South African Medical Journal (SAMJ)
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Disparities in access to treatment in relation to quality of life in people diagnosed with Parkinson’s disease in the South African healthcare setting
Get PDFBackground. South Africa’s divide between the public and private healthcare sectors has implications for healthcare access and quality of life (QoL) outcomes. This exploratory study aimed to identify the types of treatments used by people with Parkinson’s disease (PWPD) in two different healthcare settings (public and private), and their perception of treatment satisfaction. Additionally, this study compared the QoL experienced between these healthcare settings, and investigated whether the number of treatments, internet access and income level were associated with QoL.
Methods. Cross-sectional questionnaires assessing demographic variables and QoL were administered to PWPD across two different healthcare settings in the city of Johannesburg (public n=42, private n=38).
Results. PWPD in the private healthcare setting had greater access to treatment options and better QoL outcomes than PWPD in the public healthcare group (p≤0.05), who relied almost exclusively on medication to treat PD symptoms. The QoL psychological domain was the lowest across both healthcare settings. No significant differences were observed in treatment satisfaction.
Conclusion. PWPD using the public healthcare setting had reduced access to PD treatments and poorer QoL than PWPD using private healthcare. The number of treatments, household income and internet access were strongly correlated with QoL outcomes
Putting us to the test: An assessment of the agreement between preoperative investigations ordered and evidence-based guidelines at a tertiary level hospital in the Western Cape Province, South Africa – a retrospective record review study
Get PDFBackground. Recommendations for preoperative investigations are available worldwide, and are advocated for in an attempt to reduce unnecessary testing, especially in healthy patients undergoing low-risk surgery. However, despite these guidelines, unnecessary preoperative testing still occurs. This is the first South African study comparing preoperative investigations ordered with the recommendations of both the National Institute for Health and Care Excellence (NICE) and local preoperative testing guidelines.
Objectives. Primary objectives were to describe the preoperative investigations ordered in patients undergoing elective surgery, compare these with international and local guidelines, and assess the cost of overtesting. Secondary objectives were to assess the frequency of abnormal laboratory results in tests not indicated by the guidelines, as well as to assess patterns in overtesting.
Methods. This was a retrospective record review study of American Society of Anesthesiologists (ASA) 1 and 2 patients undergoing elective minor and intermediate surgical procedures in Tygerberg Hospital between November and December 2021. The preoperative investigations of 501 patients were studied, including laboratory tests (full blood count (FBC), urea, creatinine and electrolytes panel and international normalised ratio), point-of-care haemoglobin, chest radiographs (CXRs) and electrocardiograms. Tests were compared with guidelines, and the cost of any overtesting was calculated. Patterns in overtesting were evaluated. Data were sourced from electronic medical records. SPSS version 28 was used to analyse data.
Results. A total of 501 patients undergoing elective surgery were included. As many as 89% of the cohort had at least one unnecessary test done (95% confidence interval 85.9 - 91.6). Overall, FBCs and CXRs were the most overtested investigations, being done unnecessarily in one-third of patients. Redundant duplicate testing occurred 177 times. The projected potential cost savings on preoperative investigations if NICE guidelines were followed at Tygerberg Hospital are ZAR857 987 per annum, and ZAR696 515 per annum if the local guidelines are followed. Extra testing as per local guidelines compared with NICE guidelines was mostly unhelpful to reveal additional clinically relevant abnormalities. General surgery patients, patients aged >35 years, ASA 2 patients and females were subject to the highest levels of overtesting (p<0.001).
Conclusion. Preoperative testing over and above testing recommended by both international and local guidelines is common, and represents an enormous area for potential cost savings in a resource-limited environment. Additional local studies are required to further expand on overtesting and the factors contributing to it
Perspectives of doctors, nurses and rehabilitation therapists in Gauteng and Mpumalanga provinces’ public hospitals on remunerative work outside of the public service
Get PDFBackground. The remunerative work outside of the public service (RWOPS) policy enables public sector health professionals to engage in multiple job holding (MJH) in South Africa (SA) under specified conditions, but remains controversial. Empirical evidence on health professionals’ perspectives on the RWOPS policy stipulations is lacking.
Objective. To examine the perspectives of public sector medical doctors (MDs), professional nurses (PNs) and rehabilitation therapists (RTs) on the RWOPS policy.
