Masters Degrees (Family Medicine and Primary Care)
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- ItemFactors influencing Western Cape community service doctors’ choice of whether to seek employment in public, rural practice(Stellenbosch : Stellenbosch University, 2024-12) Baytopp, Tamryn; Motsohi, Ts'epo; Lomas, Vanessa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Shortage of staff in rural areas has contributed to long-standing inequitable healthcare access between urban and rural populations. One of South Africa’s strategies to address this is the compulsory community service program.(1) To capitalize on this, doctors need to be encouraged to remain in their facilities beyond their community service periods. Identifying factors that positively or negatively influence their decisions to stay could help to develop more focused strategies to promote the retention of doctors in rural areas.(2) Aim: To describe the important factors influencing Western Cape community service doctors’ choice of whether they will seek employment in public rural practice. Design and setting: This was an observational cross-sectional study with correlational analysis of community service doctors working in the Western Cape in 2022. Method: Western Cape community service doctors were invited to complete an internet-based questionnaire. Results: A total of 86 community service doctors completed the questionnaire, of whom 8% intended to work in public rural practice in 2023 and 21% considered rural practice sometime in the future. Demographic factors associated with the intention to work in rural practice were a rural upbringing (6.5 times more likely to consider rural practice) and rural placement for internship (7.7 times more likely to consider rural practice) and community service (3.5 times more likely to consider rural practice). The most important factors influencing their decision for or against rural practice were issues of personal safety and security (mean likert score of 4.7) followed by job satisfaction (mean likert score of 4.6) and mental health (mean likert score of 4.6). Rural upbringing (mean likert score of 1.8) and exposure in internship (mean likert score of 2.4) were ranked low in importance. Conclusion: This study found the proportion of community service doctors considering working in public rural practice has not significantly increased (20%) compared to previous findings in the literature. Suggestions based on the results include revision of strategy on the part of policy makers, preferential enrolment of medical students with a rural upbringing, and prioritisation of placing community service doctors in rural areas. More focus should be placed upon promoting safe, satisfying work environments which are protective of staff mental and psychological wellbeing.
- ItemInduction of labour at district hospitals in the Cape Winelands District of South Africa : a quality of care audit(Stellenbosch : Stellenbosch University, 2023-12) Hattingh, Daniel Wilhelmus; Jenkins, Louis; Williams, Andrew; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Introduction: Induction of labour (IOL) is when the process of labour is artificially initiated before the onset of spontaneous labour. Evidence suggests that IOL can improve obstetric outcomes, especially in the context of prolonged pregnancy, hypertensive disorders and prolonged rupture of membranes. Limited information is available on the quality of care received during IOL at district hospitals in South Africa. Aim: To audit the quality of care provided during IOL at district hospitals in the Cape Winelands District (CWD) of South Africa. Methods: An audit of the structure, process and outcomes of IOL performed at three district hospitals in the CWD. Retrospective data was collected from records of patients who underwent IOL at the district hospitals between 1 July 2021 and 31 December 2021. Results: This audit included 147 IOL cases. The IOL rate was 6.8 %. The most common indication for IOL was prolonged pregnancy (57.8%). Misoprostol was the induction agent of choice in 70,1 % of cases while mechanical IOL was performed in only 6.1% of cases. After IOL, 39.8 % of patients had a caesarean delivery. Vaginal delivery within 24-hours after starting IOL was achieved in 47.6% of cases. No cases of maternal or neonatal morbidity were recorded. Conclusion: Adequate structures were in place at the district hospitals to perform IOL, including the availability of medication, equipment and surgical capacity. The process of IOL did not fully align with the South African Maternity Care Guidelines regarding the correct use of the Bishop score and mechanical methods of IOL. Maternal and neonatal outcomes were satisfactory, however the high caesarean delivery rate after IOL and the low delivery rate within 24 hours after IOL were concerning.
- ItemCharacteristics of women initiated on opioid substitution therapy at primary health care level in Tshwane, South Africa(Stellenbosch : Stellenbosch University, 2023-12) Goeieman, Daniela S.; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Women who use drugs (WWUD) face specific challenges compared to men, such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence. However, this population's access to treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability. Aim: To investigate the characteristics of WWUD accessing opioid substitution therapy (OST) services in primary health care, with the goal of informing gender-sensitive services. Setting: The Community Orientated Substance Use Programme (COSUP) Tshwane, South Africa. Methods: This descriptive observational study included all 199 adult women with an opioid use disorder who received OST from COSUP in 2016-2022. Existing data were extracted from an electronic database and paper-based files. Data was analysed with the Statistical Package of Social Sciences and associations of variables with retention on OST for ≥6 months were analysed. Results: Participants were unemployed, most falling within the 20-29 years age range and accessing services from community based facilities. One in three women had experienced intimate partner violence and 19.0% were pregnant whilst on OST. Retention on OST was significantly associated with age at initiation (p=0.047), knowledge of HIV status (p=0.029), an increase in the ASSIST score (r=0.171, p=0.023), and methadone dose (r=0.339, p<0.001). Factors such as race, employment status, health system level, pregnancy, intimate partner using substances, intimate partner violence, route of administering opioids, and having tuberculosis and/or hepatitis C infection did not show a significant relationship with retention on OST (p>0.05). Conclusion: The study emphasises the intersectionality of substance use harms and retention on OST, calling for further research and the implementation of comprehensive interventions in harm reduction programs providing OST.
