A cross-sectional survey on the lifestyle and healthseeking behaviour of Basotho patients with diabetes

Objectives: The objectives of the study were to determine the level of practice of a healthy lifestyle, to assess the health education provided to patients with diabetes and to determine the prevalence of obesity among Basotho patients with diabetes.Design: A cross-sectional study enrolled 192 patients between November 2004 and July 2005. Descriptive statistics on demographic, socio-economic and lifestyle data were computed. Weight, waist circumference and hip circumference measurements were taken to compute body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR). Setting and subjects: Patients with diabetes attending three hospitals in Lesotho were recruited in the study. Outcome measures: These included obesity indices, the quality and quantity of physical exercises, the quality and quantity of provided health education and the frequency with which the subjects sought medical help.Results: The participants’ mean age was 54.73 years. The prevalence of smoking (14.6%) was higher than that of drinking (9.4%). Only 20.8% of the participants participated in recommended physical exercise. Most participants (95%) consulted their physicians on a regular basis. The Health Education Quantity Index was very low: 49.9%. The prevalence of obesity measured by BMI, WHpR and WHtR was 67.7%, 69.8% and 95.3% respectively.Conclusion: The practice of a healthy lifestyle was suboptimal, but help-seeking behaviour was satisfactory among participants. It is recommended that health education and the promotion of a healthy lifestyle are encouraged, that diabetes education is rendered by accredited educators or healthcare providers trained in communicating health messages, and that the fight against obesity is made a priority.Keywords: diabetes, health education, health-seeking behaviour, body mass index, hip circumference, waist to hip ratio, waist to height rati

The profile of maternal deaths in a district hospital: a five-year review of maternal deaths from 2006-2010

Objectives: The objectives were to determine the clinical and demographic profile of maternal deaths, determine the most common primary causes of maternal deaths at district hospital level, compare the causes of deaths at district hospital, provincial and national level, and to investigate the quality of care that was provided to maternal deaths patients and to make recommendations.Design: The design was a cross-sectional retrospective chart review.Setting and subjects: Subjects were all reported maternal deaths between January 2006 and December 2010 at Northdale Hospital, KwaZulu-Natal.Outcome measures: Outcome measures were the common characteristics and causes of maternal deaths, avoidable maternal deaths and quality of care.Results: The mean age of the 61 maternal deaths was 28 years. Thirty-three patients attended antenatal clinics. Of these, 57.6% booked at ≤ 20th week. Of the 28 (45.9%) who died in the postpartum period, seven delivered at home and three died of anaesthetic complications. Thirty-nine patients (63.9%) tested positive for human immunodeficiency virus. Only 10 were on highly active antiretroviral therapy. The five leading causes of deaths were non-pregnancy-related sepsis, miscarriage, acute collapse, pregnancy- related sepsis and anaesthetic complications. Thirty patients (49.3%) received substandard care.Conclusion: The profile of maternal deaths at this district hospital differs from the national profile published in 2005-2007Saving Mothers Report. While there was an increase in maternal deaths at national level, maternal death numbers decreasedat this district hospital. Non-pregnancy-related sepsis remained the leading cause of deaths at national and facility level, butthe other four major causes at the hospital level differed from those at the national level

The profile of maternal deaths in a district hospital : a five-year review of maternal deaths at Northdale Hospital (2006-2010).

