Fc Van Rooyen

Non-compliance with treatment by epileptic patients at George Provincial Hospital

Abstract Background Non-compliance with anti-epileptic drug treatment in the George area, resulting in recurrent seizures and visits to the emergency department of the George Provincial Hospital, has been identified as a social and economic problem. The aim of this study was to determine the socio-economic and medical factors, the information given to patients by healthcare workers, and the understanding of patients living with epilepsy who presented to the emergency department with seizures. Methods A descriptive study design was employed and the data-collection tools were a questionnaire and structured interview. Results The median age of the study population was 32 years. The patients had suffered from epilepsy for a median of two years and visited a clinic for a median of seven times a year. The median education level was primary school and three quarters had no employment or government grant. The majority did not understand the disease, the side effects of the medication and why they should be on medication. In addition, it became apparent from patient reports that healthcare workers showed a lack of counselling skills, time and appropriate knowledge. Conclusions There is a general lack of understanding of epilepsy by the patient. Not only were the patients uninformed, but they also showed apathy towards the management of their condition.

A risk-factor profile for chronic lifestyle diseases in three rural Free State towns

Abstract Background: Chronic diseases of lifestyle account for millions of deaths each year globally. These diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity, hyperlipidaemia and physical inactivity. In South Africa the burden of noncommunicable disease risk factors is high. To reduce or control as many lifestyle risk factors as possible in a population, the distinct risk-factor profile for that specific community must be identified. Therefore, the aim of this study was to assess the health status in three rural Free State communities and to identify a distinct risk-factor profile for chronic lifestyle diseases in these communities. Methods: This study forms part of the baseline phase of the Assuring Health for All in the Free State project, which is a prospective and longitudinal epidemiological study aimed at determining how living in a rural area can either protect or predispose one to developing chronic lifestyle diseases. The communities of three black and coloured, rural Free State areas, namely Trompsburg, Philippolis and Springfontein, were evaluated. The study population consisted of 499 households, and 658 individuals (including children) participated in the study. Only results of adult participants between 25 and 64 years will be reported in this article. The study group consisted of 29.4% male and 70.6% female participants, with a mean age of 49 years. During interviews with trained researchers, household socio-demographic questionnaires, as well as individual questionnaires evaluating diet, risk factors (history of hypertension and/or diabetes) and habits (tobacco smoking and physical activity levels), were completed. All participants underwent anthropometric evaluation, medical examination and blood sampling to determine fasting blood glucose levels. Results: Multiple risk factors for noncommunicable diseases were identified in this study population, including high blood pressure, tobacco smoking, high body mass index (BMI), diabetes and physical inactivity. The reported risk-factor profile was ranked. Increased waist circumference was ranked highest, high blood pressure second, tobacco smoking third, physical inactivity fourth and diabetes fifth. The cumulative risk-factor profile revealed that 35.6 and 21% of this study population had two and three risk factors, respectively. Conclusions: The study demonstrated a high prevalence of risk factors for noncommunicable diseases, e.g. large waist circumference, high BMI, raised blood pressure, tobacco smoking and raised blood glucose levels. Serious consideration should be given to this escalating burden of lifestyle diseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improve the general health and reduce the risk for noncommunicable diseases in this population are advised.

Guidelines prescribed by general practitioners to patients with acute low back pain regarding “return to work”

Abstract Background The traditional treatment protocol for acute low back pain (ALBP) primarily used by healthcare professionals has in the past decade been strict bed rest, corsets, traction and ‘back schools’. However, current research has led to dramatic changes in the traditional treatment protocol. The literature suggests that the protocol should be replaced by parsimonious imaging, early return to normal activities and greater emphasis on exercise to prevent recurrences of ALBP and to treat chronic pain. The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding ‘return to work’. Methods A systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete questionnaires. The highest qualifications of the GPs were MBChB or MFamMed, and all of them practise in the Bloemfontein area. Results Sixty-three respondents stated that 40% of ALBP patients returned for follow-up consultations. Of the 63 respondents, eight GPs had not consulted ALBP patients in the preceding two years, and thus were excluded from the final number of respondents. Bed rest is still prescribed by 67.27% of GPs and, although 47.27% of the GPs were aware of the change in protocol, only 9% prescribe ‘return to work’. A total of 18.18% are aware of evidence-based guidelines and 10% of the GPs prescribe these. Among the guidelines defined by the GPs are lifestyle changes, rest and stabilisation. Only 18.18% of ALBP patients are referred to occupational therapy for treatment. Conclusion Only 47.27% of the GPs knew about the new ALBP protocol, and even fewer had any knowledge of the content of the new protocol. Also, the guidelines prescribed by the GPs concerning ‘return to work’ were indefinite. The researchers hypothesised that the reasons for this were a lack of awareness of the change in the acute low back pain protocol suggested by the Agency for Healthcare Research and Quality, as well as a lack of knowledge of the evidence-based guidelines suggested for their profession.

