Background HIV/Aids continues to be a major factor in the morbidity and mortality of children in South Africa. Despite the implementation of new guidelines to lower mother-to-child transmission in the country, some infants are admitted to hospitals undetected and or in alarming conditions. Aim To determine the most prevalent clinical assessments of HIV-positive infants admitted at Odi District Hospital, South Africa. Methods This was a cross-sectional study based on a retrospective records review of all HIV-positive infants admitted at Odi District Hospital in Pretoria from the 1 st January 2010 to 31 st December 2012. Results Only 10.2% of the 962 files of infants admitted to Odi Hospital were HIV-positive infants, with the majority (58.2%) in the 7–12-month age range and a high admission rate (57.1%) for males. Twenty-five percent of infants had a diagnosis prior to admission. There were 44.9% lower respiratory tract infections, 25.5% malnutrition and failure to thrive, 2.4% gastroenteritis, 2% meningitis, 2% febrile convulsions, and other diseases like encephalopathy and dehydration. Conclusion The current study has presented lower respiratory tract infection as the most prevalent clinical assessment and cause of morbidity among HIV-positive infants admitted at Odi District Hospital in Pretoria, South Africa. In order to provide a comprehensive view of the issue, additional studies with large sample sizes are advised. What This Study Adds The study presents the prevalence of associated clinical conditions among infants with HIV/AIDS, listed in descending order at a South African district level of care.

Background: The prevalence of diabetes mellitus is increasing dramatically in developing countries, where diabetic patients usually present with poor glycaemic control, leading to complications and worsening the prognosis. Aim: The aim of this study was to determine the extent of poor glycaemic control and its determinants in diabetic patients. Setting: The study was conducted in a rural area of the province of Kwilu, Democratic Republic of the Congo. Methods: This research comprised a cross-sectional study involving 300 Type 1 and 2 diabetic patients attending Vanga Evangelical Hospital in the Democratic Republic of the Congo from January 2018 to March 2018. Patients’ sociodemographic, clinical and biological characteristics, accessibility to the health structure and treatment were described. The determinants of poor glycaemic control were identified using multivariate logistic regression at the p 0.05 level of statistical significance. Results: The mean age of participants was 46.9 ± 16.3 years, 68.4% were men, and 62.3% had Type 2 diabetes mellitus. Poor glycaemic control was present in 78% of patients. The independent determinants of poor glycaemic control were tobacco use (adjusted odds ratio [aOR]: 2.01 [1.77–5.20], p = 0.015), the presence of comorbidities (aOR: 2.86 [1.95–6.65], p = 0.007), the presence of a factor contributing to hyperglycaemia (aOR: 2.74 [1.83–3.67], p = 0.014), missing scheduled appointments (aOR: 2.59 [1.94–7.13], p = 0.006) and non-adherence to treatment (aOR: 4.09 [1.35–6.39], p = 0.008). Conclusion: This study shows that more than three-quarters of diabetics undergoing treatment are not controlled, with mainly patient-related factors as the main explanatory factors for this poor glycaemic control. Therefore, the establishment of a therapeutic education programme and wider integration of diabetes care services, mainly at the primary level of the healthcare pyramid, should contribute to improved diabetes treatment.

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization’s six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status ( P = 0.02) and TB diagnosis using only sputum smear test ( P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

Mineworkers constitute a major workforce in South Africa. Mining activities are known to release varying concentrations of toxic trace metals into the environment depending on the type of mining technology involved. These toxic trace metals could be ingested. inhaled, or absorbed through the dermal part of the human body. The present study evaluated and determined the levels of some selected toxic trace metals in blood of mineworkers working and living in "shacks" (informal houses) directly opposite mining industry. The study employed a mixed method approach. 96 participants (53 occupationally exposed, 23 immediate family members, and 20 participants for the control group) took part in the study. Open-ended questionnaires were used to gather information on health status, gender, and years of employment. Blood samples from the groups were analyzed for trace metal content using inductively coupled plasma mass spectrometry (ICP-MS). The mean blood levels for occupationally exposed mine workers ranged between 0.5 and 6.49 mu g/dL for lead. chromium 0.41 - 13.96 mu g/L. manganese 5.86 - 22.23 mu g/L. cobalt 0.15 - 0.88 +/- 0.05 mu g/L. arsenic 0.33 - 2.19 mu g/L, and cadmium 0.05 - 1.87 g/L. For the nonexposed and control group. the values ranged from 0.5 to 1.84 mu g/dL for lead, chromium 0.41 - 19.01 mu g/L, manganese 6.19 - 22.01 mu g/L, cobalt 0.19 -11.72 mu g/L, arsenic 0.29 - 1.83 mu g/L. and cadmium 0.04 - 1.10 mu g/L. There were significant differences (p < 0.05) in the concentrations of lead. chromium, manganese, cobalt, arsenic, and cadmium within the exposed, nonexposed, and control group. The levels of lead, chromium, manganese, and cadmium in some participants exceeded the permissible limits set by WHO in human blood. Smoking habits of some of the exposed participants in this study have a direct impact on the levels of trace metals in their blood, and there were more smokers in the exposed group compared to the nonexposed and control group. Frequent headache. fatigue, and dizziness were common health issues reported by the mineworkers. Trace metals evaluation is recommended once in 3 months for both miners and their immediate family members living with them in this area.

