Assessment of Accuracy of Suicide Mortality Surveillance Data in South Africa

Crisis ◽  
2007 ◽  
Vol 28 (2) ◽  
pp. 74-81 ◽  
Author(s):  
Stephanie Burrows ◽  
Lucie Laflamme
Keyword(s):  
South Africa ◽  
Surveillance System ◽  
Accurate Determination ◽  
Medical Practitioner ◽  
Epidemiological Data ◽  
Careful Examination ◽  
Suicide Mortality ◽  
Injury Death ◽  
Predictive Values ◽  
Medical Practitioners

Abstract. Although it is not a legal requirement in South Africa, medical practitioners determine the manner of injury death for a surveillance system that is currently the only source of epidemiological data on suicide. This study assessed the accuracy of suicide data as recorded in the system using the docket produced from standard medico-legal investigation procedures as the gold standard. It was conducted in one of three cities where the surveillance system had full coverage for the year 2000. In the medico-legal system, one-third of cases could not be tracked, had not been finalized, or had unclear outcomes. For the remaining cases, the sensitivity, specificity, and positive and negative predictive values were generally high, varying somewhat across sex and race groups. Poisoning, jumping, and railway suicides were more likely than other methods to be misclassified, and were more common among females and Whites. The study provides encouraging results regarding the use of medical practitioner expertise for the accurate determination of suicide deaths. However, suicides may still be underestimated in this process given the challenge of tracing disguised suicides and without the careful examination of potential misclassifications of true suicides as unintentional deaths.

scholarly journals Cost effectiveness of clinical associates: A case study for the Mpumalanga province in South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Joris Hamm ◽  
Petra Van Bodegraven ◽  
Martin Bac ◽  
Jakobus M. Louw
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Rural Areas ◽  
Healthcare Workers ◽  
Medical Practitioner ◽  
Literature Study ◽  
Medical Practitioners ◽  
Training Support ◽  
The Cost

Background: The National Department of Health of South Africa decided to start a programme to train mid-level healthcare workers, called clinical associates, as one of the measures to increase healthcare workers at district level in rural areas. Unfortunately, very little is known about the cost effectiveness of clinical associates.Aims: To determine, on a provincial level, the cost effectiveness of training and employing clinical associates and medical practitioners compared to the standard strategy of training and employing only more medical practitioners.Methods: A literature study was performed to answer several sub questions regarding the costs and effectiveness of clinical associates. The results were used to present a case study.Results: The total cost for a province to pay for the full training of a clinical associate is R 300 850. The average employment cost per year is R196 329 and for medical practitioners these costs are R 730 985 and R 559 397, respectively.Effectiveness: Clinical associates are likely to free up the time of a medical practitioner by 50–76%. They can provide the same quality of care as higher level workers, provided that they receive adequate training, support and supervision. Furthermore, they seem more willing to work in rural areas compared to medical practitioners.Conclusions: The case study showed that training and employing clinical associates is potentially a cost-effective strategy for a province to meet the increasing demand for rural healthcare workers. This strategy will only succeed when clinical associates receive adequate training, support and supervision and if the province keeps investing in them.

scholarly journals Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

2020 ◽  
Vol 17 (6) ◽  
pp. 1979 ◽  
Author(s):  
Prasanthi Puvanachandra ◽  
Aliasgher Janmohammed ◽  
Pumla Mtambeka ◽  
Megan Prinsloo ◽  
Sebastian Van As ◽  
...  
Keyword(s):  
South Africa ◽  
Road Traffic ◽  
Public Health Problem ◽  
Global Public Health ◽  
Injury Death ◽  
Middle Income ◽  
Suitable Alternative ◽  
Middle Income Countries ◽  
Restraint Use ◽  
Child Restraint

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

scholarly journals Secondary Analysis of an Electronic Surveillance System Combined with Multi-focal Interventions for Early Detection of Sepsis

2017 ◽  
Vol 26 (01) ◽  
pp. 47-66 ◽  
Author(s):  
Bonnie Westra ◽  
Sean Landman ◽  
Pranjul Yadav ◽  
Michael Steinbach
Keyword(s):  
Early Detection ◽  
Surveillance System ◽  
Point Of Care ◽  
Management Strategies ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Separate Analysis ◽  
Electronic Surveillance ◽  
Predictive Values ◽  
Sensitivity Specificity

