Effectiveness of home-based directly observed treatment for tuberculosis in Kweneng West subdistrict, Botswana.

Thesis (MFamMed)--Stellenbosch University, 2015.ENGLISH: ABSTRACT: Introduction: Tuberculosis and HIV are major public health problems in Botswana. The Botswana National Tuberculosis Control Programme (BNTP) was established in 1975. Short course chemotherapy was introduced in 1986 and the Directly Observed Treatment (DOT) Strategy was adopted in 1993. In the face of growing TB notification rates, a low country average cure rate, human resource constraints in health facilities and sometimes poor accessibility to health facilities by weak patients and those living far away, Botswana decided to offer home-based care using volunteers or family members. Setting: Kweneng West Subdistrict, a rural area in Botswana Aim and objectives: The aim of this study was to assess the success of home-based DOT in the management of tuberculosis compared to facility-based DOT in Kweneng West Subdistrict, Botswana and to explore the acceptability of home-based DOT among TB patients, TB treatment supervisors and health workers. Objectives: - To compare treatment outcomes for patients receiving home-based DOT and those receiving facility-based DOT through the following criteria: - To compare patient contact(s) tracing efforts among home-based providers and facility-based providers - To establish TB patient’s, TB treatment supervisor’s and health worker’s perceptions about home-based DOT Methods: A quantitative, observational study combined with qualitative in-depth interviews. Participants were selected from TB patients who attended treatment from January 2006 till June 2008 at all main clinics of Kweneng West Subdistrict, Botswana. The interview purposively selected health care workers, TB patients and community supervisors to establish their thoughts about HB DOT. A framework approach was used to analyse interviews. Results: Treatment outcomes and, particularly, the cure rates were not statistically different between FB DOT, HB DOT and MX DOT. However there was a surprisingly difference in contact tracing, with FB DOT performing better than other DOT types. Interviews revealed that patients were happy with their choice of DOT types. Among reasons to choose HB DOT was the need to shorten distances for DOT. Among reasons to choose FB DOT were the needs to ensure safety through supervision by nurses as opposed to lay people (community supervisors) and to obtain injections that no community supervisor is allowed to administer. A mix of HB DOT and FB DOT was generally adopted to allow flexibility in the administration of DOT for few patients. Overall cure rate was 78.5% and successful treatment rate was 83%. Conclusion: The introduction of HB DOT and the option given to choose this DOT type is supported. Indeed allowing patient’s preference of DOT type may impact positively on patients’ satisfaction and adherence to medication. On the other hand, issues were still raised by all stakeholders to help improve the flexibility and sustainability of HB DOT. Further studies may be needed to understand the better performance of FB DOT in contact tracing.AFRIKAANSE OPSOMMING: Nie beskikbaar

Severe hypertension in two emergency departments of Netcare Management (Pty) Limited hospitals, Johannesburg, South Africa.

Hypertension is the major cause of cardio-vascular diseases and contributes to 13.5% of premature deaths worldwide. With a 10–year risk to develop organ damages estimated at 30%, severe hypertension exposes even more patients to premature death. Severe hypertension is a type of hypertension with systolic blood pressure ≥ 180mmHg and/or diastolic blood pressure ≥ 110 mmHg that may present with or without symptoms/signs or target organ damages, and may be classified accordingly as asymptomatic (without symptoms/signs) severe hypertension, hypertension urgency (with symptoms/signs, no target organ damage) or hypertension emergency (with target organ damage). Hypertension urgency and hypertension emergency are considered hypertension crisis. This study aimed to establish the socio-demographic and clinical characteristics of the patients who presented with severe hypertension at the Emergency Departments of two private hospitals of the Netcare Management (Pty) Limited in Johannesburg during the period from the 1st of January 2010 to 30th April 2011. These patients presumably receive quality health care and may not be expected to develop severe hypertension. Therefore, this study would contribute to efforts to identify patients at risk and those who may benefit from preventive measures. The methodology of this study was a retrospective, transversal and comparative study. One thousand and forty-two patients were included in the study. All of these participants had a medical aid cover or were able to pay for medical consultation at a private hospital. Data were collected from an electronic database, the Medibank™, and from manual patients’ registers kept in each hospital’s Emergency Department. Severe hypertension was found among 1.7% of all patients who presented to the studied emergency departments. Only 817 patients were classified in the different subtypes of SH. Asymptomatic severe hypertension was the most common (83.4%) type of severe hypertension and hypertension emergency was the least common (4.8%). At Mulbarton Hospital, 50.2% of severe hypertension patients were male and at Linksfield Hospital, 60.3% were female. Male patients were younger than female patients. White patients and elderly were mostly affected by severe hypertension in the studied population. Systolic blood pressures were similar among the different races and genders. Black patients had higher diastolic blood pressure compared to white patients. White patients were older and may have had a tendency of isolated systolic hypertension. Overall, the most common symptoms/signs in hypertension urgency were chest pains (46.4%), headache (34.0%) and epistaxis (11.3%). The most common target organ damages in hypertension emergency were stroke (58.9%), left ventricular failure/congestive cardiac failure (28.2%) and seizures (12.8%). None of the studied characteristics could be claimed predictors of hypertension crisis. Also, there was no association between seasons and days of presentation and onset of severe hypertension in each hospitals. Further studies are required to include other factors that are known to affect the occurrence of severe hypertension, such as co-morbidities, smoking, alcohol intake and poor adherence to medication by known hypertensive patients. Also, risk factors contributing to the occurrence of SH among younger black patients need to be analysed

