Gboyega Ogunbanjo

Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences

BackgroundInternational medical electives are well-accepted in medical education, with the flow of students generally being North–South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North–South electives from the literature.MethodsIn-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way.ResultsThe residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal.ConclusionsThe learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere.Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.

The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

Background The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS) tool at the Mahalapye District Hospital - Emergency Department (MDH-ED), a setting where the majority of the nurses were not formally trained on the use of the SATS. Methods This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage. Results From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green), 146 (46%) and 125 (40%), respectively, or in the urgent category (yellow), they assigned 140 (44%) and 111 (35%) cases, respectively. Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5), although the level of agreement was satisfactory. Conclusion Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6).

Households’ satisfaction with the healthcare services rendered by a ward-based outreach team in Tshwane district, Pretoria, South Africa

Introduction: Households’ satisfaction is an important and commonly used indicator for measuring quality in health care. An amelioration of primary health care services at the level of households, by utilising community health workers, has led to a good healthcare system in many countries, such as Brazil. In South Africa, little is known about the satisfaction of households (HH) regarding the healthcare services they receive from ward-based outreach teams (WBOTs). A study was undertaken to determine this phenomenon. Methods: The study used a cross-sectional study design. Tshwane district had established 39 ward-based outreach teams at the time of the study and households were conveniently selected. Hence the study population was estimated to be 3 600. Using 99% confidence level and 5% confidence interval, the sample size was 660, and oversampled to 765 since all households present during the data collection were willing to be included in the survey. Data collected was captured on Microsoft Excel and analysed using SAS, version 9.2. Results: Interviews were held with members of the families, who were willing to participate. Participants’ ages ranged from 18 to 110, mean age 53.1years (SD = 19.7). The study participants included more females (74.0%), and 45.2% were single. The majority (89.8%) were unemployed. Overall satisfaction was seen in 692 participants (90.7%). Outcome of satisfaction according to sex (91.9%), age (90.7%) and employment (90.8%) was not statistically significant with p-value < 0.05. Conclusions: The findings of households’ satisfaction regarding the healthcare services rendered by the ward-based outreach team in Tshwane district, Pretoria, South Africa showed a high level of satisfaction from the households. This high level of satisfaction was referred to as excellent and was not associated with sex, age or employment status. A recommendation is made to all stakeholders that the ward-based outreach team programme cover all municipal wards in the country in order to raise the level of households’ satisfaction with the healthcare system.

Awareness of the Ward Based Outreach Team and the services offered by the programme in the Tshwane health district, South Africa

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on the principles of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households. Methods: The study assessed the awareness of the WBOT and the services offered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data were collected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers. Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, ‘Yes’ and ‘No’. A summary of the responses showed that the number of ‘yes’ responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) ‘yes’ responses and 698 (11.1%) ‘no’ responses. Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%.

Rationale and design of the comparison of three combination therapies in lowering blood pressure in Black Africans (CREOLE study): 2 X 3 factorial randomized single-blind multicentre trial

Background Current hypertension guidelines recommend the use of combination therapy as first‐line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)–lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue. Methods The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single‐blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub‐Saharan Africa (SSA). Seven hundred two patients aged 30‐79 years with a sitting systolic BP of 140 mm Hg and above, and less than 160 mm Hg on antihypertensive monotherapy, or sitting systolic BP of 150 mm Hg and above, and less than 180 mm Hg on no treatment, will be centrally randomized into any of the 3 arms (234 into each arm). The CREOLE study is taking place in 10 sites in SSA, and the primary outcome measure is change in ambulatory systolic BP from baseline to 6 months. The first patient was randomized in June 2017, and the trial will be concluded by 2019. Conclusions The CREOLE trial will provide unique information as to the most efficacious 2‐drug combination in blacks residing in SSA and thereby inform the development of clinical guidelines for the treatment of hypertension in this subregion.

Intimate partner violence: The need for an alternative primary preventive approach in Botswana

Intimate partner violence is a common social problem which causes considerable relationship stress and results in significant morbidity and mortality of the victims. Botswana, like many other countries in sub-Saharan Africa, has tried to address the problem of intimate partner violence with legislations prescribing punitive measures for the perpetrators and protection for the victims. The effectiveness of these measures in reducing the prevalence of intimate partner violence is doubtful. This article is to motivate for an alternative primary preventive approach to the problem as a more pragmatic option.

Corrigendum: The effectiveness of the South African Triage Tool use in Mahalapye District Hospital - Emergency Department, Botswana

No abstract available.

