Reasons for doctor migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons,medical professionals, often from sub-Saharan Africa, are actively recruited by developed countries. Doctors in South Africa are esteemed for the highstandard of training they receive locally, a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has, however, been reported extensively that push factors usually play a much greater role in doctors’ decision to leave their countries of origin, than do pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions, high levels of crime and violence, political instability, lack of future prospects, HIV/AIDS and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled  individuals, source countries also face substantial monetary implications caused by the migration of doctors. Government subsidy of medical students’ training could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who had emigrated from South Africa.Methods: The investigation was conducted in 2005 as a descriptive study of participants found primarily by the snowball sampling method. Theinitial participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties, living abroad andin possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information,consent letters and questionnaires were either hand-delivered or e-mailed, and completed forms and questionnaires were returned via these routes.Participation was voluntary.Results: Twenty-nine of 43 potential participants responded, of which 79.3% were male and 20.7% female between the ages of 28 and 64 years(median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985), and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4%) were in private practice before they left, 27.5% had public service appointments and 17.3% were employed by private hospitals. Seventy-nine per cent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand, United Arab Emirates, Bahrain, United Kingdom, Canada, Yemen and Australia. Forty-one per cent of respondents indicated that they would encourage South African young people to study medicine, although 75% would recommend newly graduated doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2% of the respondents, better job opportunities by 79.3%, and the high crime rate in South Africa by 75.9%. Only 50% of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country.Approximately one-fifth (17.9%) of the respondents indicated that they already had family abroad by the time they decided to emigrate.Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations,followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously, theresults presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa thanbefore. In order to prevent the loss of medical expertise from a society already in need of quality healthcare, issues compelling doctors to look forgreener pastures should be addressed urgently and aggressively by stakeholders

Clinical delineation, sex differences, and genotype-phenotype correlation in pathogenic KDM6A variants causing X-linked Kabuki syndrome type 2.

PURPOSE: The variant spectrum and the phenotype of X-linked Kabuki syndrome type 2 (KS2) are poorly understood. METHODS: Genetic and clinical details of new and published individuals with pathogenic KDM6A variants were compiled and analyzed. RESULTS: Sixty-one distinct pathogenic KDM6A variants (50 truncating, 11 missense) from 80 patients (34 males, 46 females) were identified. Missense variants clustered in the TRP 2, 3, 7 and Jmj-C domains. Truncating variants were significantly more likely to be de novo. Thirteen individuals had maternally inherited variants and one had a paternally inherited variant. Neonatal feeding difficulties, hypoglycemia, postnatal growth retardation, poor weight gain, motor delay, intellectual disability (ID), microcephaly, congenital heart anomalies, palate defects, renal malformations, strabismus, hearing loss, recurrent infections, hyperinsulinism, seizures, joint hypermobility, and gastroesophageal reflux were frequent clinical findings. Facial features of over a third of patients were not typical for KS. Males were significantly more likely to be born prematurely, have shorter stature, and severe developmental delay/ID. CONCLUSION: We expand the KDM6A variant spectrum and delineate the KS2 phenotype. We demonstrate that the variability of the KS2 phenotypic depends on sex and the variant type. We also highlight the overlaps and differences between the phenotypes of KS2 and KS1

Integrating promotive, preventive, and curative health care services at hospitals and health centers in Addis Ababa, Ethiopia

Netsanet Fetene Wendimagegn,1 Marthie C Bezuidenhout2 1Health Management and Leadership, Yale Global Health Leadership Institute (GHLI), Addis Ababa, Ethiopia; 2Department of Health Studies, University of South Africa, Pretoria, South Africa Background: The current trend in patients’ disease management is mostly aimed at addressing their present health complaints; the focus is thus purely curative. As the limits of curative medicine become apparent and the cost of medical care escalates, disease prevention is gaining prominence. Factors that contribute to unreliable delivery of an integrated health care service are worth investigation. This study explores the extent to which health promotion and disease prevention services are integrated to curative health care and identifies the factors associated with not reliably providing the services.Methods: A cross-sectional quantitative study using an exploratory and descriptive design was used to explore and describe the extent of health promotion, preventive, and curative health care services provision, and investigated factors related to low performance. Phase I of the study examined the degree of promotive and preventive health care provision at hospitals and health centers while investigating the staffing and equipment and supply status of the facilities. Phase II, using the Delphi consensus-seeking process, focused on the validation of the findings from Phase I.Results: Of all patients who attended health facilities, only 2.4% (n=20) received optimal health promotion services. Disease prevention services were optimally provided to only 3.6% (n=30) patients. Integrated health promotion and disease prevention services were provided to only 0.8% (n=7) patients. The main reasons for not providing an integrated health care service were shortage of skilled health staff, equipment, medication, protocols, and guidelines, and high service cost, poor patient awareness, and health professionals’ focus on curative health care.Conclusion: Health service providers were not routinely conducting patient-specific health promotion, disease prevention, and integrated health care services, losing the opportunities of patient’s presence for health promotion and diseases prevention purposes. Addressing barriers can help with integrating health promotion and disease prevention services to the curative health care services. Keywords: integrated health service, disease prevention, health promotion, curative care, non-communicable disease

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe’s women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women’s chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients’ records and changed policies for managing these conditions more effectively in Zimbabwe

Nama Karoo Biome

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Savanna Biome

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