Antidepressant usage by South African children and adolescents : a drug utilisation review

MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014This study set out to review and analyse aspects of antidepressant prescribing in children and adolescents in a section of the private health care sector of South Africa. The research was conducted in two phases, namely a literature review and an empirical investigation. The aim of the literature review was to provide background to the study by conceptualising antidepressants. The empirical review followed a retrospective, descriptive, observational design. The data employed in the study was obtained from the medicine claims database of a South African Pharmaceutical Benefit Management (PBM) company. The study population consisted of 3 611 children and adolescents receiving ≥1 antidepressants from 1 January 2010 to 31 December 2010. Basic descriptive statistics, such as frequency, prevalence, average, weighted average, standard deviation, weighted standard deviation, median, effect sizes, prescribed daily dosages and DU95% methodology were used to characterise the study sample, and were calculated using the Statistical Analysis System SAS® for Windows 9.3® program. The data were used to determine the prescribing patterns of antidepressants with regard to age, gender, geographic area, type of prescriber, the comparison of prescribed daily dosages vs. recommended daily dosages, and the prevalence of potential drug-drug interactions. Potential drug-drug interactions were identified and compiled by using various interaction compendia, whereas recommended daily dosages were identified by cross-referencing various dosage compendia. The study population consisted of 1 850 girls and 1 761 boys. The mean age of girls was 13.7 ± 3.9 years, vs. 12.3 ± 3.8 years for boys (d = 0.4). A total of 11 735 prescriptions containing 12 272 antidepressants were documented in 2010. Results of the study furthermore showed that the average number of prescriptions claimed per patient increased with age, from an average of 1.0 ± 0.28 among those up to the age of 2 years, to an average of 3.4 ± 3.21 among those 16 to 18 years of age. Prescribing with regard to age groups differed, rising gradually from birth and peaking at middle childhood for boys, whereas antidepressant use in girls increased from birth up to 6 years of age, reaching a plateau and increases again from age 13 and onward. Approximately 25% (n = 12 272) of antidepressants prescribed were either not indicated in children, or the dosages were deemed too high. More than 50% (n = 12 272) of antidepressants prescribed were in the Gauteng province. The SSRIs (selective serotonin re-uptake inhibitors) and the TCAs (tricyclic antidepressants) were the most prescribed antidepressants in both gender groups. The male-to-female ratio for the selective serotonin re-uptake inhibitors was 0.9, compared to 1.2 for the tricyclic antidepressants. The top three antidepressants prescribed were imipramine (21.8%), citalopram (15.3%) and escitalopram (14.7%, n = 12 272). Potential DDIs were observed on 284 (2.4%) (n = 11 743) prescriptions. The drug pairs with potential drug-drug interactions prescribed most, were imipramine with methylphenidate [43 cases (15.1%)] and valproic acid [38 cases (13.4%)], and followed by methylphenidate in combination with fluoxetine and sertraline [both documenting 32 cases (11.3%), respectively. The TCAs accounted for 182 (64.1%) cases of possible DDIs (drug-drug interactions), whereas combination therapy of SSRIs and TCAs accounted for 21.4% of potential DDIs. In conclusion, this study determined that there were a number of differences with regard to antidepressant prescribing in children and adolescents. Recommendations for future studies were made.Master

Rural community participation in tourism-based developments : the case of the Mbila community in Maputaland, KwaZulu-Natal

Rural community participation in tourism-based developments in and around protected areas has emerged as a major trend in the Developing world during the last three decades. The basic design of rural community participation in tourism-based developments involves the empowerment of rural communities to participate in such a way in the planning and management of these developments that they have a greater level of control on the effects that these developments have on them and on their environment. The motivation behind the popularity of the approach towards participatory development stems from the dissatisfaction with the centrally driven, top-down type of development that originated during the previous century and out of a desire to purposefully involve rural communities to the extent where they can effectively and sustainably develop and manage their resources. The research of this study presents an analysis of the participation of the Mbila community of the Sodwana Bay National Park in the tourism-based developments of the region. The literature in the study revealed that the principal fundamentals of rural community participation in tourism-based developments reside in the empowerment of the community to be able to involve themselves sufficiently in the tourism-based developments of their region. The focus of the research was therefore on determining the quality of the empowerment that the Mbila community enjoy and on the subsequent levels of control that this empowerment provides them with. The research results revealed however, that although the community seems to be sufficiently empowered to legally participate in the tourism-based developments of their area, they are still not involved to the degree that this participation generates meaningful changes to their overall livelihood. The reasons for these low levels of participation include aspects such as the harshness of the physical environment and the subsequent limited development opportunities in the area; the prevalence of insufficient levels of education and training; difficulties experienced in the communication between some of the institutions and the presence of certain forms of restrictive legislation. The study argues that satisfactory levels of participation can only be achieved if these difficulties are overcome to the extent where they permit community participation that achieves the enhancement of the quality of life for the Mbila community. CopyrightDissertation (MSc)--University of Pretoria, 2006.Geography, Geoinformatics and MeteorologyMScUnrestricte

Synergy of agriculture, community development, and eco-tourism Agri-tourism Farm complex

