Multicultural encounters at an academic institution

Master's thesis in global studies. School of Mission and Theology, May 201

Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward

Objectives: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward – within a general hospital, Helen Joseph Hospital (HJH). Method: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using “Generalized Linear Latent and Mixed Models” (GLLAMM). Results: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (

The effect of supplementing cereal straws with urea, trifolium hay and noug meal on feed intake and liveweight gain of growing crossbred heifers

Compares the effects of noug meal, Trifolium tembense hay and urea, fed in different combinations as supplements to wheat or teff straws, on feed intake and growth rate of crossbred heifers

Post traumatic stress disorder and resilience in veterans who served in the South African border war

Objective: The psychological impact of the South African border war on veterans has received little or no attention. This study determined the prevalence of post-traumatic stress disorder (PTSD), and extent of resilience among a cohort of veterans.Method: Of 1527 former students who matriculated from a Johannesburg high school from 1975 to 1988, only 109 were reachable for convenience and snowballing recruitment into this study. An anonymous, internet-based questionnaire was used to obtain information on demography, combat exposure, drug and alcohol use, traumatic events in later life, and recourse to medication and counselling. The Impact of Event Scale – Revised (IES-R) assessed for PTSD and the Connor Davidson Resilience Scale (CDRISC) measured resilience. Data were processed with STATA; version 11 statistical software package. Analysis included Chi square test and regression analysis.Results: The response rate was 49.5% (n=54). The prevalence of PTSD was 33% and significantly associated with combat exposure (p=.012). Despite high prevalence of PTSD in those exposed to combat, 94% showed normal to above-normal level of resilience. CD-RISC scores showed no association with the IES-R. Only current cannabis use was significantly linked with PTSD (p=.044).Conclusion: Although the prevalence of PTSD found in this sample was higher than in comparable international studies, this cohort of former SA national servicemen, showed high levels of resilience. The current use of cannabis within the context of prior exposure to military national service or combat should prompt clinicians to screen for the presence of PTSD-associated symptoms.Keywords: Combat Exposure; Post-traumatic Stress Disorder; National Service; Border War; South AfricaAfrican Journal of Psychiatry • November 2013, 16(6

The impact of highly active antiretroviral therapy on the burden of bacterial lower respiratory tract infections in children

Background. Respiratory diseases are common and associated with significant morbidity and mortality in children.Objective. To evaluate the prevalence and outcome of bacterial lower respiratory tract infections (LRTIs) in HIV-infected and uninfected children at a primary level hospital.Methods. A cross-sectional descriptive study of children aged 6 months - 18 years was conducted. Recruitment included HIV-positive children who had been on highly active antiretroviral therapy (HAART) for at least 6 months. A comparator group of HIV-negative children admitted with bacterial pneumonia was included. Laboratory data collected included CD4+ T-cell counts, HIV viral load and C-reactive protein (CRP). Data collected in both groups included demographic data, immunisation status, zinc supplementation, previous LRTIs, environmental exposures and treatment.Results. Fifty-nine HIV-infected and 20 uninfected children were enrolled. The HIV-positive children were older, with a mean age of 107.2 (standard deviation 50.0) months v. 12.0 (5.8) months (p<0.005). The HIV-infected group had a mean CD4 percentage of 31.5%, and had had an average of 3.9 visits for bacterial LRTIs. All were treated with amoxicillin with no complications. In the HIV-uninfected group, cough and rapid breathing were the most common presenting symptoms, and the mean CRP level was 463.0 mg/L. The mean hospital stay was 4 days.Conclusion. HAART is effective in reducing the burden of LRTIs in HIV-positive children, even when the diagnosis is delayed. Cough and fast breathing are still the most reliable presenting symptoms of pneumonia. The majority of children still respond to amoxicillin as first-line therapy, with low complication rates

Comparison of HTLV-associated myelopathy (HAM) in HIV-positive and HIV-negative patients at a tertiary South African hospital

Background. HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM.Aim. We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM.Methods. Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed.Results. 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients.Conclusion. Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common

HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS

Objective. As sub-Saharan Africa is highly endemic for hepatitis Bvirus (HBV) and human immunodeficiency virus (HIV) infections,and their co-infection requires special management, we aimedto assess the serological and molecular characteristics of HBV inpatients with AIDS.Design. This was a cross-sectional, case control study, whichenrolled 200 patients with AIDS and 200 HIV-negative controls.HBV serology was done in all participants and HCV serologyin participants with a hepatitis B core antibody (anti-HBc) onlyserological pattern. Nested HBV polymerase chain reaction (PCR)and HBV viral load assays were used for HBV molecular detection.Results. Hepatitis B surface antigen (HBsAg) prevalence was3-fold higher while the ‘anti-HBc only’ pattern was 6-fold higher inthe AIDS group compared with the controls. Mean HBV viral loadwas significantly higher in HBsAg-positive patients with CD4+cell counts <100 cells/ìl than in patients with CD4+ cell counts of100-200 cells/ìl (p=0.019). There were markedly reduced hepatitisB surface antibody (anti-HBs) titres in the AIDS group comparedwith the controls (p=0.002). A significant proportion of AIDSpatients with an ‘anti-HBc only’ pattern had CD4+ cell counts <100cells/ìl (p=0.004). Occult HBV prevalence was 3.5% in the AIDSgroup compared with 1% in the controls (p=0.092). When occultHBV infection was taken into consideration, the overall HBVprevalence became 10% in the AIDS group and 3% in the controlgroup.Conclusion. We showed an increased HBV prevalence in patientswith AIDS and identified a CD4+ cell count <100 cells/ìl as amajor risk factor for the ‘anti-HBc only’ pattern and increasedHBV replication. These data have significant public healthimplications for HBV in developing countries, especially in areaswhere antiretroviral (ARV) guidelines do not cater for HBV/HIVco-infection