M. Med. University of KwaZulu-Natal, Durban 2011Background The estimated global number of maternal deaths has decreased from 536000 in 2005 to 358000 deaths in 2008. Sub Saharan Africa contributed with 57% of maternal deaths in 2008. Although there is a general decrease in maternal deaths, available data shows that most countries, including South Africa, will not meet their Millennium Development Goal 5 A target by 2015. The South African target is a maternal mortality ratio of 38 deaths per 100000. Based on various sources, South African maternal mortality ratio is on the increase. The United Nations interagency estimates placed South African maternal mortality ratio at 410 in 2008 from 260 in 1990. It is therefore necessary that health facilities, the government and the community at large make an effort to reduce avoidable maternal deaths. Aims The main aim of the study was to clinically and demographically profile maternal deaths at Northdale Hospital, assess the quality of care provided to maternal death patients and make recommendations to the hospital clinical management. Secondary objectives included the determination of the following: the prevalence of Human Immunodeficiency Virus infection among maternal deaths, and the commonest primary and final causes of deaths. Methods This cross-sectional survey retrospectively reviewed maternal deaths patients’ records at Northdale Hospital, a district hospital in South Africa. All 61 pregnancy-related deaths that were reported from January 2006 to December 2010 fulfilled the criteria of maternal deaths and were included in the study. Demographic and clinical characteristics of patients were extracted from patients’ charts using a structured pre-designed data sheet. Descriptive statistics were computed and analysed using IBM SPSS software. Medical records of all 61 deaths were assessed by three assessors who determined the causes of death and evaluated the quality of care received by each patient. Results A decrease in number of maternal deaths and maternal mortality ratio has been noticed during the study period. The average maternal mortality ratio for the study period was 204 per 100000 live births: ranging from 219 to 168. The majority of participants were of African origin aged between 20 to 34 years; with a mean age of 28 ± 6.4 years. Of the 61 maternal deaths reviewed, only 33 patients (54.1%) had attended antenatal clinic. Of these patients who had antenatal care, 57.6% booked at 20th week of gestation or earlier. The median number of antenatal visits was 4 visits. Of the 28 patients who died in the postpartum period, seven delivered at home and six had a caesarean section. Of those patients who had a caesarean section, three died within 24 hours, as a result of anaesthetic complications. Only 73.8% of all maternal deaths and 93.9% of those who attended antenatal care were tested for Human Immunodeficiency Virus. Of the 39 patients who tested positive for Human Immunodeficiency Virus infection, only 17 (43.6%) patients had their Cluster of Differentiation 4 cell count results; 10 patients were on antiretroviral triple therapy and four were on antiretroviral dual therapy. Half of the patients died within 41 hours of admission to the hospital. The five most common primary causes of maternal deaths at Northdale Hospital were non-pregnancy related sepsis (54.1%), miscarriage (14.8%), acute collapse (8.2%), pregnancy related sepsis (6.6%), and anaesthetic complications (4.9%). Antepartum haemorrhage, postpartum haemorrhage, pre-existing maternal conditions, hypertension, embolism and an unknown cause contributed 1.6% each. Almost half of maternal deaths were assessed as avoidable. Equally, almost half of maternal deaths received care that was assessed as substandard. Of these 30 patients who received substandard care, a different approach to the management would have made no difference for eight patients (13.1%) whose deaths were unavoidable anyway. A multidisciplinary approach to patients’ management, availability of blood/blood products and resuscitation medicines, and good communication with consultants at the regional hospital are some of the strengths on which Northdale Hospital should capitalise. Some of the problems that contributed to substandard care include: difficulties in referring patients to the regional hospital, inability of staff to manage emergencies correctly, inconsistent patients’ monitoring, and poor communication with the casualty department and the private sector. Conclusion The study has confirmed that the profile of maternal deaths at facility level may paint a totally different picture to what is found at the national level. While there is an increase at the national level, the number of maternal deaths and the maternal mortality ratio are on the decrease at Northdale Hospital, this decrease should be treated with caution as this may just be a yearly fluctuation. Non-pregnancy related sepsis remains the leading cause at both national and district hospital (Northdale Hospital) levels; the other four major causes of maternal deaths are somewhat different. The fact that almost half of the patients received substandard care and almost half of the deaths were assessed as avoidable is an issue of concern. The hospital should capitalise on its strength and build a basis for improvement in patient care. Recommendations The Primary Health Care coordinator should sensitise the community to improve their health seeking behaviour. The establishment of a mothers’ waiting lodge and acquisition of an ambulance dedicated to pregnant women and stationed at the hospital may reduce the number of home deliveries and delays in women at risk of complications accessing the health facility. The Prevention of Mother-to-Child Transmission programme should be strengthened and contraceptive use by all women but specifically by those tested positive for human immunodeficiency virus should be encouraged. Medical officers should be trained in the management of obstetrical emergencies (especially septic abortion) and resuscitation. Medical Interns should not be left unsupervised when attending to critically ill patients. Family physicians should actively assist the department of Obstetrics and Gynaecology in managing patients with medical conditions. Innovative ways should be found to improve the referral difficulties between Northdale and Grey’s Hospitals

A cross-sectional survey on the lifestyle and health-seeking behaviour of Basotho patients with diabetes