Background/Aim: The aim of this study is to determine the pattern of computed tomographic (CT) findings in HIV-infected patients referred for CT brain at Doctor George Mukhari Academic Hospital (DGMAH) and to correlate the CD4 counts with CT brain findings of the patients on antiretroviral (ARV) drugs, and those that are ARV naive. Methods: A descriptive, retrospective review of CT brains obtained from 128 slices Philips and GE, CT scanners, medical records, and laboratory results of 364 adult HIV-infected patients over a 6-month period (October 1, 2016-March 31, 2017) was conducted at Radiology Department of DGMAH. Statistical analyses were made using a Statistical Program for Social Sciences software (SPSS version 19.0). Results: From the 364 CT brain findings of HIV-infected patients reviewed, 46.2% were male and 53.8% were female. The findings were as follows: brain atrophy (168; 46.2%); infarcts (55; 15.1%); hydrocephalus (24; 6.6%); white matter disease (18; 4.9%); mass lesions (13; 3.6%); rim enhancing lesions (12; 3.3%); intracranial bleed (11; 3.0%); tuberculous granuloma (32; 8.8%); tuberculous meningitis (15; 4.1%); and cryptococcal meningitis (2; 0.5%). Opportunistic infections and mass lesions still predominate at CD4 count <200 cells/mm3 although the reduction in the prevalence of opportunistic infections was observed. Brain infarct was seen at CD4 count <200 cells/mm3, and brain atrophy was seen at all CD4 count levels (median= 84 cells/mm3). Conclusion: This study was conducted in the post-highly active ARV therapy era, and the most common CT scan brain finding was brain atrophy, followed by brain infarct.

Background: The incorporation of community healthcare worker (CHW) involvement in the management of patients is in line with the 2006 World Health Report, which advocates increased community participation and the systematic delegation of tasks to less specialised cadres. For CHWs to function optimally, satisfaction in their duties is paramount to promote quality healthcare. The health minister included ward-based outreach teams (WBOT) as part of the National Health Insurance.1 CHWs form an important link between healthcare facilities and the communities. This study aimed to measure the satisfaction level of the CHWs with WBOT services in the Tshwane district of South Africa. Method: A cross-sectional study on CHWs was conducted in seven sub-districts. Data were obtained by trained data collectors using a piloted self-administered structured questionnaire from October 12 to November 3, 2015 in three local official languages. The study population of CHWs was 1 600. Using a 95% confidence level and 5% confidence interval, the sample size was 310. However, we over-sampled to 431 participants. Results: The mean age was 36 years (SD ± 9.46). The majority were females (82.1%); more than three-quarters (77%) had secondary education. The majority were satisfied with the WBOT services whereby 59.8% was the lowest score and 98.4% the highest score. Close to two-thirds (62%) were not satisfied with their monthly stipends. The majority of the younger members of the team (20–40 years) were not valued by their co-workers (70% or 181/255) [p = 0.03]. The overall satisfaction (n = 8593) was 73.4% (p 0.001). Conclusion: Overall satisfaction of CHWs with WBOT is good news. Dissatisfaction regarding stipend/compensation must be addressed. CHWs should be valued and motivated.

