South African congenital disorders data, 2006 - 2014

Background. The National Department of Health in South Africa (SA) routinely collects congenital disorder (CD) data for its national CD surveillance system. The current system has been implemented since 2006, but no reports on the data collected, methodology, achievements or challenges have been published to date.Objectives. To ascertain the effectiveness of the current national CD surveillance system and its implementation.Method. A descriptive, retrospective study using an audit of the current database was undertaken to evaluate the number of notifications received, types of CDs reported and the quality of reporting across SA for data received from 2006 to 2014.Results. A total of 14 571 notifications were received, including 13 252 CDs and 1 319 zero notifications, across all nine provinces. Commonly reported CDs included Down syndrome, cleft lip and palate, talipes equinovarus, neural tube defects and albinism.Conclusions. The major challenges identified included erratic compliance by health facilities and a lack of healthcare providers trained in human genetics related to CDs. This has led to misdiagnosed and undiagnosed CDs, collectively resulting in under-reporting of cases by >98% during the review period. Owing to limited human and financial resources, it is recommended that the surveillance system be modified into an electronic format. This should be piloted alongside relevant training in specific sentinel sites, to improve data coverage and quality for further evaluation

South African congenital disorders data, 2006 - 2014

Background. The National Department of Health in South Africa (SA) routinely collects congenital disorder (CD) data for its national CD surveillance system. The current system has been implemented since 2006, but no reports on the data collected, methodology, achievements or challenges have been published to date.Objectives. To ascertain the effectiveness of the current national CD surveillance system and its implementation.Method. A descriptive, retrospective study using an audit of the current database was undertaken to evaluate the number of notifications received, types of CDs reported and the quality of reporting across SA for data received from 2006 to 2014.Results. A total of 14 571 notifications were received, including 13 252 CDs and 1 319 zero notifications, across all nine provinces. Commonly reported CDs included Down syndrome, cleft lip and palate, talipes equinovarus, neural tube defects and albinism.Conclusions. The major challenges identified included erratic compliance by health facilities and a lack of healthcare providers trained in human genetics related to CDs. This has led to misdiagnosed and undiagnosed CDs, collectively resulting in under-reporting of cases by >98% during the review period. Owing to limited human and financial resources, it is recommended that the surveillance system be modified into an electronic format. This should be piloted alongside relevant training in specific sentinel sites, to improve data coverage and quality for further evaluation

Challenges faced by caregivers of children on antiretroviral therapy at Mutale Municipality selected healthcare facilities, Vhembe District, Limpopo Province

Background: Children depend solely on caregivers who can be either parents or guardians for drug administration to enhance adherence to antiretroviral treatment (ART), which might pose any number of challenges. Purpose: The purpose of this study was to explore and describe the challenges faced by caregivers of children on ART at Mutale Municipality, Vhembe District, Limpopo Province. Research design and method: The research design was qualitative, explorative, descriptive and contextual in nature. The population consisted of 16 caregivers who were 18 years of age and above, and mentally capable, irrespective of educational qualifications, caring for children aged between 0 and 15 years who were on ART between April 2013 and October 2014. Non-probability, purposive sampling was used to select the 16 caregivers. Required permission, approval and ethical clearance were obtained from the University of Venda Higher Degree Committee, Limpopo Provincial Health Department and relevant institutions. An in-depth, individual, unstructured interview method was used to collect data. One central question was asked: ‘What are the challenges you experience when caring for a child on antiretroviral treatment?’ Subsequent questions were based on the participants’ responses to the central question. Qualitative data were analysed by means of Tesch’s open-coding method. Results: The findings of this study revealed that participants, that is, caregivers of children on ART, experienced financial burdens because of transport costs needed to comply with follow-up dates and insufficient of money for food, clothing the child in need of care, pocket money for lunch boxes during school hours and time lost while waiting for consultations. Participants reported some level of stigmatisation against children on ART by family members, especially the husbands or in-laws of the secondary caregivers. Many primary and secondary caregivers seemed to have given up seeking support from government and community structures. Conclusion: The conclusions drawn from this research are that caregivers hardly receive any support from family members or the community. Fear of disclosing the HIV-positive status of children resulted in the delay of financial support from the government, thus leading to serious financial burden on the caregivers

Patient-perceived factors contributing to low tuberculosis cure rate at Greater Giyani healthcare facilities

