Management of snakebites at a rural South African hospital

Background: Snakebites remain a source of considerable morbidity and mortality in many countries, with an estimated global true incidence ofenvenomation exceeding five million a year, with about 100 000 of these cases developing severe sequelae. Despite the availability of polyvalentsnake antivenom, inappropriate first aid, regional effects of envenomation and inappropriate use of antivenom result in significant and at timespotentially avoidable morbidity and mortality, particularly in children. The study was undertaken in Lephalale (previously Ellisras) Hospital, LimpopoProvince, due to the frequency of snakebites managed at the hospital.Methods: This was a record-based retrospective study in which patient files with the diagnosis of snakebite were reviewed. The objective of thisstudy was to document the management of snakebites at Lephalale Hospital, a rural hospital in South Africa. The hospital files of all patients managed at the hospital for snakebites from 1 January 1998 to 31 December 2001 were reviewed.Results: Seventy patients were treated for snakebites during the study period. The results showed a male preponderance (60%) and a mean ageof 27.3 years among the reported cases. Twenty-nine patients (41.1%) were bitten between dusk and dawn (18:00 and 06:00), 43 (61.4%) werebitten on the lower limb and the mean duration of admission in the wards was 4.2 days. Twenty-one bites (30%) were attributed to known poisonoussnakes, 22 (31.4%) patients received polyvalent antivenom, 42 (60%) received promethazine, which has not been shown to prevent anaphylacticreactions, 12 (17.1%) developed complications and two died (a case fatality rate of 2.9%). None of the patients was given tetanus toxoid asprophylaxis, as no previous tetanus immunisation was documented.Conclusions: The findings of this study highlight gaps in the management of snakebites at this rural hospital where they were treated frequently. Itis crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites inhumans. Elevation of the affected limb, administration of intravenous fluids and administration of analgesia, with close monitoring of patients during and after antivenom administration, form the basis of most clinical protocols on the management of snakebites

Marburg haemorrhagic fever: A rare but fatal disease

No Abstract.Keywords: Marburg, Ebola, haemorrhagic fever, outbreakSA Fam Pract 2005;47(4): 2

Editorial : National Health Insurance (NHI): Time for reflections!

No Abstrac

EDITORIAL: Depression among South Africa’s civil servants: Is there a solution?

No Abstract

The experiences of family caregivers concerning their care of HIV/AIDS orphans

Introduction: The HIV/AIDS pandemic is reducing life expectancy and raising mortality. An increasing orphan population is perhaps the most tragic and long-term legacy of the HIV/AIDS pandemic. By 2010 sub-Saharan Africa is expected to have an estimated 50 million orphans and it will be staggered by this challenge. By the middle of 2006, 1.5 million children under the age of 18 years were maternal orphans in South Africa, and 66% of these children had been orphaned as a result of HIV/AIDS. Although government and non-government organisations have responded by building orphanages, most of Africa’s orphans have been absorbed into extended family networks. Many of these extended family caregivers are ageing and often impoverished grandparents.Methods: This was a descriptive, qualitative study using the free attitude interview technique. All family caregivers who consulted at the Hoekfontein Clinic, North West Province, South Africa between March and June 2006 formed the study population. A total of nine one-on-one interviews had been conducted by the time saturation of data was reached.Results: All nine caregivers were women, mostly grandmothers (67%), and the orphans were between the ages of 5 and 20 years. Emergent themes were: poverty and lack of money; bureaucratic difficulties and lack of assistance from the social support services; lack of support (financial, physical and emotional) from other family members; frustrations of coping with rebellious orphans; pain of caring for the terminally ill family members; feelings of despondency (hopelessness); conflicts in the family; and the rejection of orphans by their fathers.Conclusions: The study showed that the family caregivers experienced a lack of welfare and family/emotional support in their care of HIV/AIDS orphans. It is recommended that health care workers, including social workers and home-based caregivers be trained on available social supportfrom government and non-governmental organisations for caregivers of HIV/AIDS orphans. Keywords: HIV/AIDS; orphans; caregivers; South Afric

Adherence to HIV antiretroviral therapy Part II: which interventions are effective in improving adherence?