Background: An allergic reaction to mammalian meat has recently been reported in rural parts of South Africa and throughout other parts of the world. The cause of this allergic reaction is because of an oligosaccharide antigen known as galactose-alpha-1, 3-galactose (alpha-gal) found in mammalian meat. Hard ticks in various parts of the world have been identified as a cause of sensitisation to the alpha-gal antigen. However, mechanisms of sensitisation in Africa are poorly understood. Aim: The aim of this article is to review current literature on the alpha-gal allergy and mammalian meat ingestion and the family physician's role in diagnosing and managing this condition. Method: Indexes were searched using the keywords in the following electronic databases: Elsevier Science Direct, Google Scholar, Medline and PubMed. Results: Clinical presentation of the alpha-gal allergy occurs typically as a delayed anaphylaxis occurring within 3-6 hours after the ingestion of mammalian meat. A subset of patients described in South Africa presented with a rapid onset of symptoms occurring within 45 minutes. Furthermore, some of these patients present with abdominal symptoms only, which may be mistaken as food poisoning. Diagnosis is based on a history of reaction to mammalian meats (especially to fatty portions or organs) and serum specific alpha-gal antibodies. The main management of the alpha-gal allergy is avoidance of red meat and in mild reactions treatment with oral H1 receptor antihistamines. Conclusion: Sensitisation to the alpha-gal allergy results in adverse reactions to red meat, with tolerance to turkey, chicken and fish. A family physician can safely manage this condition.

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on the principles of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households. Methods: The study assessed the awareness of the WBOT and the services offered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data were collected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers. Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, 'Yes' and 'No'. A summary of the responses showed that the number of 'yes' responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) 'yes' responses and 698 (11.1%) 'no' responses. Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%.

Background: Psychological insulin resistance (PIR) is a common but unappreciated phenomenon by health care providers with a negative impact on the control of type 2 diabetes mellitus.Aim: To determine the frequency of PIR and its determinants in patients with type 2 diabetes.Setting: This study was conducted in Kinshasa in three health centres providing management of diabetic patients.Methods: This study was a multicentric, cross-sectional study conducted from 01 November 2017 to 31 March 2018 in Kinshasa among 213 type 2 diabetic patients who were taking oral anti-diabetic drugs. A standardised questionnaire, the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ), was used for data collection.Results: The average age of participants was 59.8 ± 11.1 years with a male to female ratio of 1.5. The prevalence of PIR was 42.7%; and its main determinants were 50 years of age (odds ratios [OR] adjusted 2.05; 95% confidence interval [CI] 1.98–4.27; p = 0.045), the presence of complications (OR adjusted 3.33; 95% CI 1.68–6.60; p = 0.001), lack of knowledge about insulin therapy (OR adjusted 1.96; 95% CI 1.03–3.71; p = 0.040) and the high cost of insulin (OR adjusted 2.32; 95% CI 1.08–4.95; p = 0.030).Conclusion: The study showed that almost half of type 2 diabetic patients had PIR with the main determinant factors related to the patient and the health system. The establishment of a therapeutic education programme, improved ‘provider–patient’ communication and the development of approaches to increase access to drugs are crucial to reduce the prevalence of PIR.

Introduction: Households' satisfaction is an important and commonly used indicator for measuring quality in health care. An amelioration of primary health care services at the level of households, by utilising community health workers, has led to a good healthcare system in many countries, such as Brazil. In South Africa, little is known about the satisfaction of households (HH) regarding the healthcare services they receive from ward-based outreach teams (WBOTs). A study was undertaken to determine this phenomenon.Methods: The study used a cross-sectional study design. Tshwane district had established 39 ward-based outreach teams at the time of the study and households were conveniently selected. Hence the study population was estimated to be 3 600. Using 99% confidence level and 5% confidence interval, the sample size was 660, and oversampled to 765 since all households present during the data collection were willing to be included in the survey. Data collected was captured on Microsoft Excel and analysed using SAS, version 9.2.Results: Interviews were held with members of the families, who were willing to participate. Participants' ages ranged from 18 to 110, mean age 53.1years (SD=19.7). The study participants included more females (74.0%), and 45.2% were single. The majority (89.8%) were unemployed. Overall satisfaction was seen in 692 participants (90.7%). Outcome of satisfaction according to sex (91.9%), age (90.7%) and employment (90.8%) was not statistically significant with p-value<0.05.Conclusions: The findings of households' satisfaction regarding the healthcare services rendered by the ward-based outreach team in Tshwane district, Pretoria, South Africa showed a high level of satisfaction from the households. This high level of satisfaction was referred to as excellent and was not associated with sex, age or employment status. A recommendation is made to all stakeholders that the ward-based outreach team programme cover all municipal wards in the country in order to raise the level of households' satisfaction with the healthcare system.