Methods. In 2022, public sector MDs, PNs and RTs were surveyed in 14 Gauteng and 15 Mpumalanga province public sector hospitals. In addition to demographic and employment data, the self-administered questionnaire collected information on whether the health professionals had obtained permission for additional jobs, their opinions on RWOPS approval requirements and restrictions and the likelihood that they would leave the public sector if RWOPS was denied. Data analysis was performed using Stata 17. The factors influencing health professionals’ perspectives on different aspects of the RWOPS policy were analysed using penalised logistic regression.
Results. A total of 1 397 health professionals completed the survey, for a response rate of 84.3%. Most MDs (61.1%) and RTs (60.5%) supported mandatory RWOPS approval, compared with 41.5% of PNs. Overall, 52.6% of MDs, PNs and RTs engaged in MJH also agreed with mandatory approval. Among those who engaged in MJH, the majority of MDs (84.7%) and RTs (87.4%) had RWOPS permission, compared with only 19.2% of PNs. MDs (odds ratio (OR) 9.9, p<0.001) and RTs (OR 30.9, p<0.001) were significantly more likely to obtain RWOPS approval than PNs. MDs (OR 2.2, p<0.001), RTs (OR 1.5, p=0.027), males (OR 1.4, p=0.039) and RWOPS participants (OR 2.8, p=0.030) were more likely to consider leaving if RWOPS was denied.
Conclusion. Our findings highlight significant variation in obtaining MJH permission among health professionals. The diverse perspectives underscore the need for targeted communication and stakeholder engagement to clarify policy and improve compliance.
The National Institutes of Health funding withdrawal: Decades of progress dismantled in a few weeks
Get PDFNew case definitions and thresholds for environmental notifiable medical conditions in South Africa: Pesticide, lead and mercury poisoning
No full textNotifiable medical conditions (NMCs) are diseases that pose significant public health risks, and may result in outbreaks, epidemics or pandemics with high morbidity and mortality rates. The World Health Organization provides an overarching framework for countries to meet obligations related to data collection, processing and notification of and rapid response to, as needed, cases of NMCs. South Africa has recently introduced new case definitions for the three NMCs related to environmental exposures: poisoning by agricultural or stock remedies (pesticides), lead and mercury. In this article, the revised case definitions and processes for reporting of NMCs are outlined. We also discuss the benefits and challenges of processing and using NMC data, and urge more widespread and effective participation in the process of notifying these important environmental medical conditions
The association between reproductive hormones and asthma-related outcomes in boys in the rural Western Cape Province, South Africa
No full textBackground. Asthma is more prevalent and severe among boys than girls, but this pattern reverses after puberty. It has been suggested that reproductive hormones may play a role in explaining these sex differences after puberty. However, the evidence for this relationship remains limited, as there have been no previous studies conducted on children in low- and middle-income countries on several reproductive endocrine hormones.
Objective. To investigate the association between reproductive endocrine hormones and asthma-related outcomes among boys residing in a rural setting.
Methods. Data on asthma outcomes and hormone levels were analysed from a cross-sectional study of 314 boys (aged 6 - 18 years) in the rural Western Cape Province, South Africa (SA). These were collected using an abbreviated International Study of Asthma and Allergies in Childhood questionnaire. Testosterone (total serum testosterone (TST) and free testosterone (FT)), luteinising hormone (LH), serum follicle- stimulating hormone (FSH), oestradiol and serum hormone-binding globulin (SHBG) were assessed using electrochemiluminescence immunoassays.
Results. Current wheezing (CW), asthma symptom score ≥2 and parental-reported asthma (PA) prevalence were 6.1%, 6.7% and 8.0%, respectively. Multivariate analysis showed that increasing levels of detected TST were significantly negatively associated with CW (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.45 - 0.98) and asthma symptom score (OR 0.64, 95% CI 0.43 - 0.95), while no statistically significant association was observed for PA (OR 0.86, 95% CI 0.59 - 1.25). FT levels showed an inverse association with all asthma- related outcomes, with a statistically significant association with asthma symptom score. Similar associations were found for FSH, while associations with LH were less consistent across outcomes, and no association was observed for oestradiol and SHBG.
Conclusion. Our findings suggest that increasing serum testosterone levels (including those in the normal range and those above the normal range) detected among boys from rural settings in the Western Cape Province, SA, are associated with a reduced risk of asthma after adjusting for important underlying risk factors