Injuries in children and adolescents seen during 2006 at the emergency department of the National District Hospital, Bloemfontein

Abstract Background: Most children and adolescents recover fully from injuries. However, permanent disabilities may occur. The objective of the study was to investigate the prevalence and profile of injuries in children and adolescents five to 19 years of age seen at the emergency department of the National District Hospital in Bloemfontein. Methods: A retrospective descriptive study was conducted. Demographic and injury-specific information obtained from hospital records of 2006 was entered into a data-capturing form. Data were analysed by using descriptive statistics. Results: The prevalence of injuries in this age group was 20.3%. Two hundred and nine records were investigated. The majority of cases were male (68.3%). The median age was 15 years, and 43.5% of injuries occurred in the age group 15 to 19 years. Approximately half (51.7%) were Afrikaans-speaking and resided in suburban areas (50%). Most injuries occurred at home (40.2%) between 12h00 and 17h00 (38.7%). Falls (33.7%) were the most common cause of injury. Soft tissue injuries (35.9%) occurred most commonly, fol lowed by lacerations (33.0%) and fractures (16.7%). Upper limb injuries (42.1%) were seen more than lower limb injuries (27.8%). Facial injuries occurred in 12% of cases. X-rays were performed in 57.9% of cases. Most patients (93.3%) received medication, while 22% were referred for specialist treatment. All cases except one were discharged from the emergency department. Parents accompanied patients in 65.6% of cases. Conclusions: Optimal treatment should be given to the injured child or adolescent to avoid possible long-term injury-related sequelae. Preventive strategies should be formulated, enforced and evaluated.

The impact of a nutrition education programme on feeding practices of caregivers with children aged 3 to 5 years in rural Limpopo Province, South Africa

Objective: To determine the impact of nutrition education on feeding practices of caregivers with children aged 3 to 5 years at baseline and post intervention. Methodology: A pre-test–post-test control group design was chosen using eight villages (four villages in the experimental group (E) and four villages in the control group (C)). The nutrition education intervention programme (NEIP) comprised ten topics emphasising healthy eating, hygiene and sanitation. Results: Majority of children in both the experimental and control groups were given three meals or more per day, including starchy and protein rich foods at baseline and post intervention. The median carbohydrates and protein intake in both groups was adequate when compared to the Estimated Average Requirements/Recommended Dietary Allowance (EAR/RDA), though median energy intake was inadequate. Even before intervention, the majority of children ate indigenous foods. Despite this, the intake of some indigenous foods did improve significantly in the experimental group, but not in the control group (termites; mopani worms; indigenous vegetables including black jack, spider flower and wild jute; and, indigenous fruits including baobab fruit and pawpaw). On the other hand, the intake of mixed traditional dishes as well as the intake of the indigenous foods, stinging nettle, meldar, wild peach, pineapple, dovhi, tshigume and thophi, increased significantly in both the experimental and control groups. Conclusion: Due to the fact that most children in both groups consumed most food items, including indigenous foods, before the intervention, improvements were only seen in a few feeding practices in the experimental group after the NEIP.

Clinical profile of patients diagnosed with primary lung cancer at the Pulmonology Division, Universitas Academic Hospital, Bloemfontein, 2010-2011

Lung cancer is regarded by the World Health Organization as a leading cause of death globally. Limited data are available on lung cancer epidemiology in South Africa. This study aimed to determine the profile of patients with lung cancer who were seen at a local pulmonology clinic. A retrospective audit was conducted on patients ≥ 18 years of age who were diagnosed with primary lung cancer at the Universitas Academic Hospital (Pulmonology Division) between 1 January 2010 and 31 December 2011. Information was collected with regard to demographic variables, smoking status, performance status, histological subtype and stage of disease. Ninety-two patients’ records were included in the study. The median age was 61.2 years (a range of 44-86 years). 57.6% of patients were black, 33.7% white and 8.7% coloured. The male to female ratio was 3:1. The largest group of patients was black men (46.7%). Most patients were current or previous smokers. 45.2% of white patients had a history of ≥ 30 smoking pack years (one pack year of smoking was defined as 20 cigarettes smoked every day for a year), compared to 26.4% of black and 37.5% of coloured patients. Squamous cell carcinoma (SCC) and adenocarcinoma were diagnosed in 34.8% and 32.6% of patients, respectively. Adenocarcinoma occurred more commonly in white patients (38.7%), while SCC was diagnosed more frequently in black patients (34%). The majority of patients presented with advanced stage of disease. Thorough recordkeeping on the epidemiology of lung cancer in South Africa is necessary to enable the planning and implementation of a national strategy with regard to treatment options and prevention.

The prevalence of the diagnosis of increased intra-ocular pressure in a general practice

Glaucoma is one of the main causes of blindness. The disease occurs in 3% to 4% of all people over the age of 70 years. As many as 50% of patients suffering from this disease are unaware of their condition until a comparatively late stage, due to the asymptomatic nature of the disease.