Background: The aim of this study is to determine the profile of abdominal computed tomography (CT) scan findings of patients diagnosed with pancreatic adenocarcinoma and other pancreatic neoplasm that simulates pancreatic adenocarcinoma, which constitute the majority of pancreatic neoplasm at Dr. George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa. Materials and Methods: A prospective study of abdominal CT scans of 67 patients, aged 12 years and older, with histologically confirmed pancreatic neoplasms, including their medical records and laboratory results, from November 1, 2013 to June 30, 2017, was conducted. CT scan images were acquired with 128 slices, Philips, and GE CT scanners. Statistical analysis was made using a Statistical Program for the Social Sciences software SPSS (version 22.0). Results: There were 36 females (53.7%) and 31 males (46.3%) in this series and four demised. The ages of the patients ranged from 12 to 90 years. The most common clinical presentation was obstructive jaundice (86.6%). The predominant histological diagnosis was adenocarcinoma (74.6%), followed by primary lymphoma of the pancreas (13.4%) and 65.7% of the pancreatic neoplasms were unresectable, while most of the other pancreatic neoplasms based on their CT scan findings masqueraded as pancreatic adenocarcinoma. Pancreatic adenocarcinoma demonstrated both typical and atypical CT scan findings. Conclusion: Accurate diagnosis and appropriate management of pancreatic neoplasms are important because of their high morbidity and mortality. The majority of the pancreatic neoplasms were unresectable at the time of their presentation. A multidisciplinary management team is recommended since pancreatic neoplasms still remain a serious clinical challenge.

Background: In 2011, South Africa established ward-based outreach teams (WBOTs) comprising Community Health Workers as part of strategies to strengthen primary healthcare. The new community health workers (CHWs) lacked experience of the programme. This study aimed at assessing perceptions of community health workers on their training, teamwork and practice.Methods: This was a cross-sectional study conducted among CHWs in the seven regions of Tshwane health district between October and November 2015. Data were collected from 431 CHWs in eight Community Health Centres and 11 clinics using a pre-tested, self-administered questionnaire. Outcome measures were CHWs’ perceptions on training, teamwork and practice regarding WBOT programme.Results: A total of 431 CHWs formed the study sample. Participants had a mean age of 36 years (SD ± 9.46). The majority (88.2%) were female. Some 77% had completed secondary school. Overall, most CHWs perceived their training (86.4%), teamwork (87.6%) and practices (67.7%) to be good (p = 0.001). The majority were able to provide efficient health care despite the challenges experienced, which were lack of equipment, walking long distances, and safety on the streets and in households with patients who had mental health problems among others. Fisher's exact test showed a significant association between training and work challenges (p = 0.006).Conclusion: The study findings showed that most CHWs had good perceptions regarding their training, teamwork and practice. Several concerns raised by CHWs suggest the need for stakeholders to ensure availability of resources for optimal functioning of CHWs.

Background: In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. Health Care Practitioners (HCPs) are important role-players in its implementation. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase. Objective: To evaluate the awareness of HCPs about the NHI in the pilot Tshwane district of South Africa. Method: A cross-sectional survey was conducted among 1753 HCPs in Tshwane district. At 95% confidence level and 5% error margin, the sample size was 315 HCPs, but we over-sampled to 480. The study was conducted in 25 health facilities within the district. A pre-tested self-administered questionnaire was used. Results: A high proportion of HCPs were unaware of the objectives of the NHI program (p < 0.001); number of NHI pilot sites [(281; 59.4%) versus (145; 30.7%), p < 0.001]; rationale used to select pilot sites [(223; 46.9%) versus (193; 40.5%), p = 0.047]; role of the Integrated School Health Services (ISHP) [(250; 52.7%) versus (70; 14.8%), p < 0.001]; and specialists constituting the District Clinical Specialist Team (DCST) (p < 0.001). However, awareness regarding the Ward-Based Outreach Team (WBOT) leader was high [(236; 49.9%) versus (135; 28.5%), p < 0.001]. Conclusion: HCPs in Tshwane district demonstrated poor awareness of the NHI. This reveals that any awareness effort towards the NHI has not taken effect among the HCPs in this district.

Background: The World Health Organization aims to reduce tuberculosis (TB) mortality rate from 15% in 2015 to 6.5% by 2025.Aim: This study determined the profile of TB and human immunodeficiency virus (HIV) co-infected patients who died in Mahalapye District, Botswana, while on anti-TB medication and the factors that contributed to such outcome.Setting: The study was conducted in the Mahalapye Health District in Botswana.Methods: This was a cross-sectional study that reviewed patient records from the Mahalapye District Health Management Team Electronic Tuberculosis Register from January 2013 to December 2015.Results: The majority of the TB and HIV co-infected patients were on antiretroviral therapy (ART) (486 [81.63%]) or were initiated cotrimoxazole preventive therapy (CPT) (518 [87.2%]) while taking anti-TB treatment. Seventy-three (13.6%) TB and HIV co-infected patients died before completing anti-TB treatment. Three-quarters (54 [74.4%]) of patients who died before completing anti-TB treatment were on ART, among them two patients who were on ART at least 3 months prior to commencing anti-TB. Also, the majority (64 [87.7%]) of TB and HIV co-infected patients were commenced on CPT prior to death. There was a bimodal density curve of death occurrence in those who did not commence ART and in those who did not commence CPT.Conclusion: This study established that TB and HIV co-infected patients had a TB mortality of 13.6%. A high mortality rate was observed during the first 3 months in those who did not take ART and during the second and the fifth month in those who did not commence CPT. Further study is needed to clarify this matter.

