An investigation into the dramatic increase in deaths from gastroenteritis during the summer of 2007/08 at National District Hospital, Bloemfontein, Free State

Introduction and background: Despite national guidelines and agreed upon admission and referral criteria for children in National District Hospital (NDH), Bloemfontein, the number of children admitted with gastroenteritis (GE) has increased dramatically since December 2007. From the previous year’s Child Healthcare Problem Identification Programme (Child PIP) data the increase in GE admissions was evident in NDH. During the preceding year, 123 children were admitted for GE and during the audit period 267. The number of deaths in NDH also increased from an average of 2.25 a month over the past 3 years to 10 a month during January and February 2008. Aim: The aims of the study were: to determine the causes of death of children in NDH; to determine the relationship between nutritional status, HIV disease, laboratory results, demographic data, time of admission, duration of admission and other diseases or conditions and GE child deaths in NDH;to determine whether doctors adhered to prescribed GE treatment protocols; to determine whether nursing personnel carried out doctors’ orders as prescribed; and to identify other factors that contributed to GE deaths. Methodology: A cross-sectional study design was used. All child deaths, as well as all children admitted with GE to Ward 3 in NDH from May 2007 to April 2008 were included in the study. The first author collected the information on a cause of death form, a data form and an audit tool. As part of the quality-improvement project, 10 items were assessed to determine whether doctors adhered to treatment protocols, and 10 items were assessed to determine whether nurses adhered to nursing orders and basic nursing care. Any other factors that contributed to poor care were also noted. Results: 1. Cause of death: During this period, 49 children died, 33 (67%) due to GE, 6 (12%) due to tuberculosis (TB), 5 (10%) due to septicaemia, 4 (8%) due to pneumonia and 1 (2%) due to congenital abnormalities. Only 4.1% of the children who died were considered as normal weight for age according to their Road to Health Chart (RTHC). Regarding HIV status, 82.5% of the children who died tested HIV positive. In total, 19.4% of allGE admissions died during this one-year period. 2. GE deaths: Demographic data such as gender and age did not influence the outcome of GE. As expected, severe malnutrition, HIV-positive status and severe dehydration all contributed statistically significantly to high mortality in GE. Severe abnormalities occurred in the laboratory results of most of the children who died and indicated the severity of their disease(s). No specific organisms were cultured from stool specimens and the quality of drinking water in Bloemfontein was declared safe for human consumption. 3. Other factors that contributed to GE deaths: Medical and nursing care were of a high standard and treatment protocols were followed. Pre-admission factors such as transport, non-availability of 24-hour medical services, non-initiation of emergency treatment before referral, and caregivers not realising the severity of the disease need urgent attention to prevent further deaths. Conclusion: GE contributed to 67% of deaths in the paediatric ward of NDH. Underlying poor nutritional status and/or HIV disease were present in 96% of the GE deaths. In more than nine out of ten cases the doctors and nurses in the hospital rendered medical care in accordance with standard guidelines. Pre-admission factors need to be addressed in order to prevent more deaths

Production and quality aspects of rooibos tea and related products. A review

Use of the herbal tea, rooibos, made from the indigenous South African fynbos plant, Aspalathus linearis spp. linearis, has shown tremendous growth on the international markets since the 1990s. From a small beginning in 1904, solely depended on wild harvesting, the industry has developed out of the selected and cultivated Nortier type, leading to improved quality. Traditional rooibos is processed, entailing an oxidation („fermentation“) step, essential to develop the characteristic sweetish flavour and red-brown colour. Higher antioxidant levels for unfermented rooibos resulted in the development of green rooibos and extracts enriched in aspalathin, a potent antioxidant unique to rooibos. Major markets for rooibos extracts are ready-to-drink iced teas and cosmetic products

Multidisciplinary Training to Undergraduate Students in the Faculty of Health Sciences: Hypertension as a Case Study

Background: Healthcare students should be aware of the specific skills, knowledge and management options of other disciplines in order to achieve an effective and cohesive working relationship. Aim: The aim of this study was to expose healthcare students at the University of the Free State to one another\'s domains, as related to hypertension management, during a formal didactic lecture attended by medical, physiotherapy and dietetic students, and to determine whether they could apply in practice the theoretical knowledge regarding blood pressure measurement and exercise, obtained during a multidisciplinary session. The perceptions of students regarding multidisciplinary sessions were also to be obtained. Method: Students received a formal lecture on hypertension from a medical doctor, a dietitian, a physiotherapist and an occupational therapist and they then worked in multidisciplinary groups to demonstrate the physiological effect of exercise on blood pressure and pulse rate. Students had to report their findings and perceptions of the session by completing data forms. Results: A total of 125 medical, physiotherapy and human nutrition students participated in the session. The students were able to demonstrate the influence of exercise on blood pressure and pulse measurements. They reported that they enjoyed the multidisciplinary session and gained information on the scope of practice of the domains of the other disciplines. Negative feedback was received on the size of the groups and lack of equipment. Conclusion: The students could apply theoretical knowledge in practice and all gave positive feedback. The sessions will continue in the current format but attention will be given to smaller groups and the availability of more equipment. South African Journal of Family Practice Vol. 50 (4) 2008: pp. 70a-70

A review of hydatid disease of the brain

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Compliance in black patients with non-insulindependent diabetes mellitus receiving oral hypoglycaemic therapy

Poor compliance with drug therapy is an important cause of therapeutic failure. Sixty-eight black patients with non-insulin- dependent diabetes mellitus receiving oral hypoglycaemic agents were interviewed and various factors, such as age, sex, degree of control and type of therapy, were recorded by means of a questionnaire. Compliance was determined by qualitatively assessing urine for the presence of the drugs. An alarmingly high incidence of non-compliance of 65% was found, which could still be an under-estimation because of the long half-life of one of the drugs involved - chlorpropamide. Although interesting trends were noted, no statistically significant differences between compliant and non-compliant patients were found. In the light of the high incidence of non-compliance, a larger and more detailed study seems to be warranted to identify problem areas and to plan appropriate interventions

An evaluation of the assessment tool used for extensive mini-dissertations in the Master’s Degree in Family Medicine, University of the Free State

Background: Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time Master of Family Medicine (MFamMed) to a full-time Master of Medicine (Family Medicine) [MMed(Fam)] degree, with changes in the curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the  postgraduate programme for Family Medicine, at the University of the Free State, and if necessary, to produce a valid and reliable assessment tool that is user-friendly.Method: An action research approach was used in this study, using mixed methods. Firstly, marks given by 15 assessors for four mini-dissertations using the current assessment tool were analysed quantitatively. In Phase 2, the regulation of the assessment bodies and the quantitative results of Phase 1 were discussed by assessors during a focus group interview, and data were analysed qualitatively. An adapted, improved assessment tool (Phase 3) was developed and re-evaluated in Phase 4.Results: The current assessment tool complied with the regulations of the assessment bodies. The scores allocated to specific categories varied with a median coefficient of variation of more than 15% in four of the possible 12 assessment categories. During the focus group interview, reasons for this were identified and the assessment tool adapted accordingly. During reassessment of the tool, individual assessors were identified as the  reason for poor reliability.Conclusion: The current assessment tool was found to be valid, but was not reliable for all assessment categories. The adapted assessment tool  addressed these areas, but identified lack of training and experience in the assessment of extensive mini-dissertations by certain assessors as the main reason for unreliable assessment