- ItemDiabetes in the Cape Town Metropole – a secondary analysis of the diabetes cascade database 2015 - 2020(Stellenbosch : Stellenbosch University, 2021-12) Boake, Megan Wilson; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Background: Diabetes is the leading cause of death in women in South Africa and one in four South Africans over the age of 45-years have diabetes. The Western Cape (WC) Provincial Health Data Centre has integrated data from multiple sources into a diabetes cascade database. The Director responsible for chronic disease management asked for an analysis of the database. Aim: The aim of the study was to describe the demographics, comorbidities and outcomes of care for patients with diabetes treated at primary care facilities in the WC between 2015 – 2020. Methods: This was a secondary analysis of data from the diabetes cascade database. Data was imported into the Statistical package for Social Sciences for analysis. Results: The database included 116726 patients with a mean age of 61.4 years and 63.8% were female. The mean age at death was 66.0 years. Ninety-eight percent of people lived in the Cape Town Metropole. Co-morbidities included hypertension (69.5%), mental health disorders (16.2%), HIV (6.4%) and previous TB (8.2%). Sixty-three percent of the study population had at least one previous hospital admission and 20.2% of all admissions were attributed to cardiovascular diseases. Coronavirus related admissions were the third highest reason for admission over a 10-year period. Up to 70% of the people were not receiving an annual HbA1c test. The mean value for the last HBA1c taken was 9.0%. Three-quarters (75.5%) of patients had poor glycaemic control (HbA1c >7%) and a third (33.7%) were very poorly controlled (HbA1c>10%). Glycaemic control was significantly different between sub-districts in Cape Town as well as rural areas. Renal disease was prevalent in 25.5%. Conclusion: Diabetes is extremely poorly controlled in the province and diabetic related morbidity and mortality are high. There is poor compliance with guidelines for HbA1c and eGFR measurement. At least 7% of diabetic patients are being admitted for diabetic-related complications annually. This is a clear call to action on the care for people with diabetes in the WC.
- ItemEvaluating the effectiveness of brief behaviour change counselling in a primary care facility(Stellenbosch : Stellenbosch University, 2020-12) Ganzevoort, J. H.; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Introduction Non-communicable diseases are associated with four risky behaviours, an unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. A new model of brief behaviour change counselling (BBCC) was developed in South Africa for primary care providers. There is South African evidence that BBCC can be effective with harmful use of alcohol and tobacco, but no local evidence with regard to unhealthy diet and physical inactivity. Aim The aim of the study was to evaluate the effect of BBCC on diet and physical activity in patients with overweight/obesity and a moderate to high cardiovascular disease (CVD) risk. The primary outcome of the study was for at least 15% of patients to achieve either a 20% improvement in dietary score or a 20% improvement in the metabolic equivalent of task (MET) minutes score Setting A primary care clinic within the Cape Winelands district in the Western Cape, South Africa Methods This was a before-and-after quantitative study that measured change in diet, physical activity and body mass index (BMI) associated with BBCC delivered by primary care providers to 145 patients. Participants completed physical activity and diet questionnaires as well as measures of blood pressure, weight and BMI at baseline and 4-8 months later. Two sessions of BBCC were given over a period of 2-4 months. Data was analysed with the Statistical Package for the Social Sciences. Results Paired data was obtained from 139 patients, mean age was 53.5 years (SD ±10.0), and 75.9% were female with a mean BMI of 36.6 kg/m2 (SD ±8.0). Overall 78.5% of patients achieved the primary outcome, 77.0% improved their diet score by >20% and 8.9% improved their MET minutes score by >20%. The mean diet score and mean MET minutes score also significantly improved (p<0.001). There were no significant changes in BMI, weight or blood pressure Conclusion This study shows the potential of BBCC in the primary care setting and adds to the evidence for the effectiveness of BBCC across all four key risk behaviours for non-communicable diseases. Training of primary care providers in BBCC should continue and further clinical trials to assess the effect of this model of BBCC in our context are needed.