Pain as a reason for primary care visits: Cross-sectional survey in a rural and periurban health clinic in the Eastern Cape, South Africa

Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province.Method: A cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95% confidence interval (CI) of pain were estimated, and the relationship with demographic variables was determined at a significance level of P < 0.05.Results: Seven hundred and ninety-six adult patients were interviewed, representing a response rate of 97.4%. Almost three-quarters (74.6%; 95% CI: 63.2-81.4%) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4%; 95% CI: 32.1-61.0%) visits and was secondary in 201 (25.3%; 95% CI: 12.8-33.7%) visits. The commonsites of pain were the head, back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain.Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province

Lifestyle and gender influence on the relationship between hypertension and intraocular pressure amongst the South Nigerian population.

Masters Degree. University of KwaZulu-Natal, Westville.Hypertension and increased intraocular pressure (IOP) have been considered to be detrimental to systemic and ocular health respectively. Untreated and prolonged increase in blood pressure (BP) has been linked to increase in IOP for some populations. Lifestyle factors such as cigarette smoking, alcohol intake, obesity, salt, fat, fruit and vegetable intake could have great influence on the relationship between hypertension and IOP. However, this has not been investigated. Aim: The aim of this study is to investigate the influence of gender and lifestyle factors on the relationship between hypertension and IOP amongst the South Nigerian population. Method: A total of 570 subjects between 20-70 years old were included in the study. Subjects were randomly selected from six approved eye hospitals within the South Nigerian region. The population was divided into two groups comprising of 285 normotensive and 285 hypertensive subjects. All subjects were presented with the information document. Only those with signed consent forms participated in the study. With each subjects, blood pressure, intraocular pressure, weight and height measurements were taken using the mercury sphygmomanometer, schiotz tonometer, measuring scale and measuring tape respectively. Thereafter, a lifestyle questionnaire about cigarette smoking, alcohol intake, obesity, salt, fat and fruit and vegetable intake were administered. Data was analyzed using the Statistical Packages for Social Sciences (Version 22), using Pearson correlation coefficient and Analysis of variance (ANOVA) Results: The percentage of male and female normotensive subjects were 33% (N=94) and 67% (N=191) respectively and served as control for the study. For the hypertensive subjects, 36.1% (N=103) were male and 63.9% (N=182) were female. The mean age was 42.31 ± 9.98 years old and 46.45 ± 10.23 years old for the normotensive and hypertensive subjects respectively. The mean IOP of the hypertensive male subjects was 21.22± 3.22 mmHg (RE) and 20.12 ± 2.62 mmHg (LE) and for the female subjects was 19.83 ± 3.75 mmHg (RE) and 18.98 ± 2.91 mmHg (LE). There was no correlation of lifestyle factors and gender on the relationship between HBP and IOP from the study. A correlation was however observed among the hypertensive subjects showing moderate correlation for SBP and DBP for IOP RE (0.375 and 0.297), respectively. A weak correlation was observed for SBP and DBP for IOP LE (0.241 and 0.204) respectively. The relationship between hypertension and IOP was statistically significant with p≤ 0.05. Conclusion: There was significant influence of gender on both hypertension and IOP for the RE and LE. Alcohol intake amongst all other lifestyle had influence on SBP, DBP and IOP RE and LE for hypertensive subjects

Bactericidal activity of human sera against Salmonella Typhiand Salmonella paratyphi A,B,C

Objectives: To determine the sensitivity of Salmonella typhi and paratyphi A,B,C, to normal human blood serum; and assess the role of blood groups (ABO system), Complement and Immunoglobulin in the resistance or susceptibility of Salmonella typhi and Salmonellaparatyphi A,B,C infections.Design: Cross sectional study.Subjects: Ninety-six apparently healthy males and females volunteers, aged 18-24 years.Main outcome measures: Resistance of Salmonella typhi and Salmonella paratyphi A,B,C infections may be blood group and immune status dependent.Results: Blood group B was most resistant to Salmonella typhi and Salmonella paratyphi A,B,C while blood group O showed least resistance (51.9%) and (22.2%) for Salmonella typhi and Salmonella paratyphi A,B,C. There was no difference in resistance pattern when blood was pooled in respect to their group types. Age or sex of the blood donors had no effect on the bactericidal activity of the sera.Conclusion: Blood group is an important factor in the susceptibility or resistance of an individual to Salmonella typhi and paratyphi infections. Individuals of blood group O are likely to be more susceptible to infections caused by Salmonella typhi and paratyphi A,B,C