Interventions to support adherence to antiretroviral therapy (ART) can be classified into four categories: cognitive, behavioural and affective interventions and (modified) directly observed therapy (DOT.) Cognitive interventions improve HIV- and ART-related knowledge, but this is not consistently associated with better adherence. Cognitive interventions that are combined with behavioural or psychological strategies are more effective in improving adherence, especially in patients who previously were less adherent. These include interventions that improve self-efficacy, provide stress management/expressive support therapy or motivational interviewing. As yet there is no evidence for the role of affective interventions and modified DOT to improve adherence to ART. When designing interventions to address adherence, it should be borne in mind that multi-component interventions are more effective than single-focus interventions. A combination of educational, behavioural and affective components is suggested to ensure optimum adherence. In countries with a high prevalence of HIV, such as South Africa, careful patient preparation, rather than selecting patients based on non-clinical predictors of adherence, seems an appropriate method for scaling up ART. South African guidelines focus on comprehensive adherence support to all patients, with additional support to patients with less than 80% adherence. More research on the effectiveness of interventions aimed at improving adherence is urgently needed, especially in developing countries. For full text, click here: South African Family Practice Vol. 48(9) 2006:6-1

The evolution of gout (an old lifestyle disease)

Background: Few diseases that confront the 21st century clinician have documented history which dates back to early human era.Methods: We reviewed how the understanding of the aetiogenesis, symptomatology, diagnosis and treatment of gout including myths have evolved and discussed the implications thereof. Results: Gout has been recognized as a clinical entity before 2000BC with Hippocrates describing the five aphorism of gout. Between the 1st and the 6th century AD, the role of genetics and the association of gout with an indulgent lifestyle and tophi were described. Hemodactyl (a source of colchicines) was also first identified during this period. “Gout” was coined from the Latin word “Gutta” in the 13th century and the microscopy of uric acid crystals and gout symptomatology were the focus of investigations between the 17th and 18th centuries. Several drug treatments were developed between the 19th and 20th centuries including salicylates, probenecid and allopurinol. Gout as a risk factor for metabolic syndrome,NIDDM and cardiovascular disease is a challenge for the 20th century and the future. Conclusion: The understanding of gout has evolved with human development but the challenges for the future will include how to deal with the associated cardiovascular co-morbidities

Why Do Patients Choose to Consult Homeopaths?

Background: Patients are using homeopathy in increasing numbers and not telling their doctors about it. It is important as family physicians that we understand the reasons why patients choose to consult homeopaths. It is important to know what our patients are looking for that they do not find in Western medicine. This information will provide valuable insights and enable us to engage with our patients in an informed and empathetic way such engagement being vital to maintaining an open relationship and providing the best possible care and advice. Methods: The aim of this study was to understand the reasons why patients choose to consult homeopaths. Eight free-attitude interviews were conducted with purposefully selected patients who consulted a particular homeopath in Gauteng province. The exploratory question was ‘Why do you choose to consult a homeopath?'. The interviews were all conducted in English, transcribed verbatim, and analysed for categories and themes using the ‘cut and paste' method. Member checks were done by verifying the transcribed data with the interviewees by e-mail. Triangulation of the data was done by audio-recording of the interviews, and using transcribed notes and field notes collected during the interviews. Results: All the participants initially consulted a homeopath after their health problems were not solved by mainstream medical treatment. Most were also concerned about the side effects of long-term mainstream medication. Many were frustrated with main-stream consultation or relationship factors, including rushed consultations, being asked too few questions and doctors being too quick to prescribe. Some participants said that doctors had a poor bedside manner, were difficult to talk to, and were judgemental or uncaring. The participants continued to consult homeopaths because they felt that the treatment was effective, natural and did not have side effects. They indicated that homeopathic treatment works with the body and health problems therefore are solved in the long term. This makes homeopathic treatment cheaper, because the same problem does not need to be treated repeatedly. Homeopathic con- sultations were longer, and homeopaths were easier to talk to and formed an equal partnership with them. In addition, problems were managed holistically mind, emotions and body, as well as work and family factors were considered. Homeopaths were considered competent and ethical and knew their limitations. Conclusion: From the reasons given for consulting homeopaths, we, as family physicians, can learn a lot about what patients con- sider important in their consultations and management. Frustration with some aspect of mainstream care has pushed them to look for solutions elsewhere Much of what the patients did not find with doctors but found with homeopaths can be found in the principles of family medicine. It will be important to validate the findings of this study by developing a hypothesis that can be tested using a quantitative paradigm. South African Family Practice Vol. 50 (3) 2008: pp. 69-69

XDR TB in South Africa - What lies ahead?

The emergence of XDR TB coupled with the high prevalence of HIV/AIDS has intensified the need to identify new treatment strategies and accelerate research into antibiotics against XDR TB before the world is faced with a global public health crisis. This article gives a short overview on the important health implications of XDR-TB in South Africa.South African Family Practice Vol. 48 (10) 2006: pp. 58-5

Management issues in hypertensive diabetics

This article discusses seven issues in the management of hypertension in diabetic patients, namely the importance of blood pressure control, optimal blood pressure control levels, the importance of blocking the renin-angiotensin system, the inevi-tability of combination anti-hypertensive therapy, drug choices, the diabetogenic effects of high dose thiazide diuretics and beta-blockers and the importance of treating other risk factors, like dyslipidaemia.South African Family Practice Vol. 48 (10) 2006: pp. 38-4