Introduction

Perspectives on gestational diabetes mellitus in South Africa

Gestational diabetes mellitus (GDM) has increasingly become a global burden alongside the obesity epidemic. According to the latest International Diabetes Federation data (2019), 16% of live births globally had some form of hyperglycaemia in pregnancy, of which 84% was due to GDM. Concerningly, the vast majority of cases arise from low- to middle-income countries (LMICs). Worldwide, the landscape of GDM has remained a dynamic entity, with the prevalence, terminology, screening protocols and diagnostic criteria continuously changing from as early as the 1980s. The varying terminology employed to define GDM was modified by the World Health Organization (WHO) in 2013 following the findings of the Hyperglycemia and Adverse Pregnancy Outcome Study (HAPO), which reported that blood glucose thresholds below recognised or accepted GDM diagnostic criteria at the time were linked to adverse maternal and neonatal outcomes. The term ‘hyperglycaemia first detected in pregnancy’ (HFDP), coined by the WHO in 2013, encompasses the varying degrees of glucose intolerance detected in pregnancy, with GDM being the milder degree of HFDP and diabetes in pregnancy (DIP) the more severe form, and will be utilised for the purposes of this article

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

COVID-19, caused by SARS-CoV-2, has wreaked havoc on global economies and healthcare systems around the world. The World Health Organization declared COVID-19 a pandemic in March 2020.[1] Waves of new infection and new, more transmissible SARS CoV-2 variants have led to protracted lockdown regulations in many countries. While lockdown has been an effective method of ‘flattening the curve’, it is not a socially or economically sustainable solution for the long term. The ability of healthcare systems to predict and plan for surges in infection has become crucial.

Curatorship applications: The role of neuropsychology

Living in an ageing society, the phenomenon of cognitive decline is likely to increase in coming years. The World Health Organization (WHO) documented that in 2019, the number of people aged ≥60  years was 1 billion. This number is projected to increase to 1.4  billion by 2030 and 2.1 billion by 2050. The WHO also estimates that 55 million people live with dementia worldwide, with an expected increase of 10 million per year. The diagnosis of dementia is also becoming more frequent.  Neurocognitive deficits associated with COVID-19[5] and the increased prevalence of HIV related dementia may contribute to the increase in dementia cases, including young-onset dementia, therefore potentially decreasing the age of persons requiring curatorship. Consequently, questions of legal competency may therefore arise more often.

COVID-19 vaccine hesitancy and missed vaccine rollout targets: The case for using general practitioners

The South African (SA) government is falling behind with its COVID-19 vaccination roll-out targets, despite using several innovative strategies to achieve them. The glaring gap in these measures, however, is the failure by the Department of Health (DoH) to utilise one of the country’s most trusted and effective health resources, that are used in several other countries – general practitioners (GPs). This failure has persisted despite the South African Medical Association (SAMA) and others calling on government to allow GPs to assist with the vaccine roll-out and stating that the roll-out programme should be less centrally controlled by government. In considering whether it would be useful to involve GPs, it is necessary to examine: (i) the reasons for COVID-19 vaccination hesitancy; (ii) the level of public confidence in the DoH and government policies; (iii) public confidence in the services provided by GPs; and (iv) the steps the DoH can take to ensure that GPs provide a proper service.

Liability of doctors based on negligence for culpable homicide: No need to change the law concerning medical negligence or to establish special medical malpractice courts – use mediation and medical assessors instead

It was recently reported that a number of doctors’ organisations have written to the Minister of Health requesting him to introduce a stricter test beyond mere negligence to ground prosecutions against doctors in criminal culpable homicide cases. The South African Medical Association has gone further and requested the establishment of medical malpractice courts to deal with the spiralling malpractice cases against doctors. The arguments for a different approach to criminal prosecutions of doctors for culpable homicide and calls for special malpractice courts seem to have been triggered by the acquittal of Dr Van der Walt by the Constitutional Court, because he had not received a fair trial when found guilty of negligently killing a child. It is intended to indicate that the concerns raised by the doctors’ organisations regarding culpable homicide and the call for separate medical malpractice courts are not warranted, because they may be dealt with by the present legislative framework and future practice directives, by using mediation and medical assessors instead.

 

Accreditation

Health Professions Council of South Africa

MDB015/MPDP/038/206

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South African Medical Journal - March 2022 Vol 112 No 3

3.0 CPD Points


Level 2