A comparison of cervical smear adequacy using either the cytobrush or the Ayre spatula: a practice audit

Background: To obtain an adequate cervical (Papanicolaou) smear, the transformation zone, including the squamo-columnar junction, should be sampled as carcinoma develops preferentially in this transformation zone. The Ayre spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency, including the cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre spatula as opposed to the cytobrush. Methods: This was a retrospective analytical study. One sampler, an experienced general practitioner, took the smears in the period 1990 to 2004. Initially, the Ayre spatula was used to consecutively sample the cervix and thereafter, a cytobrush alone was used. Two groups were thus formed for comparison. The presence of endocervical cells was accepted as an indicator of an adequate smear. A Cusco speculum was used to visualize the cervix. The sample was smeared onto a slide and fixated with an alcohol aerosol spray. Results: A total of 4561 smears were taken and 247 had no endocervical cells. A further 34 smears were classified as unsatisfactory due to the presence of degeneration (19), insufficient squamous cells (7), inflammatory exudate (4), excess blood (3) and/or a thick slide (1).The cytobrush group was similar demographically to the Ayre spatula group: 1981 (99%) and 2490 (98%) respectively were non pregnant; 67 (3%) and 110 (4%) were nulliparous, 1008 (50%) and 1370 (54%) were para 1 – 5, and 931 (46%) and 1075 (42%) were para 6 or more; 0 (0%) and 2 (0.1%) were aged between 10 – 19 years, 1496 (75%) and 2012 (78%) between 20 – 49, and 510 (25%) and 541 (21%) were aged 50 years or more. Of 2006 smears taken with a cytobrush, 1955 (97.5%) contained endocervical cells compared with 2325 (91%) of 2555 smears taken with an Ayre spatula. The difference was significant with an Odds Ratio of 4.56 (95% Confidence Interval 3.42-6.42). Conclusion: The cytobrush is significantly more efficacious than the Ayre spatula in obtaining adequate cervical smears. Use of the cytobrush will ensure less repeat smears with a consequent reduction in workload for samplers and laboratories. Although very few smears lacked sufficient squamous cells (an indicator of adequate ectocervical sampling), current best practice is that the cytobrush be used together with a wooden spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone. For full text, click here: South African Family Practice2006;48(9): 15-15

Comparison of the health-related quality of life, CD4 count and viral load of AIDS patients and people with HIV who have been on treatment for 12 months in rural South Africa

This study compared the level of CD4 count, viral load and health-related quality of life (HRQOL) between treatment-naı¨ve AIDS patients and a cohort of people living with HIV who have been on treatment for 12 months. This study is based on a secondary data analysis of the records of 642 people with HIV consisting of 311 treatment-naı¨ve AIDS patients and 331 people with HIV who have been on treatment for 12 months. The study findings are mostly presented in tables and analysed using the t-test to compare HRQOL scores, CD4 count and viral load in the two groups. The study generally noted poor financial capacity and low activity tolerance among the participants. Significant changes were noted in all the domains of HRQOL compared between the treatment-naı¨ve patients and the 12 months treatment cohort. In the same manner, the median CD4 cell count and viral load differed significantly between both groups. The treatment-naı¨ve and the 12 months treatment cohorts consistently reported much lower quality of life scores in the level of dependence domain which includes the measures of mobility, activity of daily living, dependence on medication and work capacity. There were little or no associations between the biomedical markers (CD4 count and viral load) and HRQOL indicators. However, the quality of life tended to increase with increase in the CD4 cell count. The poor to no association between the biomedical markers and HRQOL indicators show that these cannot be direct proxies of each other and that the CD4 cell count and viral load alone may be inadequate eligibility criteria for social support.Keywords: AIDS/HIV, CD4 cell count, health-related quality of life, viral load, WHOQOL-HI