SummarySummary: To conduct an independent secondary analysis of a multi-focal intervention for early detection of sepsis that included implementation of change management strategies, electronic surveil-lance for sepsis, and evidence based point of care alerting using the POC AdvisorTM application. Methods: Propensity score matching was used to select subsets of the cohorts with balanced covariates. Bootstrapping was performed to build distributions of the measured difference in rates/ means. The effect of the sepsis intervention was evaluated for all patients, and High and Low Risk subgroups for illness severity. A separate analysis was performed patients on the intervention and non-intervention units (without the electronic surveillance). Sensitivity, specificity, and the positive predictive values were calculated to evaluate the accuracy of the alerting system for detecting sepsis or severe sepsis/ septic shock.Results: There was positive effect on the intervention units with sepsis electronic surveillance with an adjusted mortality rate of –6.6%. Mortality rates for non-intervention units also improved, but at a lower rate of –2.9%. Additional outcomes improved for patients on both intervention and non-intervention units for home discharge (7.5% vs 1.1%), total length of hospital stay (-0.9% vs –0.3%), and 30 day readmissions (-6.6% vs –1.6%). Patients on the intervention units showed better outcomes compared with non-intervention unit patients, and even more so for High Risk patients. The sensitivity was 95.2%, specificity of 82.0% and PPV of 50.6% for the electronic surveillance alerts. Conclusion: There was improvement over time across the hospital for patients on the intervention and non-intervention units with more improvement for sicker patients. Patients on intervention units with electronic surveillance have better outcomes; however, due to differences in exclusion criteria and types of units, further study is needed to draw a direct relationship between the electronic surveillance system and outcomes.

Bogus Doctor Deceptions during Multi-Casualty Events and Disasters

2000 ◽  
Vol 15 (3) ◽  
pp. 25-27 ◽  
Author(s):  
Antony Nocera ◽  
Anne M. Newton
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
Medical Literature ◽  
Health And Safety ◽  
Medical Practitioner ◽  
Security Threat ◽  
Medical Practitioners ◽  
Secure Systems ◽  
Public Health And Safety

AbstractBogus doctors pose a threat to public health and safety, and they present a security threat at disaster and multi-casualty event sites. A “bogus doctor” is an individual who misrepresents him/herself as a registered medical practitioner by their demeanour, actions, dress, or surroundings, while not entitled to be on a register of medical practitioners. There are very few reports in the medical literature, but practitioners have encountered them at the site of a disaster or multi-casualty event. This paper examines the five cases identified in the literature. Secure systems that confirm a health professional's identity and qualifications are required to avoid unnecessary delays and to protect the victims and health professionals providing the care.

scholarly journals Mycotoxins and health risks

1986 ◽  
Vol 5 (3) ◽  
pp. 154-156
Author(s):  
P. G. Thiel
Keyword(s):  
South Africa ◽  
Immune System ◽  
Health Risks ◽  
Chronic Exposure ◽  
Epidemiological Data ◽  
Domestic Animals ◽  
Agricultural Products ◽  
Farm Animals ◽  
Fungal Contamination ◽  
Experimental Animals

Fungal contamination of agricultural products can prove to be harmful to humans and domestic animals as these fungi produce a variety of mycotoxins which can eventually occur in food. Acute intoxications with mycotoxins occur regularly in farm animals but, fortunately, are infrequently observed in humans. However, the chronic exposure of humans to mycotoxins occurs regularly. Such exposures are potentially teratogenic and carcmogenic and can suppress the immune system. It is presently impossible to establish safe levels of exposure for most mycotoxins due to scanty epidemiological data and insufficient observations on experimental animals. With respect to aflatoxin all available data point to a real health risk. Risk analysis based on epidemiological observations shows that the liver-cancer risk for individuals in South Africa is potentially increased by continued exposure to the present legally permitted level of aflatoxin in food.

scholarly journals Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South Africa

2013 ◽  
Vol 19 (4) ◽  
pp. 5
Author(s):  
Paulina M Van Zyl ◽  
Carlo A Gagiano ◽  
Willie F Mollentze ◽  
Jacques S Snyman ◽  
Gina Joubert
Keyword(s):  
South Africa ◽  
Alcohol Withdrawal ◽  
Real Life ◽  
Therapeutic Benefit ◽  
Free State ◽  
Prescribing Practices ◽  
Related Condition ◽  
Free State Province ◽  
Medical Practitioners ◽  
Selection Of

