specialists, and patients using BM, a Delphi method was used to guide an experts' panel into consensus on the different opinions in the questionnaire, and from this, a framework for the use of BM was constructed. RESULTS: From the surveys, 76.2% of the newly qualified doctors and 91.7% of the prescribing specialists indicated that they had limited knowledge on the pharmacology of BM, and, respectively, 64.5% and 77.8% admitted that their knowledge on BM was not adequate for prescribing and taking care of patients on BM. Also, 58.3% and 75% of the prescribers indicated that the high cost and the tedious procurement process, respectively, were barriers of access to BM. The Delphi panel reached consensus after two rounds, and the resultant framework recommends that, appropriate use of BM requires establishing guidelines for the use of BM, increasing BM content in the medical training programs and information resources used by healthcare professionals, enacting drug regulations and drug policies that will increase availability of BM, offering appropriate patient information and public engagement. CONCLUSION: The lack of knowledge on BM by health professionals, together with the high cost and a complex procurement processes are the major impediment to access to BM. A framework for the use of BM in South Africa was successfully developed to address these and other challenges.

Profile of dog bite injuries in patients presenting at Kimberley Hospital Complex's emergency and gateway centres, 2015 to 2017.

BACKGROUND: Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa. AIM: To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites. SETTING: Kimberley Hospital Complex emergency and gateway centres. METHODS: A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases. RESULTS: During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors. CONCLUSION: Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs.

Profile of dog bite injuries in patients presenting at Kimberley Hospital Complex's emergency and gateway centres, 2015 to 2017

Background: Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa. Aim: To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites. Setting: Kimberley Hospital Complex emergency and gateway centres. Methods: A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases. Results: During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors. Conclusion: Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis.

BACKGROUND: Healthcare-associated tuberculosis (TB) has become a major occupational hazard for healthcare workers (HCWs). HCWs are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Whenever there is a possibility of exposure, implementation of infection prevention and control (IPC) practices is critical. OBJECTIVE: Following a high incidence of TB among HCWs at Maluti Adventist Hospital in Lesotho, a study was carried out to assess the knowledge, attitudes and practices of HCWs regarding healthcare-associated TB infection and infection controls. METHODS: This was a cross-sectional study performed in June 2011; it involved HCWs at Maluti Adventist Hospital who were involved with patients and/or sputum. Stratified sampling of 140 HCWs was performed, of whom, 129 (92.0%) took part. A self-administered, semi-structured questionnaire was used. RESULTS: Most respondents (89.2%) had appropriate knowledge of transmission, diagnosis and prevention of TB; however, only 22.0% of the respondents knew the appropriate method of sputum collection. All of the respondents (100.0%) were motivated and willing to implement IPC measures. A significant proportion of participants (36.4%) reported poor infection control practices, with the majority of inappropriate practices being the administrative infection controls (> 80.0%). Only 38.8% of the participants reported to be using the appropriate N-95 respirator. CONCLUSION: Poor infection control practices regarding occupational TB exposure were demonstrated, the worst being the first-line administrative infection controls. Critical knowledge gaps were identified; however, there was encouraging willingness by HCWs to adapt to recommended infection control measures. Healthcare workers are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Implementation of infection prevention and control practices is critical whenever there is a possibility of exposure.