Describing final diagnosis and outcome for patients investigated for suspected acute coronary syndrome at a regional, public South African emergency centre

Thesis (MFamMed)--Stellenbosch University, 2018.ENGLISH SUMMARY : No abstract available.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar

Effectiveness of home-based directly obeserved treatment for tuberculosis in Kweneng West subdistrict, Botswana

CITATION: Kabongo, D. & Mash, B. 2010. Effectiveness of home-based directly obeserved treatment for tuberculosis in Kweneng West subdistrict, Botswana. African Journal of Primary Health Care & Family Medicine, 2(1): 1-6, doi: 10.4102/phcfm.v2i1.168.The original publication is available at http://www.phcfm.orgBackground: Tuberculosis (TB) and HIV are major public health problems in Botswana. In the face of growing TB notification rates, a low cure rate, human resource constraints and poor accessibility to health facilities, Botswana Ministry of Health decided to offer home-based directly observed treatment (DOT) using community volunteers. Objectives: The aim of this study was to assess the outcomes of home-based directly observed treatment (HB-DOT) versus facility-based, directly observed treatment (FB-DOT) in the Kweneng West subdistrict in Botswana and to explore the acceptability of HB-DOT among TB patients, community volunteers and health workers. Method: A quantitative, observational study using routinely collected TB data from 405 TB patients was conducted and combined with 20 qualitative in-depth interviews. Results: The overall cure rate for smear-positive pulmonary TB patients was 78.5%. Treatment outcomes were not statistically different between FB-DOT and HB-DOT. Contact tracing was significantly better in FB-DOT patients. Interviews revealed advantages and disadvantages for both FB and HB options and that flexibility in the choice or mix of options was important. A number of suggestions were made by the interviewees to improve the HB-DOT programme. Conclusion: HB-DOT is at least as good as FB-DOT in terms of the treatment outcomes, but attention must be given to contact tracing. HB-DOT offers some patients the flexibility they need to adhere to TB treatment and community volunteers may be strengthened by ongoing training and support from health workers, financial incentives and provision of basic equipment.http://www.phcfm.org/index.php/phcfm/article/view/168Publisher's versio

Describing suspected non ST-elevation acute coronary syndrome using troponin at a regional, public South African emergency centre with the Roche cardiac reader

CITATION: Kabongo, D., et al. 2018. Describing suspected non ST-elevation acute coronary syndrome using troponin at a regional, public South African emergency centre with the Roche cardiac reader. SA Heart, 15(2):102-107, doi:10.24170/15-2-3043.The original publication is available at https://www.journals.ac.za/index.php/SAHJBackground: There are few data available regarding acute coronary syndrome presenting to emergency centres in sub-Saharan Africa compared to the rest of the world. The aim of this study was to describe the acute coronary syndrome diagnosis and its outcome in an undifferentiated chest pain population when using a troponin assay that predates current reference standards at a public, Cape Town emergency centre. Methods: A retrospective, cross-sectional design was used. Comparisons were made between the diagnosis, outcome and troponin result (using the Roche cardiac reader). Findings were descriptively presented. Troponin results were qualitatively described in relation to a non ST-elevation acute coronary syndrome diagnosis. Associations were tested using the Chi2-test. Results: Nine hundred and sixty-nine patients were included in the study, of which 40 patients (4%) were excluded due to poor clinical record keeping. Acute coronary syndrome was diagnosed in 256 patients (28%), from which 54 (21%) were troponin positive which differed to troponin negative acute coronary syndrome (p <0.001). Unstable angina was diagnosed in 197 (77%) of acute coronary syndrome patients. Conclusions: Unsurprisingly, a high proportion of chest pain patients did not have acute coronary syndrome. Unstable angina numbers were much higher than described elsewhere. Although it is not possible to relate this finding to the assay’s lower accuracy using only a descriptive design, a higher sensitivity assay would likely benefit the diagnostic process as it does elsewhere. Further research is required to explore safe, local diagnostic strategies that can strike a balance between patient safety and cost effectiveness.https://www.journals.ac.za/index.php/SAHJ/article/view/3043Publisher's versio

African Federation for Emergency Medicine’s Francophone Working Group – May 2018 Report

Even though the African Federation for Emergency Medicine (AFEM) has been successfully developing emergency care in Africa for the past nine years, a considerable amount of potential AFEM members from the African-Francophone countries are not able to access AFEM resources. In response, an AFEM Francophone Working Group has been created to coordinate all existing and new initiatives to promote emergency care in African-Francophone countries. Keywords: Emergency care, Emergencies, French, Afric