<strong>Background.</strong>The selection of pharmacotherapy for the treatment of alcohol withdrawal remains a clinical challenge. Research continues into the underlying pathophysiology of dependence and withdrawal. A spectrum of clinical presentations of alcohol dependence is emerging, yet recommendations and guidelines have remained unchanged for some time. <p><strong>Objectives.</strong> To engage with the problem of translating research into practice, as reflected by the selection of pharmacotherapy for alcohol withdrawal by medical practitioners in the Free State Province, South Africa.</p><p><strong>Methods.</strong> A questionnaire-based survey and interviews were conducted among 121 professionals in both the private and public sectors across the province. A subgroup was formed comprising the 58 doctors who indicated that they prescribe for alcohol withdrawal. Participants worked in private general practice, specialist psychiatry practice, in a state hospital or in a treatment centre.</p><p><strong>Results.</strong> Prescribing practices varied based on practitioners’ geographical distribution and professional capacity. Deviation from standard recommendations included the routine use of clothiapine and antidepressants in withdrawal regimens. Prescribing clothiapine appears to be a local custom. While prescription of antidepressants may indicate unrealistic expectations of therapeutic benefit, there are clear indications that this is maintained to mask the diagnosis of an alcohol-related condition. Prescribing for alcohol withdrawal is therefore not necessarily determined by pathophysiology or efficacy of medication.</p><p><strong>Conclusion.</strong> Withdrawal regimens need to be reassessed by researchers, policy makers and funders, balancing new developments with the real-life experiences and challenges of prescribers and their patients.</p>

scholarly journals Ethical misconduct by registered physiotherapists in South Africa (2007–2013): A mixed methods approach

2015 ◽  
Vol 71 (1) ◽  
Author(s):  
Willem A. Hoffmann ◽  
Nico Nortjé
Keyword(s):  
South Africa ◽  
Content Analysis ◽  
Mixed Methods ◽  
Data Analysis ◽  
Qualitative Content Analysis ◽  
Epidemiological Data ◽  
Unethical Conduct ◽  
Mixed Methods Approach ◽  
Ethical Misconduct ◽  
Patient Consent

Background: The role of ethics in a medical context is to protect the interests of patients. Thus,it is critically important to understand the guilty verdicts related to professional standard breaches and ethics misconduct of physiotherapists.Aim: To analyse the case content and penalties of all guilty verdicts related to ethics misconduct against registered physiotherapists in South Africa.Methods: A mixed methods approach was followed consisting of epidemiological data analysis and qualitative content analysis. The data documents were formal annual lists (2007–2013) of guilty verdicts related to ethical misconduct. Quantitative data analysis focused on annual frequencies of guilty verdicts, transgression categories and the imposed penalties. Qualitative data analysis focused on content analysis of the case content for each guilty verdict.Results: Relatively few physiotherapists (0.05%) are annually found guilty of ethical misconduct. The two most frequent penalties were fines of R5000.00 and fines of R8000.00–R10 000.00. The majority of transgressions involved fraudulent conduct (70.3%), followed by performance of procedures without patient consent (10.8%). Fraudulent conduct involved issuing misleading, inaccurate or false medical statements, and false or inaccurate medical aid scheme claims.Conclusion: Unethical conduct by physiotherapists in South Africa occurs rarely. The majority of penalties imposed on sanctioned physiotherapists were monetary penalties.

Critical reflection: a general practice support group experience

2018 ◽  
Vol 24 (3) ◽  
pp. 204
Author(s):  
Sophia Samuel ◽  
Heather Thompson
Keyword(s):  
Support Group ◽  
Best Practice ◽  
Critical Reflection ◽  
Medical Practitioner ◽  
Theory And Practice ◽  
Medical Practitioners ◽  
Workplace Satisfaction ◽  
Australian Health ◽  
Social Work Theory ◽  
Pastoral Support

The problem of medical practitioner burnout and loss of morale remains an ongoing challenge in the Australian health workforce. Collegiate recommendations are individualistic or personalised, or worse, punitive. Critical reflection in supervision is a long-accepted and key aspect of social work theory and practice. The use of critical reflection within a general practitioner support group is examined and key learnings from our findings over 3years are discussed. All participants reported the group enhanced individual and team workplace satisfaction, and wellbeing. This Practice and Innovation paper offers an example that could help improve current best practice in the pastoral support of medical practitioners.

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