South African Medical Journal (SAMJ)
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Fairway to fractures: Income inequality and violent crime as the driving factors for golf club-related assaults – a case series of 21 compound skull fractures
Get PDFBackground. Golf club-related traumatic brain injuries are an uncommon occurrence in adults, and the use of golf clubs as a weapon of interpersonal assault resulting in compound skull fractures is rare.
Objective. To present a case series of golf club-related compound skull fractures in adults secondary to assault, representing the largest study of this entity to date.
Methods. A retrospective analysis was performed of a prospectively maintained database for patients admitted to Tygerberg Academic Hospital in Cape Town, South Africa, with golf club-related compound skull fractures between 1 January 2018 and 31 December 2021. Data on demographic details, computed tomography brain image findings, presenting Glasgow Coma Scale, surgical operative notes, septic complications and outcomes at discharge were collected.
Results. A total of 21 patients were included. The majority were male (95.2%) and the mean age was 32.6 years. Fractures were most commonly seen in the frontal bone (n=9), followed by parietal (n=8), temporal (n=3) and occipital (n=1) bones. Depressed skull fractures were the most common type of injury, and local pneumocephalus was present in the majority of patients. The mean presenting Glasgow Coma Scale was 14, and most patients had no focal neurological deficits. Surgical debridement was required in the majority of patients, with a high rate of septic complications (33.3%). However, most patients had good neurological outcomes at discharge, and the mean length of stay was 11.9 days.
Conclusion. This study highlights the potential dangers of golf clubs as a weapon of interpersonal assault, and the need for prompt and appropriate management of compound skull fractures to reduce the risk of complications
Cyberattack on the National Health Laboratory Service of South Africa – implications, response and recommendations
Get PDFCybersecurity is now an integral consideration in the management of healthcare institutions in this modern technological era. Cyberattacks primarily targeting healthcare institutions have increased exponentially. Recently, the information technology systems of the National Health Laboratory Service (NHLS) of South Africa (SA) were targeted by cyberterrorists using disruptive ransomware. As a result, all files on the affected computers and servers became inaccessible, thus affecting all NHLS operations. We share our experience of this cyberattack from the department of haematological pathology at Tygerberg Hospital, Cape Town, SA. We outline the negative impact on the NHLS and the immediate response, and make future recommendations, including a draft of a business continuity plan
Cerebral palsy and its medicolegal implications in low- resource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia: A narrative review
Get PDFThe objective of this study was to establish scientific causality and to devise criteria to implicate intrapartum hypoxia in cerebral palsy (CP) in low-resource settings, where there is potential for an increase in damaging medicolegal claims against obstetric caregivers, as is currently the situation in South Africa. For the purposes of this narrative review, an extensive literature search was performed, including any research articles, randomised controlled trials, observational studies, case reports or expert or consensus statements pertaining to CP in low-resource settings, medicolegal implications, causality, and criteria implicating intrapartum hypoxia. In terms of causation, there are differences between high-income countries (HICs) and low-resource settings. While intrapartum hypoxia accounts for 10 - 14% of CP in HICs, the figure is higher in low-resource settings (20 - 46%), indicating a need for improved intrapartum care. Criteria implicating intrapartum hypoxia presented for HICs may not apply to low-resource settings, as cord blood pH testing, neonatal brain magnetic resonance imaging (MRI) and placental histology are frequently not available, compounded by incomplete clinical notes and missing cardiotocography tracings. Revised criteria in an algorithm for low-resource settings to implicate intrapartum hypoxia in neonatal encephalopathy (NE)/ CP are presented. The algorithm relies first on specialist neurological assessment of the child, determination of the occurrence of neonatal encephalopathy (by documented or verbal accounts) and findings on childhood MRI, and second on evidence of antepartum and intrapartum contributors to the apparent hypoxia-related CP. The review explores differences between low-resource settings and HICs in trying to establish causation in NE/CP and presents a revised scientific approach to causality in the context of low-resource settings for reaching appropriate legal judgments
Understanding the impact of the COVID‑19 pandemic on healthcare services for adults during three waves of COVID‑19 infections: A South African private sector experience
Get PDFBackground. Since the onset of the COVID‑19 pandemic, healthcare resources have been repurposed to focus on COVID‑19. Resourcereallocation and restrictions to movement that affected general access to care may have inadvertently resulted in undue disruptions in the continuum of care for patients requiring non-COVID‑19 healthcare services.Objectives. To describe the change in pattern of health service use in the South African (SA) private sector.Methods. We conducted a retrospective study of a nationwide cohort of privately insured individuals. An analysis of claims data wasperformed for non-COVID‑19 related healthcare services provided from April 2020 to December 2020 (year 1 of COVID‑19) andApril 2021 to December 2021 (year 2 of COVID‑19) relative to the same period in 2019 prior to the COVID‑19 pandemic in SA. Over andabove plotting the monthly trends, we tested for statistical significance of the changes using a Wilcoxon test given the non-normality of all the outcomes.Results. Between April and December 2020, relative to the same period in 2021, and also relative to the same period in 2019, we found a 31.9% (p<0.01) and a 16.6% (p<0.01) reduction in emergency room visits, respectively; a 35.9% (p<0.01) and 20.5% (p<0.01) reduction in medical hospital admissions; a 27.4% (p=0.01) and 13.0% (p=0.03) reduction in surgical hospital admissions; a 14.5% (p<0.01) and 4.1% (p=0.16) reduction in face-to-face general practitioner consultations for chronic members; a 24.9% (p=0.06) and 5.2% (p=0.54) reduction in mammography for female members; a 23.4% (p=0.03) and 10.8% (p=0.09) reduction in Pap smear screenings for female members; a 16.5% (p=0.08) and 12.1% (p=0.27) reduction in colorectal cancer registrations and an 18.2% (p=0.08) and 8.9% (p=0.07) decrease in all oncology diagnoses. Uptake of telehealth services throughout the healthcare delivery system increased by 5 708% in 2020 compared with 2019, and 36.1% for 2021 compared with 2020.Conclusion. A significant reduction in emergency room visits, hospital admissions and utilisation of primary care services was observed since the start of the pandemic. Further research is required to understand if there are long-term consequences of delayed care. An increase in the use of digital consultations was observed. Research on their acceptability and effectiveness may open new modalities of care, which may have cost- and time-saving benefits
Progress towards 90-90-90 and 95-95-95 strategy implementations and HIV positivity trends in the City of Johannesburg
Get PDFBackground. The 95-95-95 strategy implementation is a positive initiative for moving the HIV tide towards elimination, with a focus on addressing the huge inequalities in existence in access to HIV services.Objectives. To establish performance towards the 90-90-90 and 95-95-95 targets and trends in HIV positivity rates since strategy implementation rollout in the City of Johannesburg (CoJ), South Africa.