Audit of antenatal care at a community health centre in Tshwane North subdistrict, Gauteng province

Objective: Few studies document the level of compliance with antenatal care protocols in primary health care in South Africa. The aim of this study was to conduct an audit of antenatal care at a community health centre in Tshwane North subdistrict in order to measure the level of compliance of maternity staff with antenatal care protocols. This study was part of a larger study on a quality improvement initiative in primary health care.Design and setting: A retrospective cross-sectional descriptive study was undertaken of women attending antenatal care at the study clinic. Data were collected through a review of the women’s antenatal cards using criteria from the Guidelines for maternity care in South Africa and the basic antenatal care (BANC) checklist. In addition, qualitative interviews of maternity staff were undertaken in order to investigate reasons for  noncompliance with the maternity care guidelines.Results: The overall rate of compliance of nurses was 85.1%. This is less than optimal. The response (decision-making and interpretation)  component of compliance was only 57.6%. This represents a significant missed opportunity in terms of quality of antenatal care. Important  protocols, such as that pertaining to the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus, were also not carried out correctly. The response to PMTCT protocols was 50% only, another significant opportunity missed. Administrative factors, patient-related factors and deficiencies in the knowledge and skills of nurses were identified and documented as reasons for noncompliance.Conclusion: The study has provided a detailed picture of the situation with regard to non-compliance with the maternity care guidelines in a primary health care facility. Therefore, these data are very important in terms of quality assurance of maternity services in primary health care

Factors related to hospital readmissions in people with spinal cord injury in South Africa

Background. People with spinal cord injury (PWSCI) face various challenges after being discharged from rehabilitation that can result in readmission to hospital. Little is known about readmission of PWSCI in South Africa (SA). Readmission is costly, interrupts community involvement and negatively affects quality of life.Objectives. To investigate readmission rates within 5 years of rehabilitation, causes of readmission and factors related to readmission in PWSCI in Pretoria, SA.Methods. We quantitatively analysed retrospective data gathered from files of patients admitted to a private rehabilitation facility in Pretoria between January 2008 and December 2012. Data were analysed using Stata 13 statistical software. Descriptive statistics were initially presented. Univariate logistic regression was used to identify individual factors that had significant association with the outcome measure (readmission). Thereafter, multivariate logistic regression was used to identify risk factors for readmission. The level of statistical significance was set at p<0.5.Results. Data from 543 patient files were analysed. In total, 100 patients (18%) were readmitted between January 2008 and December 2012. Twenty-eight of the 100 readmitted patients had a subsequent second readmission, 10 patients had a third readmission, and 2 patients were readmitted for a fourth time. The most common reason for readmission was secondary health conditions (SHCs) (80%), followed by further rehabilitation, including gait rehabilitation (12%). Eight patients (8%) had undocumented reasons for readmission. The common SHCs in the first readmission were pressure ulcers (39%), followed by urinary tract infections (12%), deteriorating neurological status (6%) and constipation (3%). Patients with paraplegia had 2.3 times greater odds of readmission compared with tetraplegics (p=0.000, 95% CI 1.47 - 3.55). Those in the category T1 - T6 level of injury had 2.6 times greater odds of readmission (p=0.04, 95% CI 1.04 - 6.71, while those with incomplete spinal cord injury had 2.5 times greater odds (p=0.001, 95% CI 1.44 - 4.46).Conclusions. Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention.Â

The success of various management techniques used in South African children with type 1 diabetes mellitus

Background. Despite the availability of international guidelines for the treatment of type 1 diabetes mellitus (T1DM) in children, important aspects of treatment are not accessible to all young patients in South Africa (SA). Objective. To investigate factors in diabetes management strategies that are associated with poor glycaemic control and decreased quality of life (QoL) in SA children with T1DM. Methods. Eighty children (mean (standard deviation) age 12.9 (2.7) years) with T1DM were asked to answer standardised questionnaires on demographics, management techniques used and perceptions of diabetes. The height and weight of each child was recorded and glycosylated haemoglobin (HbA1c) measured. Informed consent and assent for each participant was obtained before enrolment. Results. A total of 51.4% of the participants had poor metabolic control, with an HbA1c level >10.0% (86 mmol/mol). Factors in clinical practice found to have a significant association with decreased HbA1c and/or QoL were healthcare system (p<0.001), insulin administration (p=0.001), correction dose (p=0.002), carbohydrate counting (p<0.001) and number of severe hyperglycaemic events (p=0.048). Regular exercise did not show any association with HbA1c classification or QoL. Children from single-parent households were prone to unsuccessful diabetes management regardless of treatment techniques used (p=0.002). Conclusions. The use of premixed insulin without access to rapid-acting insulin, absence of correction doses for hyperglycaemia and lack of carbohydrate counting showed significant association with poor diabetes management. Some recommendations regarding the adoption of more effective diabetes management strategies in the public healthcare system are suggested.http://www.samj.org.zaam201