A cross-sectional study of socioeconomic status and cardiovascular disease risk among participants in the Prospective Urban Rural Epidemiological (PURE) Study

Background. Cardiovascular diseases (CVDs) are a challenge to populations and health systems worldwide. It is projected that by 2020 about a third of all deaths globally will be caused by CVDs, and that they will become the single leading cause of death by 2030. Empirical evidence suggests that there is socioeconomic patterning in the distribution and prevalence of risk factors for CVD, but the exact nature of this relationship in South Africa remains unclear.Objective. To examine the association between socioeconomic status (SES) and risk factors for CVD in a cohort of adult South Africans living in rural and urban communities.Method. This was a cross-sectional analytical study of baseline data on a population-based cohort of 1 976 SA men and women aged 35 - 70 years who were part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study.Results. We found a complex association between SES and CVD risk factors, its pattern differing between urban and rural participants. Marital status showed the most consistent association with CVD risk in both groups: widowed participants living in urban communities were more likely to be hypertensive as well as diabetic, while single participants in both locations were more likely to use alcohol and tobacco products. Level of education was the only SES variable that had no significant association with any CVD risk factor in either study group. All measured SES variables were significantly different between urban and rural participants (p<0.05), with diabetes, obesity and alcohol use significantly more prevalent in urban than in rural participants (p<0.05) while hypertension and tobacco use were not (p≥0.05).Conclusions. In this cohort of South Africans, there were significant associations between SES and CVD risk, with marked differences in these associations between rural and urban locations. These findings highlight the need to consider SES and area of residence when designing interventions for CVD prevention and control

Global differences in lung function by region (PURE): an international, community-based prospective study

BACKGROUND Despite the rising burden of chronic respiratory diseases, global data for lung function are not available. We investigated global variation in lung function in healthy populations by region to establish whether regional factors contribute to lung function. METHODS In an international, community-based prospective study, we enrolled individuals from communities in 17 countries between Jan 1, 2005, and Dec 31, 2009 (except for in Karnataka, India, where enrolment began on Jan 1, 2003). Trained local staff obtained data from participants with interview-based questionnaires, measured weight and height, and recorded forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). We analysed data from participants 130–190 cm tall and aged 34–80 years who had a 5 pack-year smoking history or less, who were not aff ected by specifi ed disorders and were not pregnant, and for whom we had at least two FEV1 and FVC measurements that did not vary by more than 200 mL. We divided the countries into seven socioeconomic and geographical regions: south Asia (India, Bangladesh, and Pakistan), east Asia (China), southeast Asia (Malaysia), sub-Saharan Africa (South Africa and Zimbabwe), South America (Argentina, Brazil, Colombia, and Chile), the Middle East (Iran, United Arab Emirates, and Turkey), and North America or Europe (Canada, Sweden, and Poland). Data were analysed with nonlinear regression to model height, age, sex, and region. FINDINGS 153 996 individuals were enrolled from 628 communities. Data from 38 517 asymptomatic, healthy nonsmokers (25 614 women; 12 903 men) were analysed. For all regions, lung function increased with height nonlinearly, decreased with age, and was proportionately higher in men than women. The quantitative eff ect of height, age, and sex on lung function diff ered by region. Compared with North America or Europe, FEV1 adjusted for height, age, and sex was 31·3% (95% CI 30·8–31·8%) lower in south Asia, 24·2% (23·5–24·9%) lower in southeast Asia, 12·8% (12·4–13·4%) lower in east Asia, 20·9% (19·9–22·0%) lower in sub-Saharan Africa, 5·7% (5·1–6·4%) lower in South America, and 11·2% (10·6–11·8%) lower in the Middle East. We recorded similar but larger diff erences in FVC. The diff erences were not accounted for by variation in weight, urban versus rural location, and education level between regions. INTERPRETATION Lung function diff ers substantially between regions of the world. These large diff erences are not explained by factors investigated in this study; the contribution of socioeconomic, geneWeb of Scienc

Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection

HIV and AIDS incidence among infants in South Africa is on the increase.The uptake of prevention of motherto- child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services.This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT.The major findings included that approximately 85% of the participants had heard of PMTCT.There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use.The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated. Keywords: PMTCT, HIV/AIDS, health education intervention, vertical transmission, nevirapine, behavioural intention, theory of planned behaviour. Résumé Le cas de VIH/SIDA augmente parmi les bébés en Afrique du Sud. L'assimilation des interpositions de prévention de transmission mère á enfant (PMTCT) est souvent vu d'être dépendante de croyances et de besoins éducatifs de ceux qui ont besoin des services PMTCT. Cette étude a pour but de vérifier l'effet des interpositions de l'éducation sanitaire clinique-basées (HEI) sur l'intention comportementale de PMTCT auprès de 300 femmes enceintes originaires de 4 services de santé primaire dans les bassins de captation de l'hôpital Tshilidzini, en Afrique du Sud. Un barème d'entretien a été utilisé pour obtenir des informations concernant les caractéristiques démographiques des participants, le niveau d'être exposé aux HEI clinique-basées, les croyances principales et l'intention comportementale sur les PMTCT. Les résultats principaux ont démontré qu'approximativement 85% de participants avaient déjà entendu parlé de PMTCT. Il y a eu une association très étroite entre la fréquence de visites antenatales et le niveau d'être exposé à l'information de PMTCT. L'utilisation du préservatif avait les résultats de croyances principales les plus bas. La croyance de commande était la croyance la plus commune qui contribue à l'intention comportementale. En général, l'association entre les croyances principales des PMTCT et l'intention comportementale était faible. Les HEI clinique-basées avaient un impact sur l'intention comportementale du dépistage de VIH, la croyance normative des visites antenatales régulières et la prise du nevirapine. La contribution primordiale des sources alternatives d'informations sur les PMTCT comme la radio et la télévision a été observée. Rehausser les initiatives vers le développement des femmes et la coordination meilleure de HEI qui existent à travers une meilleure mise en oeuvre de la stratégie de l'éducation sanitaire pourraient renforcer l'actuelle intention modérée des PMTCT dans le lieu en question. Mots clés: PMTCT,VIH/SIDA, interposition de l'éducation sanitaire, infection verticale, nevirapine, intention comportementale, théorie d'un comportement prévu

Screening for gestational diabetes: evaluation of prevalence in age-stratified subgroups at Central hospital Warri Nigeria

Background: The prevalence of gestational diabetes depends on the method of diagnosis as well as ethnic background. Maternal age has also been identified as a factor, but has not been given much attention. The notion of gestational prediabetes has also speculated, but is equally yet to be a focus in discussion. Aim: This work aimed at evaluating the screening for gestational diabetes in Central Hospital, Warri; to determine prevalence of gestational diabetes in the general population and in stratified age groups. The other objective was to investigate the effectiveness and use of the methods of diagnosis. Materials and Methods: This was a retrospective review of laboratory data of de-identified antenatal patients. Hospital records of gestational diabetes from 2013 to 2015 were obtained from the Central Hospital, Warri. Data collected included age of the de-identified patients, blood glucose results and whether the test was fasting or random. Other information was the month/year of test. A total of 3 589 results were analyzed. Results: Averaged prevalence of 5.85% is identified. Fasting blood sugar (FBS) measurement was used more and it also identified more positives (9%) compared to random blood sugar (<2%). On a dichotomous age group, prevalence of gestational diabetes appeared low in women below 25 years compared to those ≥26 years old. In a more stratification of age groups, potential antepartum prediabetes in pregnancy was lower in women above 40 years old relative to the younger age subpopulations (p < 0.000001). No significant variation was observed in level of usage of either method between months/years. Conclusion:  There is an ongoing good practice of using affordable screening test, which is FBS. The significant finding was that there may be up to 9% prevalence of GDM and that this number may erroneously be lower if random blood glucose measurement is used. Another worthy observation was that the prevalence in stratified age groups was non-directional, especially as prediabetes appears higher in the younger age subpopulation