Knowledge of type 2 diabetic patients about their condition in Kimpese Hospital diabetic clinic, Democratic Republic of the Congo

Background Diabetes mellitus is a worldwide increasing health problem of which type 2 diabetes is the most prevalent. Previously considered as a problem of industrialised countries, diabetes is currently a huge concern in developing countries and the Democratic Republic of the Congo (DRC) is one of the sub-Saharan countries with a high prevalence rate of diabetes. Deficit of knowledge has already been shown to be one of the barriers preventing diabetic patients from controlling their disease. Objectives This study aimed to assess the knowledge of type 2 diabetic patients seen at the Institut Médical Evangélique (IME) Kimpese Hospital diabetic clinic, DRC, and the factors associated with their knowledge. Methods A cross-sectional study involving 184 respondents was conducted at the diabetic clinic of the IME Kimpese Hospital, DRC. We administered a pre-tested questionnaire. Out of a total of 10, scores of < 5, 5 to < 7, and ≥ 7 were classified as ‘poor knowledge’, ‘moderate knowledge’ and ‘good knowledge’, respectively, according to expert consensus. All statistical tests were performed using p < 0.05 as the level of statistical significance. Results The mean age of respondents was 57.5 years (s.d. ± 1.4, ranging from 40 to 83 years), with 56% being male. The mean diabetes knowledge score was poor: 3.2 out of a total of 10 (s.d. ± 1.7), with the range between 0.2 and 7.7. The majority of respondents (72.3%) had poor general knowledge about diabetes mellitus. Respondents also scored poorly in areas of the causes (35.6%), risk factors (39.3%), clinical features (34.9%), complications (20.5%) and management (42.4%) of diabetes mellitus. Using the student t-test analysis, it was found that age (p = 0.001), gender (p = 0.002), educational level (p = 0.007) and duration of disease (p = 0.032) were significantly associated with poor knowledge of diabetes mellitus. Conclusions Knowledge of diabetes mellitus among type 2 diabetic patients seen at our setting was poor. Areas of deficiency and factors associated with knowledge of diabetes were identified. Our findings suggest the need for a health education intervention programme for our diabetic patients.

Factors affecting the implementation of nurse-initiated antiretroviral treatment in primary health care clinics of Limpopo Province, South Africa

Introduction: The implementation of nurse-initiated antiretroviral (ARV) treatment at primary health care clinics was introduced in 2010 as a response to lower the HIV prevalence rate in the community. Aim: The aim of the study was to identify the factors affecting the implementation of nurse-initiated ARV treatment in primary health care clinics referring patients to Dr CN Phatudi Hospital, Limpopo Province. Methodology: A qualitative study was conducted in 2013 with a purposeful sample of nurses from 12 clinics involved in the nurse-initiated antiretroviral treatment (NIMART) programme. Two free-attitude focus groups and two individual interviews were conducted (audio- and video-recorded whilst the researcher took field notes). These interviews were transcribed verbatim and analysed using the colour-coding as well as cut-and-paste methods. Results: Common themes that emerged from the individual and focus-group interviews were: (1) lack of resources, which included health care workers, drugs, stationery, telephones, poor training and inadequate workspace; (2) factors affecting treatment adherence, such as stigma, poverty, poor roads and the restrictions on the ‘one pill’ regime; (3) support from management and the visiting doctor and (4) nurses’ work satisfaction. Conclusion: Two of the themes that emerged acted as barriers to the implementation of the NIMART programme, namely: (1) lack of resources and (2) factors affecting treatment adherence. The two other themes enhanced the implementation of the NIMART programme, namely: (1) support visits and (2) nurses’ work satisfaction.

Assessment of self-reported adherence among patients with type 2 diabetes in Matlala District Hospital, Limpopo Province

Introduction Complications associated with Diabetes Mellitus are a burden to health services, especially in resource poor settings. These complications are associated with substandard care and poor adherence to treatment plans. The aim of the study was to assess the self-reported adherence to treatment amongst patients with type 2 diabetes in Matlala District Hospital, Limpopo Province. Methods This cross-sectional study used convenience sampling with a standardised, validated questionnaire. Data were collected over 4 months, and Microsoft Excel was used for data capturing. Results We found that 137 (70%) of the participants considered themselves adherent to their diabetes medication. Younger age (p = 0.028), current employment (p = 0.018) and keeping appointment were factors significantly associated with adherence. Reasons given for poor adherence were that the clinic did not have their pills (29%), they had forgotten to take their medication (16%) and gone travelling without taking enough pills (14%). Reasons given for poor adherences to a healthy lifestyle were being too old (29%), 22% had no specific reason, 13% struggled to motivate themselves and 10% simply forgot what to do. Sixty-eight percent of the adhered participants recommended the use of medication at meal times, 14% set a reminder, and 8% used the assistance of a treatment supporter Conclusions and recommendations The study revealed a higher than expected reported level of adherence to diabetes treatment. Further research is needed to assess whether self-reported adherence corresponds to the metabolic control of the patients and to improve services.