South African Medical Journal - May 2023 Vol 113 No 5

Introduction

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans: Layperson aspects and the role of emergency medical services

Snakebites occur in one of two distinct scenarios, which are categorized as legitimate and illegitimate: so-called legitimate bites occur where a person unintentionally and unknowingly provokes a venomous snake (e.g. stepping on a snake while out walking), while illegitimate bites occur when someone sees a snake and then tries to catch, kill or otherwise interact with it and is bitten. The latter bites are typically seen in snake owners, breeders or snake-removers who are intentionally interacting with often the more venomous species. Most of what is recommended in the care of snakebite is largely expert opinion based on retrospective data, with little or no randomized or prospective studies available on the treatment of snake envenomation in this country. The article aims to provide the current best evidence and best practice information for the benefit of every SA citizen. The attached flip-chart addressing the level of care aims to provide a pocket-friendly resource for the layperson and the emergency medical services (EMS) practitioner. 

Medical internship training in South Africa: Re¬ections on the new training model 2020 – 2021

Medical internship training in South Africa (SA) was introduced by the Health Professions Council of SA (HPCSA) as a 1-year programme in the 1950s, followed by the introduction of a year of community service from 1999. As per the HPCSA guidelines, the purpose of medical internship training is for trainee doctors to complete their training under supervision in accredited facilities. Internship training should be comprehensive and complement the SA healthcare system rooted within the primary healthcare (PHC) approach. This concept of PHC has been defined by three interrelated and synergistic components, comprising of meeting people’s health needs through promotive, preventive, curative, rehabilitative and palliative care, by addressing social, economic, and environmental factors through policies, and then by empowering people and communities to optimize their health as self-carers and caregivers. Training should provide the intern with exposure to a spectrum of clinical conditions and develop skills in the management of common emergencies.

The incidence and outcomes of high-risk acute coronary syndromes in Western Cape Province, South Africa: A prospective cohort study

Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite a high burden of communicable disease, ischaemic heart disease (IHD) is the 10th most common cause of death in South Africa (SA), and recent data suggest that it is on the rise. IHD was ranked as the most common cause of death in a recent survey in Western Cape Province, at 90 per 100¬ 000. SA is an upper-middle-income country (UMIC) as defined by the 2021 World Bank summary. However, although SA is an UMIC, because of inequality in resource distribution a large proportion of its population face challenges characteristic of a low- to middle-income country (LMIC).

Knowledge, attitudes and practices of undergraduate health sciences students on hepatitis B vaccination at a South_African university highlight the need for improvement of policies, implementation and co-ordination

Hepatitis B is a potentially life-threatening liver disease that is caused by the hepatitis B virus (HBV). It remains a major public health challenge, with approximately 296-million people chronically infected globally, and ~1¬ million persons dying annually from consequent complications, such as liver cirrhosis and hepatocellular carcinoma. HBV is estimated to be up to 100 times more infectious than HIV, and can survive outside of the body for up to 7¬ days, during which the virus is still capable of causing infection. Transmission of HBV occurs through exposure to infected blood and other bodily fluids. The timing of exposure and transmission routes typically accounts for the geographic variation in severity and prevalence of HBV infection. Chronic HBV infection disproportionately affects low- and middle-income countries, including many in sub-Saharan Africa, where exposure typically occurs at an earlier age (infancy and early childhood), leading to hyperendemic levels. With no ‘curative’ therapies currently available, the prevention and control of HBV infection depends on the effective implementation of policies ensuring the provision of the safe and highly effective hepatitis B vaccine (HepB) to at-risk populations.

SARS-CoV-2 transmission risk in the school environment: A pilot case-ascertained prospective study to inform future school-based surveillance

A systematic review of global studies of SARS-CoV-2 school-based studies identified that transmission is low in schools, but that most studies are not sufficiently controlled or well designed to provide comparative data to ascertain the true risk in schools compared with the community. In addition, results may be biased, as the initial response to the COVID-19 pandemic resulted in school closures across the world, with few early studies conducted with schools in full attendance. The role of school transmission in the spread of the SARS-CoV-2 virus within communities therefore remains uncertain.

Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors

Spinal cord injury (SCI) is a serious medical event that almost always requires hospitalization for medical intervention as well as rehabilitation. The primary effects of SCI are sensorimotor deficits and autonomic system dysfunction, which if left unmonitored could_ set in motion a cascade of secondary health conditions (SHCs). To mitigate these, specialized and comprehensive healthcare and rehabilitation services are needed to limit the impact of the primary and secondary effects of the injury on functioning and health.

Healthcare workers’ knowledge and practice of the South_African national tuberculosis management guidelines

Tuberculosis (TB) is a global epidemic and remains one of the world’s top infectious diseases, claiming the lives of ~4 000 persons every day. About a quarter of the world’s population is infected with Mycobacterium tuberculosis, the bacterium that causes TB. The probability of developing active TB disease is increased among people living with HIV, and people exposed to risk factors such as poverty, diabetes, smoking, and excessive alcohol consumption. People living with HIV (PLHIV) are 18 times more likely to develop active TB disease than people without HIV. In 2019, 10 million people had active TB disease worldwide. Of these, 5.6 million were men, 3.2 million were women, and 1.2 million were children. Although TB is preventable and treatable, a total of 1.4 million people died from the disease in 2019, including 208 000 PLHIV.

Operating theatre e_ ciency at a tertiary eye hospital in South Africa

The South African (SA) public health system has limited resources and long surgical waiting lists. Efficient running of operating theatres is therefore particularly crucial given the limited budget. Operating theatre inefficiency is a significant cause of wasted resources. In_the USA, the cost of operating time has been estimated at USD22 - 80_ per minute. In a 2018 study in SA, Samuel and Reed found that theatre time costs ZAR32 per minute in a regional state hospital. In their costing model, they included as many relevant costs as they could, preferring to over-estimate costs in order to be as inclusive as possible. Although this figure gives an estimate of theatre costs in regional state hospitals, it is likely to be an underestimation for operating theatres in a central hospital.