Households’ satisfaction with the healthcare services rendered by a ward-based outreach team in Tshwane district, Pretoria, South Africa

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.

Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 × 3 factorial randomized single-blind multicenter trial

BACKGROUND

Current hypertension guidelines recommend the use of combination therapy as first-line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)-lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue.

METHODS

The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single-blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub-Saharan Africa (SSA). Seven hundred two patients aged 30-79 years with a sitting systolic BP of 140 mm Hg and above, and less than 160 mm Hg on antihypertensive monotherapy, or sitting systolic BP of 150 mm Hg and above, and less than 180 mm Hg on no treatment, will be centrally randomized into any of the 3 arms (234 into each arm). The CREOLE study is taking place in 10 sites in SSA, and the primary outcome measure is change in ambulatory systolic BP from baseline to 6 months. The first patient was randomized in June 2017, and the trial will be concluded by 2019.

CONCLUSIONS

The CREOLE trial will provide unique information as to the most efficacious 2-drug combination in blacks residing in SSA and thereby inform the development of clinical guidelines for the treatment of hypertension in this subregion.

Prof George Samuel Fehrsen 26 August 1938 – 22 May 2018 (almost 80 years)

No abstract available.

Intimate partner violence: The need for an alternative primary preventive approach in Botswana

Intimate partner violence is a common social problem which causes considerable relationship stress and results in significant morbidity and mortality of the victims. Botswana, like many other countries in sub-Saharan Africa, has tried to address the problem of intimate partner violence with legislations prescribing punitive measures for the perpetrators and protection for the victims. The effectiveness of these measures in reducing the prevalence of intimate partner violence is doubtful. This article is to motivate for an alternative primary preventive approach to the problem as a more pragmatic option.

Mastering your Fellowship, Vol 58, No 1 (2016)

The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.

Have we lost the global obesity battle?

No abstract available.

Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences

BACKGROUND

International medical electives are well-accepted in medical education, with the flow of students generally being North-South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North-South electives from the literature.

METHODS

In-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way.

RESULTS

The residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal.

CONCLUSIONS

The learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere. Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.

The contribution of family physicians to district health services: a national position paper for South Africa

This position paper on Family Medicine in South Africa was written for the National Department of Health in 2014 for the purposes of delivering a comprehensive assessment of the contribution that family physicians could make to the health system, and the issues that need to be addressed in order to realise this contribution. The paper mainly addresses issues in the public sector. It outlines the policy environment, health and health services context, the contribution of family physicians, their role in relationship to other healthcare workers, the initial evidence of their impact, the implications for posts and career pathways and the current state of training programmes, as well as providing key recommendations. The paper represents the viewpoint of the South African Academy of Family Physicians and the College of Family Physicians of South Africa, and attempts to speak with one voice on the current situation and need for future action.

Beyond the Millennium Development Goals deadline: what next?

No abstract available.

Impact of the 1996-1997 supplementary measles vaccination campaigns in South Africa

BACKGROUND

In South Africa, as part of an effort to eliminate indigenous measles by 2002, vaccination campaigns were conducted in 1996-1997 targeting all children aged 9 months to 14 years; coverage was estimated at 85%. The impact of the campaigns on measles disease burden was evaluated in 1999.

METHODS

We analysed routine measles surveillance data and undertook a retrospective review of hospital registers in two of South Africa's nine provinces.

RESULTS

In Mpumalanga in the pre-campaign years (1992-1996), 4,498 measles cases and 6 deaths were reported; 182 cases and no deaths were reported in 1997-1998. Hospital registers showed 1,647 measles hospitalizations and 11 deaths in the pre-campaign period, and 60 hospitalizations and no deaths after the campaign (1997-April 1999). In Western Cape in pre-campaign years (1992-1997), 5,164 measles cases and 19 deaths were reported; 132 cases and no deaths were reported in 1998. Hospital registers showed 736 measles hospitalizations and 23 deaths in the pre-campaign period, and 29 measles hospitalizations and no deaths post-campaign (1998-July 1999).

CONCLUSIONS

Study findings indicate that reported measles cases, measles-related hospitalizations and deaths were considerably reduced in both provinces after the campaign compared with the pre-campaign period. Longer observation is needed to evaluate the long-term impact of the campaigns.