The exceptional potential in extending primary care exposure for South African medical interns.

No abstract available.

An approach to the management of acute poisoning in emergency settings.

The impact of poisoning can differ significantly depending on the specific substance consumed. Identifying toxic substances in a patient is crucial to obtaining a thorough medical history. Frontline healthcare providers in the emergency department often handle patients presenting with poisoning. Their clinical presentation can vary depending on their dose, duration of exposure, and pre-existing medical conditions. Initially, poisoning management entails administering supportive care such as absorption and enhancing the elimination of poison with charcoal and antidote administration after identifying the poisoning substances. This article aims to provide a basic overview of the concepts involved in evaluating and managing these individuals.

Myriad untold stories unfolding daily: South Africa's pursuit of quality primary health care.

No abstract available.

Mastering your fellowship: Part 1, 2024.

The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination.

Primary health care providers' views on managing substance use among people living with HIV.

BACKGROUND: The growing culture of substance use among people living with human immunodeficiency virus (PLWH) is a serious threat to the human immunodeficiency virus (HIV) pandemic. As the gatekeepers of comprehensive care, primary care providers are responsible for screening, assessing, and managing individuals who use substances. AIM: This study aimed to evaluate primary care providers' views and approaches to substance use management among PLWH who attend primary care services in Mthatha. SETTING: This study was conducted at Ngangelizwe and Mbekweni Community Health Centres (CHCs) in the Eastern Cape province's King Sabata Dalindyebo (KSD) sub-district municipality. METHODS: This qualitative phenomenological study involved the views of primary care providers. This study included 32 primary health care (PHC) providers. All participants were female except one male with a mean age of 48.6 years (range 27-64 years). Semi-structured interviews were conducted until saturation of the theme was reached. Then, the data from the transcribed interview were analysed with a thematic framework. RESULTS: Substance use among PLWH was reported to be associated with poor clinical outcomes and disruption of antiretroviral therapy (ART) adherence. The significant barriers reported for substance use management in PHC settings were a lack of resources, skilled providers and poor community participation. CONCLUSION: Substance use management programmes are not commonly offered in PHC because of the lack of human and infrastructural resources, the lack of skilled providers and poor community engagement.Contribution: This study provides a context-specific PHC providers' approach to substance use management.

A review of published research in the South African Family Practice - A clarion call to action.

No abstract available.

Prevalence of hepatitis-B virus co-infection among people living with HIV in Mthatha region of South Africa.

Background: Hepatitis-B virus (HBV) co-infection among people living with HIV (PLWH) is highly endemic in South Africa. Despite the availability of an effective vaccine for the last four decades, chronic HBV infection is a major cause of morbidity and mortality among PLWH. Although the incidence of most opportunistic infections has been reduced in individuals with HIV since the implementation of the universal test and treat program in South Africa, HBV co-infection among PLWH is still accounting for high morbidity and mortality. Methodology: This cross-sectional descriptive survey was conducted in King Sabata Dalindyebo sub-district municipality in the Eastern Cape Province of South Africa to determine the prevalence of HBV co-infection among PLWH. Results: Two-thirds (65.5%) of the 602 PLWH who participated in the study had been screened for HBV co-infection. The mean age of the participants was 38.8±10.5 years and the majority (75.1%) were female. The prevalence of HBV co-infection among PLWH was 12.2%; among males were three times more frequently than females (OR=3, 95% CI 1.6-5.6, p=0.001). The median CD4 count of participants was 508 cell/mm3 (inter-quadrantile range = 307 to 715) and there was no significant association between HBV co-infection and CD4 count. Conclusion: There is a high prevalence of HBV co-infection among PLWH in the Mthatha region of South Africa. The high prevalence of HBV co-infection indicates the need for routine screening for hepatitis B among PLWH in South Africa.

The effect of substance uses on antiretroviral treatment adherence in primary health care.

