Wilhelm Johannes Steinberg

Knowledge of and attitude towards pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa

Abstract Background This study determined womens knowledge of and attitudes to pain relief during labour. Methods This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief. Results The median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3%) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5%) or from friends and relatives (55.3%). Of the women who had knowledge of pain relief (n=85), 65.9% indicated injections. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. Of those who had been told (n=41), 75.6% found the information useful. The women who had previously delivered in a health facility rated the service received in relieving labour pain as fair (47.3%) and good (31.2%). Most of the women (99.3%) believed that the staff had an important role to play in helping to relieve labour pain. Most of the women (78%) expressed no concern about problems associated with pain relief methods, while a large number (83.4%) expressed little or no confidence in labour pain relief. Conclusion Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief.

Staphylococcus aureus on computer mice and keyboards in intensive care units of the Universitas Academic Hospital, Bloemfontein, and ICU staff’s knowledge of its hazards and cleaning practices

Nosocomial infections result in severe health and financial difficulties for patients and healthcare facilities. The objective of the study was to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas Academic Hospital, Bloemfontein, and ICU staffs knowledge regarding cleaning of computer mice and keyboards and their potential hazard as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial infections. In addition to various environmental microorganisms and normal human flora, S. aureus was initially isolated from one computer mouse, and from two keyboards and five mice six months later. The questionnaire response rate was 85.6%. Seventy-one percent of respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless, 62% of doctors and 40.3% of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents were not aware of an official cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial transmission between equipment, staff and patients, proper cleaning policies should be implemented.

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis.

Abstract Background Healthcare-associated tuberculosis (TB) has become a major occupational hazard for healthcare workers (HCWs). HCWs are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Whenever there is a possibility of exposure, implementation of infection prevention and control (IPC) practices is critical. Objective Following a high incidence of TB among HCWs at Maluti Adventist Hospital in Lesotho, a study was carried out to assess the knowledge, attitudes and practices of HCWs regarding healthcare-associated TB infection and infection controls. Methods This was a cross-sectional study performed in June 2011; it involved HCWs at Maluti Adventist Hospital who were involved with patients and/or sputum. Stratified sampling of 140 HCWs was performed, of whom, 129 (92.0%) took part. A self-administered, semi-structured questionnaire was used. Results Most respondents (89.2%) had appropriate knowledge of transmission, diagnosis and prevention of TB; however, only 22.0% of the respondents knew the appropriate method of sputum collection. All of the respondents (100.0%) were motivated and willing to implement IPC measures. A significant proportion of participants (36.4%) reported poor infection control practices, with the majority of inappropriate practices being the administrative infection controls (> 80.0%). Only 38.8% of the participants reported to be using the appropriate N-95 respirator. Conclusion Poor infection control practices regarding occupational TB exposure were demonstrated, the worst being the first-line administrative infection controls. Critical knowledge gaps were identified; however, there was encouraging willingness by HCWs to adapt to recommended infection control measures. Healthcare workers are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Implementation of infection prevention and control practices is critical whenever there is a possibility of exposure.

The bird’s-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

Abstract Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine.

The perceived impact of family physicians on the district health system in South Africa : a cross-sectional survey

BackgroundEvidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also contextually defined. The South African family medicine discipline has agreed on six roles. These roles were incorporated into a family physician impact assessment tool, previously validated in the Western Cape Province.MethodsA cross-sectional study design was used to assess the perceived impact of family physicians across seven South African provinces. All FPs working in the district health system (DHS) of these seven provinces were invited to participate. Sixteen respondents (including the FP) per enrolled FP were asked to complete the validated 360-degree assessment tool.ResultsA total number of 52 FPs enrolled for the survey (a response rate of 56.5%) with a total number of 542 respondents. The mean number of respondents per FP was 10.4 (SD = 3.9). The perceived impact made by FPs was high for five of the six roles. Co-workers rated their FP’s impact across all six roles as higher, compared to the other doctors at the same facility. The perceived beneficial impact was experienced equally across the whole study setting, with no significant differences when comparing location (rural vs. metropolitan), facility type or training model (graduation before and ≥ 2011).ConclusionsThe findings support the need to increase the deployment of family physicians in the DHS and to increase the number being trained as per the national position paper.

The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

PURPOSE Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system. METHODS We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size. RESULTS Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P =.049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P =.03) and coordination of care (3.05 vs 3.51; P =.02). CONCLUSIONS In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.

Abdominal Pregnancy a Report of Two Cases

Background: Abdominal pregnancy is a rare condition and potentially life-threatening if not diagnosed early and treated adequately. It has a high maternal and foetal mortality. Two cases of abdominal pregnancy are discussed. Both occurred in mothers aged 35 yrs and were managed as part of the author’s routine work during 2011. In both cases the mother booked for antenatal care, had an ultrasound performed that missed the condition initially. The diagnosis of an abdominal pregnancy was only made in advanced pregnancy. Both were treated with definitive surgery and recovered post operatively. Conclusion: In both cases there was a failure in the diagnosis of an abdominal pregnancy during the initial ultrasound. In both cases the placenta was attached to the outside of the fallopian tube. The latter may be the reason for the initial sonar to appear intrauterine. Surgical removal of an advanced abdominal pregnancy with foetal demise is advocated.

Evaluation of Clinical Medicine in the Final Postgraduate Examinations in Family Medicine

Abstract Background: The Family Medicine Department, University of the Free State (UFS) recently supervised the MFGP assessments of the College of Medicine in South Africa (first sitting), as well as the final assessment of the M Med Fam programme of the UFS (second sitting). The examinations, which took place in October and November 2006, were subjected to an internal quality assurance evaluation with the view to improve the standard and reliability of the examinations. Methods: All the candidates, as well as the examiners who participated in the MFGP and M Fam Med examinations, were included in the evaluation. Opinions were obtained from the students and examiners for each assessment on a structured data form directly after the examinations. A Smits blueprint was established for the written paper. Results: The majority of the students assessed the OSCE as being fair, understood the questions and agreed with the time allocated per question. A broad variety of competencies were assessed in a structured manner, which enhances the reliability of the examinations. The examiners evaluated the OSCE as being well structured and fair, as well as testing for the competencies of a family physician. Good agreement was achieved between the two different sets of candidates and examiners, and similar marks were achieved despite the separate settings, thus enhancing the validity of the examinations. The structured oral was evaluated as being fair regarding the variety and relevance of the questions by all the candidates and examiners. The written paper was on a relatively high cognitive level and tested a broad spectrum of knowledge. Although it did not cover the entire module, skills and approaches necessary for problem solving were tested. If a student could master these problems, he/she should be able to manage other areas not covered in the paper. Conclusion: The authors are of the opinion that the quality evaluation of clinical medicine in the final postgraduate examinations in Family Medicine held at UFS in 2006 showed it to be authentic, fair, reliable and objective, and that it assessed competencies for real-life situations, as well as the theoretical knowledge, attitudes and values required for a family practitioner.

Misoprostol use for second‐trimester termination of pregnancy among women with one or more previous cesarean deliveries

To establish the safety and efficacy of misoprostol for second‐trimester termination of pregnancy among women with one or more previous cesarean deliveries.

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.