Jacques Raubenheimer

Food insecurity among students at the University of the Free State, South Africa

Abstract Objective: The objective of this study was to investigate food insecurity in students in a developing country with high national food insecurity. Design: This was a cross-sectional survey. Subjects and setting: Registered students at the University of the Free State were invited to participate. Thirty-one thousand and fourteen students were enrolled in 2013. One thousand, four hundred and sixteen students completed a self-administered web-based questionnaire. Outcome measures: Food insecurity was assessed using a one-item measure, i.e. the Australian National Nutrition Survey, and a 10-item measure, i.e. the United States Department of Agriculture Community Food Security Assessment Toolkit. Associations of food insecurity with biographical attributes, food procurement measures and coping strategies were determined using the chi-square test and multivariate logistic regression analysis. Results: The prevalence of food insecurity according to the one-item measure was 65%. Using the 10-item measure, 60% of the students experienced food insecurity “with hunger”, and 26% food insecurity “without hunger”. The highest prevalence of food insecurity was in black and coloured, undergraduate, first-generation and male students, as well as in students who were unmarried, unemployed and those relying on loans or bursaries. Using the regression model, the strongest significant predictors of food insecurity were race, gender, being a first-generation student, not having enough food money, having borrowed food money from parents, having asked for food and having sold belongings to obtain food. Conclusion: Severe food insecurity in students may be contributing to the high attrition rates experienced by universities in South Africa. Urgent intervention is required, as not having access to enough nutritionally adequate and safe food could be one of the reasons why more than 50% of South African university students never graduate.

The effectiveness of the implementation of the Cape Triage Score at the emergency department of the National District Hospital, Bloemfontein

Background: The need for an appropriate South African triage system led to the development of the Cape Triage Score (CTS), a system to prioritise emergency departments’ workloads. This study evaluated the effectiveness of the CTS at the National District Hospital emergency department, Bloemfontein. Methods: In this retrospective, descriptive, observational study, files of adult patients triaged at the emergency department during February 2013 were randomly selected. Inclusion was subject to the availability of the files. Physiological parameter results were used to calculate the Triage Early Warning Score (TEWS). The side-room investigations and South African Triage Score (SATS) were recorded. Other information gathered included diagnosis, outcome, and times the patient was triaged and seen by the doctor. Results: A total of 396 files were included in the study. Patients, of whom 57.8% were women, were between the ages of 16–89 years. More than half (52%) of side-room investigations were omitted or inappropriate. The adjustment of the TEWS to the SATS was done incorrectly in 52% of cases. The majority of patients (69.9%) were discharged home after treatment, although 88% were SATS orange coded. Over-triage occurred in 8.1% of TEWS and 67.8% of SATS cases. The mean waiting time from triage until patient was seen by the doctor was 2 hours. Conclusions: The TEWS proved to predict outcome better than the SATS. Due to inaccurate triage, only 8% of patients were seen within the recommended waiting times. The CTS has not been effectively implemented at the National District Hospital emergency department.

The long-term effects of training interventions on transfusion practice: A follow-up audit of red cell concentrate utilisation at Kimberley Hospital, South Africa

This audit in chronically anaemic adult patients assesses whether red cell concentrate is transfused according to guidelines, and evaluates the impact of training interventions, compared with a similar audit conducted in 2010. Retrospectively, 25 transfusion episodes were audited for appropriateness, the investigation of anaemia, threshold achievement, wastage, and informed consent. After training interventions, a further 25 episodes were prospectively analysed. The effects of current training interventions were not shown to have a statistically significant impact. Compared to a 2010 audit, however, a statistically significant improvement was demonstrated in transfusion practice, suggesting that training interventions may lead to sustainable long-term improvements.