BACKGROUND: Adherence to antiretroviral treatment (ART) is the primary factor determining how an individual responds to their treatment. Unfortunately, individuals who use substances experience suboptimal adherence to their treatment, but little is known about the exact effects of their use on ART adherence in primary health care settings. METHODS: The authors used a prospective cohort study to evaluate substance use's effects on ART adherence among people living with HIV (PLWH) who attend primary health care services in the Mthatha region of South Africa. RESULTS: During the study period, 601 PLWH were followed up for 6 months. The participant's mean age was 38.5 (standard deviation [s.d.] = 11) years, with a mean CD4 count of 491.7 (s.d. = 241). Suboptimal ART adherence and default rates were 20.2% and 9.3%, respectively. Among the substance users, suboptimal adherence to ART was statistically significantly higher than non-users (24.6% and 15.9%, respectively, p = 0.007). The authors also observed suboptimum ART adherence among people who presented with clinical comorbidities. CONCLUSION: Substance use has negatively affected ART adherence among PLWH who attend primary health care services in the Eastern Cape province of South Africa. Therefore, an integrated substance use management strategy in primary health care is recommended to achieve optimal adherence to ART.Contribution: Substance use disorder significantly affected the adherence to ART in primary health care. This is important since primary care is the gateway to the HIV care continuum. The study highlighted the role of integration of substance use management in primary care.

One World, One Health: A growing need for an integrated global health approach.

No abstract available.

Do not lose your patient in translation: Using interpreters effectively in primary care.

South Africa is a multicultural society characterised by a rich diversity of languages. As a result, many healthcare providers and their patients often do not speak the same language, which makes communication challenging. The language barriers, when present, require an interpreter to ensure accurate and effective communication between the parties. In addition to assisting in a clear exchange of information, a trained medical interpreter also acts as a cultural liaison. This is especially true when the provider and the patient come from different cultural backgrounds. Based on the patient's needs, preferences, and available resources, clinicians should select and engage with the most appropriate interpreter. The effective use of an interpreter requires knowledge and skill. Patients and healthcare providers can benefit from several specific behaviours during interpreter-mediated consultations. This review article provides practical tips on when and how to use an interpreter effectively during clinical encounters in primary healthcare settings in South Africa.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa.

BACKGROUND: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. METHODS: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. RESULTS: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. CONCLUSION: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI.Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa.

BACKGROUND: Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. METHODS: A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. RESULTS: Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. CONCLUSIONS: HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.

Guiding the emerging primary care researcher: A report of research capacity-building workshop.

There is an escalating interest in research capacity building across the globe. Research is an integral part of the continuous improvement process, clinical decision making and health system strengthening and should be embedded into the health system. The South African Family Practice Journal editorial team held a workshop on 19 August 2022 at the 24th National Family Practitioners Congress in Cape Town, with the aim of supporting primary care clinicians in their development from early-career researchers to established clinician-scientists. Small group and plenary discussions yielded valuable insights into the lived experiences of early career researchers and highlighted critical action areas to build the landscape of clinician-led research in the South African context.Contribution: This article contributes to current literature by providing insight into the lived experiences of early-career researchers and explores opportunities for research capacity-building.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

The outbreak of monkeypox: A clinical overview.

The development of new zoonotic diseases such as coronavirus disease 2019 (COVID-19) and monkeypox that can cause epidemics and high mortality rates have significantly threatened global health security. However, the increasing number of people with no immunity to poxvirus because of the end of the smallpox vaccination programme has created a vulnerable population for the monkeypox outbreak. On 23 July 2022, it was announced that the World Health Organization's director-general has determined that the multicountry outbreak of monkeypox constitutes a Public Health Emergency of International Concern. The monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar to smallpox but less severe. Many unanswered questions remain regarding monkeypox's pathogenesis, transmission and host reservoir. There is currently no evidence that transmission by individuals can sustain zoonotic infections during human-to-human transmissions; the continued emergence of these pathogens highlights the interconnectedness of animals and humans. The increasing number of monkeypox cases outside the endemic region has highlighted the need for effective global capacity building to prevent the spread of the disease and its impact on global health security. The priority now is to stop the spread of the disease and protect frontline healthcare workers and the most vulnerable individuals. This article aims to comprehensively analyse the various aspects of the transmission and epidemiology of monkeypox. It also explores possible diagnostic techniques, therapeutics and prevention strategies. A key recommendation is that primary care and public health professionals are expected to increase their efforts to be vigilant and contain any potential outbreaks.

