Case fatality of patients with stroke over a 12-month period post stroke

Introduction. Stroke is among the top 4 causes of death in SouthAfrica and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital.Methods. A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature.Results. Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died.Conclusion. The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores

The outcome of Mental Health Care Users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002)

Objective: To determine the outcomes of mental health care users (MHCU’s) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes. Method: The study was a retrospective record review of MHCU’s, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22’s during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records. Results: During the six-month study period, 718 MHCU’s were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU’s and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU’s diagnosed with delirium were more likely to be admitted intoa medical ward as compared to a psychiatric ward. Conclusion: As has been the case in most countries where police services have been incorporated into mental health acts, South Africa’s new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU’s end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have thecapacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU’s presenting with such factors to appropriate treatment facilities without admitting them to the hospital.Keywords: Mental Health Care Act; Outcome; Police services; Mental illness, South Afric

Common lower extremity injuries in female high school soccer players in Johannesburg east district

Objectives. Soccer is one of the sports in South Africa which hasseen an increase in the participation of youth and adult female players. The aim of this study was to determine point and 1-year prevalence, profile of injuries that affect female soccer players, associations between injuries and player position, age, use of equipment, frequency of play, and training duration. Methods. A retrospective questionnaire-based descriptive survey of 103 first team high school female soccer players in the Johannesburg east district was conducted.Results. The 1-year prevalence for the participants who reportedinjuries was 46% (N=47) and the point prevalence was 33% (N=34). From these, a total of 78 and 42 injuries for the 1-year and point prevalence respectively were reported. An extended duration of skills (p=0.0001) and fitness (p=0.02) training in this population reduced the likelihood of incurring an injury. The older the participants, the more chance there was of sustaining injuries (p=0.01). The participants who wore shin guards were less prone to shin/leg injuries (p=0.01), the relative odds being 0.35. Themidfielders had more foot and toe injuries than the other players(p=0.05). Starting age (p=0.78), frequency of play (p=0.83), wearing of shoes (p=0.54) and stretching had no influence on injury. The knee and ankle were the main locations of injury, with defenders and midfielders mostly being injured. Conclusion. A decrease in the duration of training for both skills and fitness and not wearing shin guards are risk factors for injury in female soccer players in high school. The profile of injuries andthe risk factors determined from this study do not differ from the studies done in male adolescent and adult soccer players

Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.

Introduction: In low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care. Methods: A pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys. Results: There was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space. Conclusion: LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics. Trial registration number: ISRCTN12128227.The Nkateko study was funded by the UK Medical Research Council under the Global Alliance for Chronic Diseases (GACD) Programme