Background: Compliance with tuberculosis (TB) treatment is unpredictable. Most patients do not comply because they do not see the importance of doing so, which is usually influenced by lack of knowledge. Objectives: The purpose of the study was to explore and describe the factors contributing to low TB cure rates in Greater Giyani Municipality, as viewed by patients. Method: The study was conducted in the Greater Giyani Municipality in Limpopo Province which had a TB cure rate ranging from 14% to 94%. The research design in this study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of all TB patients diagnosed and referred for treatment and care in Primary Health Care (PHC) facilities. Non-probability purposive sampling was used to select TB patients and health facilities which had a cure rate lower than the national target of 85%. One patient was sampled from each PHC facility. An in-depth face-to-face interview was used to collect data using an interview guide. Results: The findings showed that most of the TB patients come from poor families, which makes it difficult for them to obtain financial and food security. The health facilities often run out of food supplements and TB medicine. Cultural beliefs about TB also lead to TB patients seeking assistance from traditional health practitioners and faith-based healers. Conclusion: There is a need to have a policy regarding how discharged tuberculosis patients on treatment are supervised when at home. Healthcare facilities should also ensure that there is enough medication for these patients as lack of medication can lead them to default.   Agtergrond: Dit is onmoontlik om te bepaal of pasiënte by hulle tuberkulosebehandeling gaan hou. Die meeste pasiënte hou nie daarby nie omdat hulle nie die belangrikheid daarvan insien nie. Doelwitte: Die doel van die studie was om die faktore wat in die Groter Giyani Munisipaliteit tot lae genesingskoerse onder TB-pasiënte lei, te ondersoek en te beskryf, soos deur pasiënte gesien. Metode: Die studie is in die Groter Giyani Munisipaliteit in die Limpopo Provinsie gehou, waar die genesingskoers vir TB tussen 14% en 94% is. Die navorsing in hierdie studie was kwalitatief, verkennend, beskrywend en kontekstueel van aard. Die populasie het bestaan uit alle gediagnoseerde TB-pasiënte wat vir behandeling en sorg na primêre gesondheidsorgfasiliteite verwys is. Nie-waarskynlikheid, doelgerigte steekproefneming is gebruik om TB-pasiënte en gesondheidsfasiliteite te kies wat ’n laer genesingskoers as die nasionale doelwit van 85% het. Een pasiënt uit elke primêre gesondheidsorgfasiliteit is by die steekproef ingesluit. ‘n Diepgaande persoonlike onderhoud is gebruik om data met behulp van ‘n onderhoudgids in te samel. Resultate: Die bevindinge toon dat die meeste van die TB-pasiënte uit arm gesinne kom, wat dit vir hulle moeilik maak om finansiële en voedselsekerheid te hê. Die gesondheidsfasiliteite se voedselaanvullings en TB-medisyne raak dikwels op. Kulturele oortuigings oor TB lei ook daartoe dat TB-pasiënte by tradisionele gesondheidsorgpraktisyns en geloofsgebaseerde genesers hulp soek. Gevolgtrekking: Dit is nodig dat ‘n beleid oor toesig oor die behandeling van ontslaande TB-pasiënte wat tuis aansterk, opgestel word. Gesondheidsorgfasiliteite behoort ook seker te maak dat daar genoeg medisyne vir hierdie pasiënte is, aangesien ‘n gebrek aan medisyne daartoe kan lei dat die pasiënte ophou om hulle medikasie te gebruik

Views of professional nurses regarding low tuberculosis cure rate in Greater Giyani Municipality, Limpopo Province

Background: Management of patients suffering from tuberculosis (TB) after discharge from hospital plays a critical role in the cure rate of TB. Despite interventions developed by the World Health Organization (WHO) to improve the cure rate, TB remains a worldwide health problem. Objective: The purpose of the study was to explore and describe the views of professional nurses regarding the low TB cure rate in primary healthcare facilities of Greater Giyani Municipality in Limpopo Province, South Africa, with the aim of determining strategies that can be used to improve this low rate. Method: This study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of professional nurses working in primary healthcare facilities within Greater Giyani Municipality, which has a TB cure rate below the national target of 85 %. Data gathering was through individual face-to-face interviews using an interview guide. Open-coding was used to analyse the data in this study. Results: The theme that emerged from data was ‘factors contributing to low TB cure rate’. This theme was supported by the following sub-themes: poor referral system, lack of knowledge about TB and its treatment, stigma attached to TB, and cultural and religious beliefs. The professional nurses suggested counselling of TB patients upon diagnosis, advice about patients’ responsibilities and the involvement of family members. Conclusion: The involvement of community stakeholders in TB prevention, health promotion and education activities devoted to disease spread and cure is vital so that the stigma attached to TB can be eliminated. TB education and awareness programmes should be included in the curriculum of primary schools

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology