Soornarain S. Naidoo

Sociodemographic characteristics of persons committing suicide in Durban, South Africa: 2006–2007

Abstract Background Suicidal behaviour is a leading contributor to the burden of disease worldwide and varies widely between countries. South African figures are amongst the highest in the world, with recent trends indicating a disturbing rise, especially amongst the younger age groups, across all races. Aim This study analysed sociodemographic characteristics and trends relating to suicides committed in Durban, South Africa during the period of 2006–2007. Method A retrospective analysis of suicidal deaths (during 2006–2007), extracted from autopsy registers at all three government-run mortuaries in Durban, was conducted. Results The total number of suicides in Durban increased by 6.68% from 2006 to 2007. Suicide accounted for an average of 8.8% of all non-natural deaths per year of the study. The overall suicide rates of 14.53 (2006) and 15.53 (2007) per 100 000 population are comparable with national and global figures. The majority of suicides occurred in single unemployed persons, men and younger age groups. The largest number of suicides per year was recorded in black people, followed by Indian, white and mixed-race people. Hanging was the preferred method in the majority of victims, followed by self-poisoning, shooting and jumping. Conclusions The findings indicate a disturbingly high suicide rate amongst the various population and age groups in Durban. The dominant methods used may be influenced by ease of access. The reported trends may worsen unless there is a swift and decisive public health response and cohesive community-based programmes which include a supportive multidisciplinary network.

Sociodemographic and clinical profiles of suicidal patients requiring admission to hospitals south of Durban

Abstract Background: Suicidal behaviour has become a major public health concern worldwide. Non-fatal suicidal attempts outnumber fatal episodes by wide-ranging figures across, and within, many countries. Approximately 6 500 suicides and 130 000 suicide attempts occur annually in South Africa, with at least one suicide taking place every 40 seconds, compared to one suicide attempt every three seconds. It is more common for all forms of suicidal behaviour to occur in younger persons. This study aimed to analyse the characteristics of suicide attempters who were admitted to two community-based state hospitals in the south of Durban. Method: Adult patients presenting at two university-affiliated state hospitals, following a suicide attempt during a two-year period, were invited to participate in the study. A World Health Organization standardised questionnaire was used to collect basic data relating to the suicide attempt. All participants provided informed consent. Data were analysed using SPSS® version 19. Results: The majority of the 688 participants were women who were young, single, unemployed, low-income earners, of Indian ethnicity, belonged to the Christian faith, and had a primary school education. Four hundred and thirty-eight participants (63.7%) suffered from varying levels of depression. The majority of suicide attempts (97.2%) had taken place within the home environment of the attempters. Self-poisoning emerged as the dominant method that was used by 92.2% of all attempters. Conclusion: Disturbing levels of non-fatal suicidal behaviour were found in all the population groups. A number of modifiable factors were identified. These have implications for healthcare policy planners and prevention strategies.

The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa

Abstract Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal, South Africa. Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded, semi-urban clinic in the eThekwini Municipal District, KwaZulu-Natal, South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D) and clinic-based pill counts, respectively. Socio-demographic and clinical data were collected during interviews and from patient records. Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale, and 32% were less than 95% adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.0–4.1] and unemployment (OR 2.8; 95% CI, 1.3–6.0), while non-adherence was associated with unemployment (OR 2.4; 95% CI, 1.0–6.1) and mid-range CD4 counts (200–499 cells/μl; OR 3.0; 95% CI, 1.3–6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95% CI, 0.2–1.2; p-value, 0.125). Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and non-adherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment, while non-adherence was associated with unemployment and mid-range CD4 counts (200–499 cells/μl). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world.

Will graduating medical students prefer to practise in rural communities

Abstract Background: The shortage of doctors and their maldistribution between urban and rural areas contribute to inequitable health care delivery. Strategies are being sought by the government and universities to address these challenges. At the Nelson R Mandela School of Medicine of the University of KwaZulu-Natal the admissions policy ensures greater access to rural students and curricular interventions have been introduced to increase an awareness of the plight of vulnerable communities. This study attempted to ascertain the career intentions of final-year medical students and the influence of area of origin and gender on the location of their proposed future practice. Methods: The 2005 final-year cohort was surveyed by means of an anonymous questionnaire. Demographic information, area of origin and career intentions were canvassed. Students of rural origin were identified as those who matriculated from rural schools and lived more than 200 km from the nearest city. The data were analysed descriptively. Results: Female and rural students accounted for 63% and 11% of the sample respectively. Women were less likely than men to practise in rural areas. Thirty-five per cent indicated a preference for a public government service career as opposed to a private medical (26%) career. Slightly more than 13.7% (n = 26) of the cohort wished to pursue practice or postgraduate careers overseas. Nearly 62% (n = 90) of the students in the current cohort received government subsidies for their studies. Conclusions: The increased intake of students from rural origin and curricular attempts to increase social awareness of vulnerable rural communities are inadequate to alter the perceptions of medical graduates towards rural practice. While government initiatives and medical schools are starting to work together to service rural communities, alternative strategies need to be explored to entice physicians to rural practice.

An evaluation of stress in medical students at a South African university

Background: Medical educational programmes strive to produce competent and skilled graduates. However, studies have shown that undergraduate medical students experience varying degrees of stress which impacts on their health, academic performance and social functioning. This study explored the prevalence and causes of stress, its impact on students and their coping strategies in a racially diverse cohort of final-year medical students exposed to a problem-based learning curriculum in South Africa. Method: This descriptive cross-sectional study was undertaken by final-year medical students in 2008 at a South African medical faculty with a racially diverse student population. Semi-structured interviews were conducted. Data were thematically analysed. Results: Ninety-four students, representing 47% of the final-year medical student cohort, participated in the study. Seventy-eight per cent of the participants (n = 73) experienced stress during the programme, and the majority (n = 49) were females. Ethnic and gender differences were observed for the variables studied. Academic and personal problems were the main sources of stress. Coping strategies included individual lifestyle adaptations, family support, religious structures and study groups. Conclusion: Maladaptive stress impacts negatively at multiple levels on undergraduate medical students. Mentorship and educational support programmes should be integrated into the undergraduate medical curriculum and made available to all preclinical and clinical students. Students need to be taught and guided to identify and monitor their own well-being and to select positive strategies to overcome stress. These measures should assist students to manage their workload and time effectively.

An evaluation of the Triage Early Warning Score in an urban accident and emergency department in KwaZulu-Natal

Abstract Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission. As this triage tool has only been evaluated to a limited extent, this study assessed its effectiveness in identifying patients at risk of early deterioration to enable timely medical intervention. Design and setting: This was a retrospective study of medical records within the accident and emergency department of an urban public hospital. Outcome measures: The calculated TEWS was compared to one of four possible outcomes viz. discharge within 24 hours, admission to the ward, admission to the intensive care unit (ICU), or death in hospital. Pearsons chi-squared tests and cross-tabulation was used to determine the statistical significance of the association. Results: Of the 265 patient records analysed, 233 (87.9%) had a TEWS of < 7. Of patients with a TEWS of < 7, 53.7% were discharged, compared to 18.7% with a score ≥ 7, who were discharged. The average score of the four patients who died was 9.5, and 8.2 for the three admitted to ICU. Higher TEWS were significantly associated with increased admission to hospital and in-hospital deaths (p-value 0.032). Conclusion: An effective triage scoring system ensures that those requiring emergency care are appropriately categorised. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the appropriate service level, including ICU.

Unmasking depression in persons attempting suicide

Background: Suicidal behaviour is highly prevalent and increasing at an alarming rate among all socio-demographic groupings in South Africa. Approximately 9.5% of all unnatural deaths in young people in South Africa are due to suicide. The ratio of non-fatal suicide attempts to attempts with fatal outcomes varies between 20:1 and 40:1 depending on the geographical region and the community composition being studied. Although depression is a common co-existing finding in many studies involving patients with suicidal behaviour, current evidence suggests that it is either not detected or it is inappropriately managed in clinical practice. Aim: This study compared self-reported perceived and objectively assessed personal physical and mental well-being of adults attempting suicide and being admitted to two local community-based public hospitals in South Africa. Method: Validated questionnaires were used to elicit relevant data from 688 adults attempting suicide and being admitted to two community-based public hospitals in Durban which was analysed using SPSS®. Results: The majority of participants were female, single, younger age group, unemployed, low education and low income level. Only 30.3% of participants reported long-standing illnesses lasting more than 6 months. The majority perceived their physical and mental health to be normal. However, an objective assessment revealed a large number of participants to be suffering from varying levels of depression. Conclusion: The study population comprised mainly the younger age group in both sexes, and showed that depression is an important co-morbid risk factor in suicidal behaviour in this and other groups. This finding cannot be ignored, and the authors endorse the call for a scaling up of screening strategies to diagnose depression, and for an improved prevention and management framework.

Effectiveness of a Buddy intervention support programme for suicidal behaviour in a primary care setting

Background: Suicidal behaviour is a major contributor to the health burden globally. Non-fatal suicidal behaviour may be 10–40 times more frequent than fatal suicidal behaviour. National responses to this crisis have been variable. This study was designed to evaluate and compare the effectiveness of a brief Buddy intervention support programme with the World Health Organization Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) programme with regard to a cohort of suicide attempters. Method: Six hundred and eighty-eight suicide attempters were recruited into this randomised control study following admission and stabilisation in two community-based hospitals. They were randomised into either the SUPRE-MISS intervention group (control) or the Buddy intervention support group (experimental), and followed-up over 18 months. Data were analysed using SPSS® 19. Results: Three suicides occurred in the control group and one in the Buddy group. Collectively, 171 further suicide attempts were recorded during the 18 months, with 103 in the control group and 68 in the Buddy group. Differences between the two groups were statistically significant. Conclusion: The Buddy intervention was found to be effective and relevant in reducing suicidal behaviour in the local community. These findings have practical implications for implementation at primary care level in all communities.