OBJECTIVES: The objectives of the study were to determine the level of practice of a healthy lifestyle, to assess the health education provided to patients with diabetes and to determine the prevalence of obesity among Basotho patients with diabetes. DESIGN: A cross-sectional study enrolled 192 patients between November 2004 and July 2005. Descriptive statistics on demographic, socio-economic and lifestyle data were computed. Weight, waist circumference and hip circumference measurements were taken to compute body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR). SETTING AND SUBJECTS: Patients with diabetes attending three hospitals in Lesotho were recruited in the study. OUTCOME MEASURES: These included obesity indices, the quality and quantity of physical exercises, the quality and quantity of provided health education and the frequency with which the subjects sought medical help. RESULTS: The participants’ mean age was 54.73 years. The prevalence of smoking (14.6%) was higher than that of drinking (9.4%). Only 20.8% of the participants participated in recommended physical exercise. Most participants (95%) consulted their physicians on a regular basis. The Health Education Quantity Index was very low: 49.9%. The prevalence of obesity measured by BMI, WHpR and WHtR was 67.7%, 69.8% and 95.3% respectively. CONCLUSION: The practice of a healthy lifestyle was suboptimal, but help-seeking behaviour was satisfactory among participants. It is recommended that health education and the promotion of a healthy lifestyle are encouraged, that diabetes education is rendered by accredited educators or healthcare providers trained in communicating health messages, and that the fight against obesity is made a priority.www.safpj.co.zaam201

Prevalence and outcomes of central venous catheter-related bacteraemia in HIV-infected versus non-HIV-infected patients undergoing haemodialysis treatment for end-stage kidney disease

Background: Central venous catheter (CVC) haemodialysis (HD) to implement renal replacement therapy is the preferred choice in the urgent setting. Unfortunately, CVC placement is associated with multiple complications including nosocomial bloodstream infections. There is a paucity of data on the prevalence and pattern of pathogenic organisms in haemodialysed HIV-infected versus non-HIV-infected patients with end-stage kidney disease. Method and results: We undertook a retrospective study of 228 patients who were dialysed using a CVC at a tertiary referral hospital in KwaZulu-Natal, South Africa. Seventy-eight patients (34.2%) complicated with bacteraemia and sepsis requiring antibiotics. Removal of the catheter was necessary in 58 patients (74.0%). The most common organisms isolated were Staphylococcus aureus (30.8%), Staphylococcus epidermidis (24.4%) and Klebsiella pneumoniae (15.4%). There was no statistically significant difference between HIV-infected and non-infected patients with regards to infection rate, time interval from insertion of CVC to infection and final outcome. However, HIV-infected patients took longer to recover; 54.3% of non-infected patients versus 10.3% HIV-infected patients had their sepsis controlled within one week. Acidosis, hypotension, line malfunction and line discharge were infrequent signs of sepsis. Fever, rigors and raised white cell count occurred in over 80.0% of patients. Conclusion: The infection rate in CVC HD is not more frequent in HIV-infected patients, provided that CD4+ count is ≥ 200 cells/µL and the patient is virologically suppressed. Outcomes following intravenous antibiotic and removal of the CVC are similar in HIV-infected and non-infected patients but response to treatment is slower in HIV-infected patients. A high index of suspicion is needed in detecting CVC-related bacteraemia

Avoidable factors associated with pregnant and postpartum patients admitted to two intensive care units in South Africa

Background. Identification and prevention of any avoidable factor (AVF) associated with pregnancy may reduce critical illnesses and theneed for intensive care unit (ICU) admission.Objectives. To determine AVFs that occurred prior to the admission of pregnant and postpartum patients to two ICUs in South Africa(SA) and the resulting maternal outcomes.Methods. The hospital records of all pregnant and postpartum patients in two public hospital ICUs in Pietermaritzburg, SA, between 1 July2010 and 30 April 2011 were assessed to identify pre-ICU AVFs. Each patient was followed up until the 7th day after ICU discharge or untilhospital discharge (whichever came first), to observe maternal outcomes: survival, death or hypoxic ischaemic brain injury (HIBI).Results. Of 84 patients assessed, 41 (48.8%) had ≥1 AVF. Patient-related, administrative and health-worker-related AVFs wereidentified in 32.1% (27/84), 19.0% (16/84) and 7.1% (6/84) of patients, respectively. The most common patient-related AVF was thecommencement of antenatal care after 20 weeks’ gestation. Unavailability of ICU beds was the most common administrative AVF.Iatrogenic pulmonary oedema associated with intravenous fluid resuscitation was the most frequent health-worker-related AVF. Ofwomen who had AVFs, 9 (22.0%) died, 2 (4.9%) had HIBI and 30 (73.2%) suurvived. The relative risk of death or HIBI among patientswith AVF/s was 1.2 (p=0.7).Conclusions. The principal interventions that may prevent AVFs are ongoing community health promotion, strengthening of obstetricskills training on fluid resuscitation and expansion of critical care services