South Africa’s listeriosis outbreak has topped the charts as the largest outbreak in history. The first reported case of the current outbreak of listeriosis was in January 2017. On 27 Feb 2018, the South African National Institute of Communicable Diseases (NICD) reported 945 confirmed cases, of which 176 had died (case fatality rate of 19%). Most reported cases were from Gauteng Province (59%, 555/945), followed by the Western Cape (12%, 116/945) and KwaZulu-Natal (7%, 66/945) provinces.1 South Africa is not the only country experiencing outbreaks of listeriosis. Europe has been experiencing a multi-country outbreak since 2015, with a combined number of only 26 cases from Austria, Denmark, Finland, Sweden and the United Kingdom classified as a confirmed microbiological cluster on the basis of whole genome sequencing (WGS) analysis, including core genome multilocus sequence typing (cgMLST) and single nucleotide polymorphism (SNP) based analysis, depending on the country. Four cases have died (case fatality 15.4%).2

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Background: A possible increasing trend in the incidence of diverticulosis was observed in adult patients referred to the Diagnostic Radiology department of Dr George Mukhari Academic Hospital (DGMAH), Ga-Rankuwa, Pretoria, for barium enema studies. The study will be the first to document the magnitude of this condition at our hospital since its inception.Objective: The aim of this study is to evaluate the current prevalence of diverticulosis at DGMAH Ga-Rankuwa whose patients are predominantly South Africans of African descent.Materials and Methods: We reviewed the medical records of all adult patients referred to DGMAH for barium enema investigations for 1 year. Barium enema studies of 166 patients who met the inclusion criteria were systematically evaluated radiologically for the presence of diverticulosis. Data from the records were analyzed using the Statistical Package for Social Sciences (SPSS, version 22.0) software program.Results: The patients' ages ranged between 18 and 95 years, with a mean age of 60.1 years. From the records analyzed, 77.7% were radiologically negative, whereas 22.3% were positive for diverticulosis. There was a female preponderance (23 cases [62.2%] among females versus 14 cases [37.8%] among males; P < 0.0001) and the diverticulosis had a diffused pattern. The increasing trend of diverticulosis observed at DGMAH did not reflect any statistically significant difference when compared with previous studies done in sub-Saharan Africa.Conclusion: This study demonstrates a possible trend of diverticulosis previously unrecorded in barium enema studies at DGMAH, probably attributable to the effects of urbanization and higher consumption of refined carbohydrate with low fiber residue.

Background Ectopic pregnancy (EP) is a life-threatening condition; at Odi Hospital, approximately 7–10 EPs are managed weekly. Our study is the first to assess the management of this life-threatening condition at Odi Hospital. Aim This study aimed to determine the incidence of EP and to assess the profile of women who presented with EP at Odi District Hospital from 01 January 2010 to 31 December 2014. Setting The study was conducted at Odi District Hospital, located in Mabopane, a township in Gauteng province, 45 km north of Tshwane, South Africa (SA). Methods This was a cross-sectional study. Results We analysed 263 completed patient records. The incidence rate was 22 per 1000 live births. The mean age was 28.9 years (SD ± 6.09), 57% were within the age group of 25–34 years, 90.9% were single and 85.2% were unemployed. Abdominal pain was the most common presenting complaint (81.1%). Ninety-nine (37.8%) were in a state of haemorrhagic shock. Possible risk factors were not documented in the patient files for 95%. A third (34.2%) were operated on within 4 hours of consultation. Early management was associated with poor record-keeping (p = 0.02). There was a delay in confirming the diagnosis in 48.7%. It was associated with gestational age (p = 0.0017), previous abdominal surgery (p = 0.0026), normal haemoglobin level at the time of consultation (p = 0.0024), considerable haemoperitoneum at operation (p < 0.00001) and per vaginal bleeding (p = 0.003). Conclusion The study highlighted the need to emphasise the importance of good record-keeping and documentation in patients, as well as the urgent need for ultrasound skills training among clinicians to implement the Essential Steps in Managing Obstetric Emergencies programme at this hospital to improve the management of EP and other obstetric emergencies.