South African Medical Journal (SAMJ)
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Orthopaedic-related pathological conditions in the paediatric population presenting at outreach clinics in central South Africa over a 20-year period
Get PDFBackground. Outreach, as a component of health service delivery in South Africa (SA), increases diagnostic and treatment capacity for populations living in remote areas. It further allows for close population surveillance of specific health-related conditions. Paediatric orthopaedic outreach for central SA provides a unique opportunity to provide insight into the incidence rates of common paediatric orthopaedic-related conditions.
Objective. To investigate the absolute numbers and incidence rates of orthopaedic-related pathological conditions in the paediatric population presenting at outreach in central SA between 1997 and 2016.
Methods. A retrospective investigation was conducted, which included all paediatric patients residing in the Northern Cape and Free State provinces accessing public healthcare for orthopaedic-related conditions during outreach services. Patient demographic and clinical data were collected and divided into (i) periods; (ii) age groups; (iii) geographical location; and (iv) presenting pathology. Age group-specific incidence rates (ASIR) and paediatric incidence rates (PIR) were calculated using census data from 2001, 2006 and 2011, and estimated values were adjusted to reflect the percentage of the population expected to use public health facilities per 10 000 paediatric population per year.
Results. A total of 3 418 patients were included, with the largest number of patients seen in the Central Free State (n=985). The ASIR for all age groups varied considerably between geographic regions and periods, with the highest rates (2005 - 2008, 21.8 per 10 000 per year) observed in the neonate/infant age group in the northern Free State region. The PIR for pathological groups also varied considerably, with high incidences of congenital talipes equinovarus observed in the northern and eastern Free State regions and a high incidence of cerebral palsy in the central (2001 - 2004, 0.79 per 10 000 per year) and Eastern Free State (2001 - 2004, 0.62 per 10 000 per year).
Conclusion. This information can provide a unique context for planning healthcare service delivery and pathology-orientated scientific research
Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox
Get PDFWe report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithium toxicity. Plasma lithium concentrations and thyroid-stimulating hormone (TSH) were taken, but results were not acted upon. One week later, he presented obtunded, severely dehydrated and in renal failure. His plasma lithium concentration was 4.3 mmol/L (toxic threshold >1.5 mmol/L) and TSH >100 mIU/L. After admission to the intensive care unit, including haemodialysis and 12 days of ventilation, he developed profound polyuria, with a peak output of 15 L/day. Amiloride with hydrochlorothiazide adequately reduced the polyuria. Management of lithium-induced NDI remains complex, and includes diuretics, which paradoxically reduce polyuria in this setting. Failure to follow up critical results led to profound morbidity, and is a crucial learning point in this case
AI and its application within UK healthcare: British Medical Association perspective
Get PDFThis paper is based on a talk given by Dominic Norcliffe-Brown of the British Medical Association (BMA) to the South African Medical Association on 28 November 2024, which explained the BMA policy paper ‘Principles for Artificial Intelligence (AI) and its application in healthcare’. The policy paper provides further detail on the information discussed below
Bridging the gap in rural and underserved areas through AI‐enabled solutions
Get PDFHealthcare disparities between urban and rural populations remain one of the most pressing challenges in global health. In underserved areas, patients face numerous obstacles, including a lack of healthcare infrastructure, long distances to medical facilities, shortages of skilled professionals, and limited access to real-time medical resources. These challenges result in poor health outcomes, higher mortality rates, and increased disease burden in rural communities.
However, artificial intelligence (AI) is emerging as a transformative tool in addressing these healthcare gaps. By leveraging AI-driven solutions, we can create sustainable and scalable healthcare models that improve access, enhance the quality of care, and optimise resources for underserved populations. This article explores how AI is revolutionising rural healthcare, with a focus on the practical applications that can make a meaningful difference
Association of tuberculosis active case finding with knowledge, attitudes, stigma and health-seeking behaviour among patients in Eswatini
No full textBackground. Tuberculosis (TB) poses a significant global public health challenge, with >10 million new infections reported annually, making it one of the top 10 causes of death worldwide. Eswatini has one of the world’s highest TB incidence rates, with an estimated rate of 398 cases per 100 000 population in 2019, as reported by the World Health Organization. In Eswatini, despite the implementation of TB active case finding (ACF) interventions aimed at improving TB case detection and reducing community transmission, there is limited empirical evidence on their association with improved knowledge, attitudes and health-seeking behaviour. This study seeks to address this gap to inform future advocacy, communication and social mobilisation strategies for enhanced TB control and prevention.
Objective. To assess the association of TB ACF and improved knowledge, attitudes, perceptions of stigma and discrimination and health- seeking behaviours among individuals diagnosed with TB.
Methods. The study employed a cross-sectional design from April to May 2023 to review Eswatini TB patients from treatment registers at 14 selected TB basic management units. The TB treatment register was used to determine the entry point of TB patients into care. Those exposed to the ACF programme were located by the TB champions (community volunteers engaged to conduct TB ACF) (n=208), while the unexposed were drawn from outpatients (n=204). The scores for overall knowledge, attitude and health-seeking behaviour were transformed into binary categories based on the calculated median scores. Descriptive statistics were used to summarise participant characteristics, and a multinomial logistic regression model was applied to determine significant risk factors.
Results. A total of 412 TB patients (mean (standard deviation) age 42.21 (4.9) years) were included in the study, and 260 (63%) displayed knowledge about TB. Among the patients, 268 (65%) reported that they had not felt stigmatised, 147 (36%) had sought care early (within 2 weeks) and 297 (72%) exhibited good health-seeking behaviour. Exposure to ACF was associated with higher odds of TB knowledge (adjusted odds ratio (aOR) 6.85; 95% confidence interval (CI) 4.21 - 11.14; p<0.001) and higher odds of seeking care within 2 weeks of symptom onset (aOR 6.84; 95% CI 4.06 - 11.52; p<0.001).
Conclusion. Generally, patients found through ACF were associated with greater knowledge about TB and favourable health-seeking behaviour. However, there remained a notable proportion of TB patients without adequate knowledge and with suboptimal health-seeking behaviour, who may pose a considerable risk for TB transmission
Achieving community-oriented primary healthcare through collaborative learning: The KwaZulu-Natal Primary Health Care Transformation Committee
No full textThis in-practice article describes the processes involved in the development and functioning of the KwaZulu-Natal Primary Health Care Transformation Committee (PHCTC) as a collaborative learning governance structure. The PHCTC brings together the Department of Health policy-makers, University of KwaZulu-Natal academics, the Office of the Premier, non-governmental organisations, civil society representatives and other sectors. This platform has facilitated multi-level planning and mobilisation informed by a co-developed theory of change towards strengthening primary healthcare (PHC); generated co-developed and impactful public health research that has informed the adoption of evidence-based approaches, innovations and implementation strategies for strengthening PHC; and enabled contextually relevant teaching programmes in line with PHC. Key considerations for similar academic multistakeholder generative, collaborative structures to the PHCTC include the importance of cultural brokering, mutual capacity building, shared values and multi-level long-term planning and service-level agreements to promote sustainability
The mysterious joint: Septic arthritis and acute osteomyelitis due to Fusarium species in a child with type II Chiari malformation
No full textFungal bone infection due to Fusarium species is unusual. We report a case of a child who presented with septic arthritis and osteomyelitis due to Fusarium species. The lack of clinical trials and the organism’s intrinsic resistance to most antifungal agents make antimicrobial management difficult. Our patient attained a favourable response to therapy with amphotericin B and voriconazole. This case report highlights a rare manifestation of joint- and bone-related Fusarium infection in a child