Methods. This was a descriptive study, part of the bigger quasi-experimental study using the monthly District Health Information System during the implementation and rollout of the 90-90-90 strategy. HIV access trends were tracked and compared with the set strategy implementation targets. In addition, the HIV positivity rate was analysed to observe trends. A time trend analysis for aggregated data was performed on all the measured indicators to determine whether the decrease or increase was statistically significant. P<0.05 was used to indicate statistical significance.
Results. The study has shown that by March 2022, 15 months after December 2020, CoJ had reached 91-65-88. There were significant steady increases in the number of people who knew their HIV status (slope = 0.044, p<0.001) and initiating on antiretroviral therapy (ART) (slope = 0.001, p<0.001), and significant decreases for overall HIV positivity rate (slope = –0.016, p<0.001), adolescent positivity rate (slope = –0.0087, p<0.001) and antenatal care HIV positivity rate (slope = –0.013, p<0.001).
Conclusion. This study has established positive progress made by the CoJ towards HIV testing, ART initiation, viral load suppression and HIV positivity rate. On the other hand, gaps in linkage to care after testing positive have been highlighted. It is therefore critical in the 95-95-95 strategy implementation era to focus on finding those missed during the 90-90-90 phase through revised and renewed innovative approaches
Operating theatre efficiency at a tertiary eye hospital in South Africa
Get PDFBackground. South Africa (SA) is a resource-limited country that needs efficient operating theatres in order for surgical care to function cost-effectively. Regular assessment of theatre efficiency in our setting is therefore needed.
Objectives. To describe ophthalmology theatre efficiency at a central hospital in SA and compare this with international benchmarks.
Methods. St John Eye Hospital is the ophthalmology section of Chris Hani Baragwanath Academic Hospital in Soweto, SA. It has three operating theatres. A cross-sectional study was done of the theatres’ registry of surgical procedures over a 6-month period. Data analysed included the starting and finishing times of theatre lists, surgical cases that were cancelled on the day of surgery, and theatre utilisation rates. These data were compared with international benchmarks.
Results. A total of 1 482 surgical procedures in 229 theatre lists were included in the study. Sixty-five percent of these theatre lists started late, accounting for 4 236 minutes of lost theatre time, significantly more than the maximum of 10% recommended by the Royal College of Anaesthetists. Of theatre lists, 23% and 30% finished after 16h15 (theatre overrun) and before 16h00 (theatre underrun), respectively. This is more than double the 10% recommended by the Royal College of Anaesthetists. The theatre utilisation rate was 62%, which is significantly lower than the ideal utilisation rate of 80%. The cancellation rate was 16%, which is significantly higher than the international benchmark of 2% recommended by the New South Wales guidelines. The most common reasons for cancellations were medical unfitness of the patient and lack of operating theatre time.
Conclusion. All theatre efficiency parameters at St John Eye Hospital were below international benchmarks
Patients’ experiences of termination of pregnancy at a regional hospital in Durban, South Africa
Get PDFBackground. Safe and effective termination of pregnancy (ToP) services have helped to resolve the uncertainty that surrounds unwantedpregnancies globally and in South Africa (SA). It is important to determine the demographic profile of women requesting ToP and to assessthe reasons for ToP and the beliefs and experiences of women seeking these services in order to improve service delivery.Objectives. To determine the sociodemographic profile and emotional and psychological experiences of women undergoing ToP at aregional hospital in Durban, SA.Methods. The study population consisted of women seeking either medical or surgical ToP at the Addington Hospital ToP clinic from Juneto August 2021. The participants were requested to complete a structured self-reporting questionnaire on their sociodemographics, theirawareness of, attitude to and knowledge of ToP, and their reasons for seeking ToP services, as well as contraception method and use. Thequestionnaire also captured their experience after the ToP was completed.Results. Of the 246 participants, the majority (92.3%) were aged 16 - 35 years, with 62.6% having little or no income and dependent ontheir family or partner for financial support. Most of the participants (73.2%) were parous and had secondary education and above (94.3%).Furthermore, 59.0% of the participants indicated they were not on any form of contraception before becoming pregnant, even though 70.3%of them were single. The most cited reasons for ToP were lack of finance (37.5%), schooling (33.9%), and not feeling ready to be a parent(20.0%). Although some participants (35.7%) were fearful of ToP, most of them (78.0%) reported feeling relieved after the procedure.Conclusion. Unemployment and financial dependency appeared to be common reasons for seeking ToP in our study population. Most ofthe women were single and many had not used any contraception prior to the pregnancy