The meaning of a place results from accumulated interactions between an individual's life history and a setting. Place experiences often include some feeling of ownership. Ownership in this case is a psychological phenomenon that does not require legal title to a piece of land or a building, but rather, a sense that the person has some uncommon, special relationship with that particular setting. Although much of what characterizes a place may be very personal. Groups and even entire communities can develop place attachments. The objective of the study is the design of agri-tourism facilities within the realm of local community development. These facilities need to meet a variety of criteria to fulfil the expectations of the three main stakeholders, being agriculture, tourism and local community. A design that is context, and energy conscious, with a sympathy to existing ecological systems and self-sustainability, will determine the success of this project. The design, including before mentioned criteria, of an agri-tourism complex , incorporates local skills training which form part of the activities on the farm Madi A Thava, Makhado district in the Limpopo province. These facilities must meet the needs of the different clientele for each of the three entities. Each facility has its own identity arising from its specific function. The agri-tourism complex will have a dominant agricultural character, as this facility houses the main activity to ensure self-sustainability of the farm as a whole.Dissertation (MArch(Prof))--University of Pretoria, 2007.Architectureunrestricte

Progress with different land reform options in South Africa

The land reform programme of the South African government has three focus areas, namely restitution of land rights to the victims of forces removals, redistribution of land to the disadvantaged and tenure reform aimed at promoting security of tenure for all. In realising a programme of rapid and effective land reform it is important that all possible options of land transfer to previously disentitled South African should be pursued. This paper briefly describes the different options for land reform in South Africa and discusses the progress made in implementing the land reform programme of the government and each of the options outside the programme. Based on current trends in the land redistribution programme and private land and a number of other assumptions it is estimated that around 0,39 percent of commercial farm land in South Africa could be transferred through a combination of models to less advantaged groups by the end of 1996.For more information on the Agricultural Economics Association of South Africa or subscription to Agrekon, visit http://www.aeasa.org.zahttp://aeasa.org.z

Land reform in South Africa : options to consider for the future

The paper examines alternative modalities for the forthcoming process of land reform in South Africa. It is argued that the criteria of relieving rural poverty and maximizing allocative efficiency will conflict to some degree. However, it is possible to visualize a range of land reform options which encompass both of these objectives as a basis for the operations of the new multiracial government which will take office in South Africa on 27 April, 1994

Strategic focus areas and emerging trade arrangements in the South African agricultural industry since the demise of the marketing boards

This paper investigates the responses of agribusiness managers to drastic changes in the policy and marketing environment of South African agriculture. The process of deregulation and liberalisation of agricultural markets exposed agribusiness managers to international trends, which required new institutions and relationships. Based on a survey conducted among business managers, we explored emerging growth strategies, strategic focus areas and coordination preferences. Results suggest that managers prefer a growth strategy based on market penetration and market development. Important strategic drivers are value-adding and power drive. Managers expressed their preference for increased coordination and cooperation resulting in relation-based contracts and equity-based alliances

Contractual relationships between smallholder sugarcane growers and millers in the sugar industry supply chain in Swaziland

This paper proposes and analyses a model of relationships between smallholder sugarcane growers and millers in the Swaziland sugar industry supply chain. In particular, it identifies the behavioural factors that contribute to the level of satisfaction that sugarcane growers perceive in their relationship with the millers. Using recursive models and multiple regression analysis, the results indicate that higher levels of trust lead to higher levels of cooperation that, in turn, lead to higher levels of commitment by the smallholder growers to the business relationship. Cooperation is also an antecedent of the benefits and of the satisfaction that these growers gained from the relationship. These results agree with a priori theory that trust, cooperation, strategic benefits, commitment and absence of opportunistic behaviour are essential elements for a successful relational exchange. The findings imply that both cane growers and millers need to focus on initiating, signalling and disclosing their behaviours in an effort to improve their relationship with each other. A relationship founded on trust and mutual respect is more likely to succeed than a relationship of convenience supported by legal contingencies. Therefore, relationships characterised by trust and physical and psychological commitment as well as cooperation between exchange parties is more important for mutual benefit and good quality relationship.For more information on the Agricultural Economics Association of South Africa or subscription to Agrekon, visit http://www.aeasa.org.zahttp://www.aeasa.org.z

Job satisfaction and perception of workloads among dietitians and nutritionists registered in South Africa

Background: Personal perspective concerning work demands directly impacts quality health care and patient satisfaction. Little is known about job satisfaction amongst dietitians and nutritionist, while workload has not previously been studied in this population. Methods: A descriptive cross-sectional study was performed using an online questionnaire. Data were collected on sociodemography. Job satisfaction was measured with Spector’s Job Satisfaction Survey (JSS) (including an added subscore for resource availability) and workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: Respondents (n = 238) had a median age of 32.0 years (IQR: 27−39 years); 92.4% were female; 95.7% were dietitians, 2.4% were nutritionists and 18.9% had a postgraduate degree. Respondents had practised the profession for a median of 8 years (IQR 3−15 years), and 225 were in dietetic and nutrition-related jobs. Median scores indicated that they were slightly satisfied with their jobs (n = 224) and experienced slightly high workload (n = 224). Most respondents were moderately satisfied with the nature of their work and found it rewarding. The median scores for salaries, promotion opportunities, work environment and availability of resources were low. Total JSS was higher in older and more experienced dietitians and nutritionists than in younger ones (p < 0.05). Those employed in the government sector (n = 100) experienced higher physical demands and levels of frustration, and had lower JJS than those employed elsewhere (n = 124), particularly regarding promotion opportunities and resources availability. Conclusion: Despite being generally positive towards practising their profession, South African dietitians and nutritionists, particularly in the public health sector, experienced only slight job satisfaction, related to salary and promotion issues and lack of resources, and were slightly overworked. Understanding the factors that shape perceptions of work within nutrition and dietetics may assist managers in recruiting and retaining a highly skilled workforce, particularly in developing countries with overburdened healthcare systems