A scoring framework for assessing anatomy competence of undergraduate preclinical students

Recent higher education changes toward outcomes‐based education emphasize competent learners, but a widely accepted definition of competence is still lacking. Although the importance of anatomy in health professions education is recognized, there is still uncertainty about what anatomical competence entails and how to assess it. This study aimed to provide a framework for assessing anatomical competence, using an anatomy competence score, for the anatomy course in the undergraduate medical learning program at the University of the Free State in South Africa. All assessments within the dissection program of two student groups (July 2012 to June 2014) were explored to determine the representation of the three competence domains: knowledge, skill and application in context. Student performance in the final objective structured practical examination (OSPE) was investigated for the three domains and the different body regions. Knowledge had ±50% representation in assessments and the different body regions (in final OSPE) for both groups, and skill and application represented ±25% each in both groups. The best average student performance was in the skill domain (64% and 67% for the respective groups). All domains showed good reliabilities (> 0.75) and student performance correlated well between the domains (P < 0.001). This study suggests a representation ratio of 2:1:1 between knowledge, skill and application (i.e., 50% knowledge and 25% skill and application respectively), for anatomical competence assessment. However, this ratio depends on the assessment type, the stage of the anatomy course and the institutional context. Nonetheless, it provides a guideline for ensuring that assessments address all competence domains. Anat Sci Educ 9: 319–329.

Body mass index of 16-year olds in urban Maseru, Lesotho.

Background Overweight and/or obesity amongst children and adolescents is a global epidemic with health consequences that track into adulthood. No data are currently available regarding overweight/obesity amongst adolescents in Lesotho. Aim and setting To assess the prevalence of overweight and/or obesity and the associated risk factors amongst 16-year olds in urban Maseru, Lesotho. Method A cross-sectional descriptive study was conducted on a systematic sample of 16-year olds in grade four (N = 221; 56.6% girls) from randomly-selected schools in urban Maseru. Diet histories and data on lifestyle, physical activity and knowledge, attitudes and/or perceptions and practices regarding nutrition were obtained during structured interviews and body mass index (BMI) was determined. Results Amongst these 16-year olds, 27.2% girls and 8.3% boys were overweight and/or obese based on World Health Organization cut-offs for BMI; 39.8% were insufficiently active or inactive; 6.4% used alcohol regularly; and 11.7% used tobacco. Whilst 28.1% reported no television watching/electronic gaming/computer usage (combined screen time) outside school, 23.6% reported ≥ 4 hours of combined screen time outside school. Most (91.4%) consumed < 3 servings of vegetables/day; 86.4% consumed < 2 servings of fruits/day; and 95.5% consumed < 2 servings of dairy/day. The majority consumed maize porridge (56.1%), bread (63.8%) and margarine/oil/fat (82.3%) daily and added sugar to their food (74.2%). Fruits, vegetables, dairy, meat, pulses and traditional foods were only consumed weekly or less often. Most bought from tuck shops (18.6% daily; 54.3% weekly). Various gaps in knowledge, perceptions and practices were identified that may benefit from educational intervention. Conclusions The current study identifies westernised dietary and lifestyle changes, along with overweight and/or obesity, amongst 16-year old adolescents in Lesotho.

Performance evaluation of the microINR® point-of-care INR-testing system

Point‐of‐care International Normalised Ratio (INR) testing is used frequently. We evaluated the microINR® POC system for accuracy, precision and measurement repeatability, and investigated instrument and test chip variability and error rates.

Levels of burnout among registrars and medical officers working at Bloemfontein public healthcare facilities in 2013

Background: Burnout is prevalent among medical personnel and affects their work environment. This study investigated the level of burnout among registrars and medical officers at public healthcare facilities in Bloemfontein. Methods: An analytical cross-sectional study included registrars and medical officers at four public healthcare facilities in Bloemfontein. Socio-demographic information was collected and participants completed the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalisation and personal accomplishment. Results: Of the 300 potential participants, 205 were included in the result. Only 3.4% of the participants showed no burnout on all three subscales and 28.3% had only low to moderate levels of burnout on all three subscales. A quarter (26.3%) of the participants showed high burnout on one subscale, but not the others. Furthermore, 26.3% showed a high level of burnout on any combination of two of the three subscales. A high degree of burnout on all three subscales was found in 15.6% of the participants. Conclusion: Burnout is a major problem among registrars and medical officers working in public hospitals in Bloemfontein. An action plan needs to be put in place in partnership with the Departments of Health and Higher Education to prevent burnout among an important working cadre.