Artificial intelligence: A strategic opportunity for enhancing primary care in South Africa.

No abstract available.

Epidemiology of interpersonal violence at a regional hospital emergency unit in the Eastern Cape, South Africa.

BACKGROUND: This study describes the profile, mechanism and pattern of injuries, and highlights important gaps in clinicians' consultations with patients who experienced interpersonal violence (IPV) in the predominantly black South African township of Mdantsane, Eastern Cape. METHODS: This retrospective cross-sectional study was conducted at the Cecilia Makiwane Regional Hospital, Mdantsane. Medical records of patients who received emergency care for trauma between 01 December 2017 and 31 March 2018 were reviewed. The records of patients identified with IPV were selected for further analysis. Data were disaggregated by demographics, mechanism of injuries and circumstances of the incidents using simple descriptive statistics. RESULTS: A total of 1064 patients reported IPV as the mechanism of injury for emergency department (ED) visits, accounting for 42.4% of all trauma-related injuries. The majority of patients with IPV were men (72.0%), unemployed (78.0%) and single (89.0%). Blunt force injury was the most common pattern of injury (53.3%); about half (50.5%) of the incidents took place in the patients' homes. The majority of the patients (68%) knew their assailants, and a quarter of them were an intimate partner of the assailant (27.6%). The flow of patient with IPV to the ED was skewed towards the weekend (weekend effect). Also, there was an upward trend in the flow of patients with IPV to the ED from 19:00 onwards, reaching a peak at 20:00. CONCLUSION: Interpersonal violence is the most prevalent mechanism of injury reported in this region. It is crucial to engage stakeholders in the design of interventions in order to reduce IPV-related injuries in the region.

Vaccine Breakthrough Infections of SARS-Cov-2: A Case Report.

BACKGROUND: Novel mRNA vaccines provide a high degree of protection against COVID-19 infection, hospitalisation, and death. However, no vaccine claimed 100% effectiveness and it is expected that a small proportion of vaccinated individuals may develop a breakthrough infection. There is a concern relating to the ability of variants to evade vaccine-induced immunity that leads to asymptomatic infection or occasionally progress to disease. The extent of this ability is largely unknown. CASE REPORT: An 88-year-old male patient was brought to the emergency department on July 25, 2021, with a presentation of a lower respiratory tract infection. He was screened for SARS-CoV-2, and tested positive for the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2. According to the patient, he was diagnosed with benign prostatic hyperplasia (BPH) after a prostate biopsy in 2015 but, at the time of admission, he was not taking any chronic medication. He received the first dose (batch no. FA7812) of the Pfizer-Biotech vaccine on June 8, 2021, and the second dose (batch no. FE2090) on July 20, 2021. He was admitted to the isolation ward with a diagnosis of vaccine breakthrough COVID-19 infection and BPH. CONCLUSION: This case report highlights the issue of vaccine breakthrough infections and the potential risk of contracting the COVID-19 disease despite successfully receiving two doses of the Pfizer-BioNTech vaccine six weeks apart.

Erratum: Malnutrition in children under the age of 5 years in a primary health care setting.

No abstract available.

The impact of the COVID-19 pandemic on healthcare service access for the victims of sexual assault.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted the provision or exacerbated the existing gap of access to essential healthcare services. An unanticipated effect on access to healthcare services emerged with the introduction of COVID-19 lockdown regulations. Violence against women is prevalent with varying degrees of severity in all spheres of society. METHODS: This study aims to evaluate the impact of the COVID-19 pandemic on the access to healthcare services for the victims of sexual assault in the Mthatha region of South Africa. This is a records review of victims of sexual assault survivors who visited and were treated at the Sinawe TCC at Mthatha Regional Hospital. The data on sexual assault cases at Sinawe TCC were compared with a time-matched control group from 2014 to 2020. RESULTS: There were 5747 sexual assault cases reported at Sinawe TCC between 01 January 2014 and 31 December 2020. There was a major drop in reported cases at Sinawe TCC during the 2020 year, with only about half (451) of the annual average cases being reported. CONCLUSION: The COVID-19 pandemic has an impact on access to healthcare services for the victims of sexual assault survivors in the Mthatha region of South Africa.