Beliefs about medication, medication adherence and seizure control among adult epilepsy patients in Kimberley, South Africa

Background: Patients with epilepsy regularly present to the Kimberley Hospital Complex’s emergency department and are managed and discharged but within a short period present again to casualty with seizures. This study aimed to explore whether beliefs about medication have any relationship with treatment adherence and seizure control among adult patients with epilepsy attending the hospital and clinics in Kimberley. Methods: In this descriptive observational study, participants included patients presenting to casualty with seizures, and epileptic patients collecting their antiepileptic drugs. Participants completed a questionnaire that included the Morisky eight-item medication adherence scale and Belief about Medication Questionnaire. Results: The majority of the 197 participants were male (61.9%), unemployed (84.3%), and reporting two or more seizures annually (67.0%). The age range was between 19 and 68 years (mean age 40 years). High adherence was reported by 107 (54.6%) participants. The relationship between adherence and seizure control was not statistically significant. There was a statistically significant correlation between medication concerns and harm, and adherence but no correlation between medication overuse and adherence. Conclusion: Patients’ beliefs about medications can influence their adherence; beliefs about medication did not influence the control of the patient’s seizures. Patients’ medication adherence did influence the seizure control in this sample.

Does forgiveness mediate the impact of school bullying on adolescent mental health

Objective The link between both bullying and victimisation and psychopathology has been well established. Forgiveness has been associated with better mental health. However, few studies have examined the relationship between adolescent forgiveness, psychopathology and bullying/ victimisation. This study investigated forgiveness as a mediator of the adverse mental health problems experienced by bullies and victims of bullying. Method Participants were 355 Year 10 or Year 11 pupils (age = 14.9 years) from two British secondary schools in 2007, who completed self-administered measures on bullying and victimisation, mental health, forgiveness of self and others, and forgivingness. The mediating influence of forgiveness on the impact of bullying/victimisation on mental health was tested with a structural equation model. Results Data from 55.6% of the 639 eligible pupils were analysed. Results confirmed an association between bullying/victimisation, forgiveness and psychopathology. Forgiveness scores were found to play a mediating role between bullying/victimisation and psychopathology. Conclusions Victimised adolescents who were better able to forgive themselves were more likely to report lower levels of psychopathology, while bullying adolescents who were unable to forgive others were more likely to report higher levels of psychopathology. This suggests a greater role for forgiveness within future research, intervention and policy on bullying. Forgiveness can form a valuable part of preventative and educational anti-bullying programmes.

Diabetes-related knowledge, attitude and practices (KAP) of adult patients with type 2 diabetes mellitus in the Free State province, South Africa

Introduction: Type 2 diabetes mellitus (T2DM) is a global health problem with high morbidity and mortality in patients who are mostly still economically active. The growing incidence and health implications for those affected make T2DM a major public health issue. Objectives: To compile a demographic, anthropometric and knowledge, attitude and practices (KAP) profile of adult patients with T2DM in the public health sector of the Free State province, South Africa. Design: A descriptive observational study was conducted. Setting: A total of 255 participants attending public health facilities in the Free State were interviewed. Outcome Measures: Questionnaires were completed in an interview to determine demographics and KAP. Anthropometric measurements were obtained by standard techniques. Results: The majority of the participants (n = 222; 87.1%) were black women from urban areas, who were overweight and obese. The median age at diagnosis was 48 years (range 15–80 years), and 25 participants (9.8%) lacked formal schooling. In 212 participants (83.1%), a waist circumference above cut-off points was observed. Only half of the participants knew the normal range for blood glucose. Approximately 80% felt that they would be a different person if they did not have diabetes. Although 96.1% of participants were knowledgeable about the benefits of physical exercise, only 31.0% reported exercising on a daily basis. A statistically significant association was found between knowledge and attitudes, indicating that better knowledge about diabetes could be associated with a more positive attitude towards diabetes. Conclusion: Poor knowledge, a negative attitude and poor practices related to diabetes were observed in a very high percentage of participants, which may contribute to morbidity and mortality. The fact that knowledge was associated with attitude indicates that interventions aimed at improving knowledge could benefit patients in more than one way. Interventions to equip patients to successfully manage their condition are urgently required.