- 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.
- ItemAssessment, diagnosis and management of pulmonary tuberculosis in children under five years of age in the Langeberg sub-district, Western Cape, South Africa(Stellenbosch : Stellenbosch University, 2020-12) Williams, Andrew; Pather, Michael Karl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: TB remains one of the top 10 leading causes of death worldwide as millions of people still contract the disease annually. It is estimated that TB caused between 1.2 and 1.4 million deaths globally in 2017. The incidence of TB in children is a reflection of the underlying factors that fuel the TB epidemic, as these infections reflect ongoing TB-transmission. Aim: To describe how the diagnosis of Pulmonary Tuberculosis (PTB) in children under 5 years is made in the Langeberg sub-district. Setting: The Langeberg sub-district includes Robertson and Montagu District Hospitals as well as their surrounding clinics. A total of nine primary healthcare (PHC) clinics as well as two mobile clinics serving the farm areas in the sub-district were included. Methods: A retrospective descriptive study was conducted. The researcher obtained statistics from the information management department of the Langeberg sub-district and utilised information of all known and notified cases of tuberculosis in the district. All cases of PTB diagnosed from 1st January 2018 to 31st December 2018, in children under 5 years of age were included. Results: A total sample of 166 folders were reviewed. A proven positive adult contact was identified in 39% of cases. A suggestive chest x-ray was found in 93,4% of cases although specific CXR findings were not documented. Gastric washings were done in 52 of the children and had a positive yield of 13%. A total of 4,7% had HIV/TB co-infection and 12% had comorbid malnutrition. 85,5% of children had a positive treatment outcome (treatment completed or cured). Conclusion: The diagnosis of PTB in children primarily remains a radiological diagnosis, but clinical factors like symptoms and their duration, weight trends and the presence of an adult contact have also been considered. Microbiological confirmation was absent in the majority of cases started on TB treatment. Comorbid HIV infection, malnutrition or asthma did not contribute to increased risk for adverse outcomes. Contact tracing needs to be improved within the sub-district.
- ItemThe role of community health workers in non-communicable disease in the Helderberg district(Stellenbosch : Stellenbosch University, 2020-12) Williams, Doresha Lize-Marie; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Introduction: Community health workers (CHWs) have been part of primary health care (PHC) for many years and are integral to the Department of Health’s (DOH) strategy for the re-engineering of PHC. The DOH envision that the role of CHWs should be comprehensive, covering the breadth of health care issues and including health promotion and disease prevention interventions, treatment adherence support as well as rehabilitation and palliative care. However, their roles in non-communicable diseases (NCDs), are less clear. Aim: The aim of this study was to explore the current role of CHWs with regard to NCDs. Setting: The research was conducted at a non-governmental organisation, in the Helderberg sub-district of Cape Town, South Africa. Methods: The study design was a qualitative exploratory descriptive study that made use of non-participant observation and qualitative interviews with community health workers, non-governmental organisation manager and nurse coordinator, and the sub-district manager of community-based services at the DOH. Findings: CHWs displayed a strong sense of significance and pride in their work because they were embedded in the communities they served. Their role with regard to NCDs was potentially comprehensive, but limited by a lack of sufficient training, inadequate supportive supervision, poor inter-sectoral support from social services and a need for more clarity on their roles in rehabilitation and palliative care. Training might also have been limited by low educational backgrounds. A number of opportunities and threats were identified such as poor remuneration and labour law issues, poor integration of community- and facility-based teams, the need for a more functional and electronic data collection system that was linked to the district health information system, and some deficiencies in terms of equipment and resources. Conclusion: CHWs have the foundation to provide a comprehensive approach to NCDs, but their work needs to be strengthened in many of the key areas to support their activities. In relation to NCDs, they need training in basic and brief behaviour change counselling and risk factors as well as in the areas of rehabilitation and palliative care.
- ItemTo evaluate the psychometric properties of a tool used to assess a new model of brief behaviour change counselling in the South African context(Stellenbosch : Stellenbosch University, 2019-12) Fouche, Jani; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Introduction: Brief behaviour change counselling (BBCC) in primary care can address many of the behavioural risk factors underlying the burden of disease such as unhealthy eating, physical inactivity, tobacco smoking and alcohol use. A new model combined the 5 As (Ask, Alert, Assess, Assist, Arrange) with a guiding style of communication. Training and evaluation of this new model requires a valid and reliable assessment tool. Aim: To evaluate the validity and reliability of a tool used to assess a new model of BBCC in the Western Cape, South Africa. Methods: Exploratory sequential mixed methods included initial qualitative feedback from an expert panel to assess validity, followed by quantitative analysis of internal consistency, inter- and intra- rater reliability. Six raters assessed 33 randomly selected audiotapes from a repository of 123 tapes of BBCC at baseline and 1 month later. Results: Changes to the existing tool involved, item changes, added items, as well as grammatical and layout changes. The ‘ABC tool’ had good overall internal consistency (Cronbach alpha 0.955), inter-rater (Intra-class correlation (ICC) 0.813 at follow up) and intra-rater reliability (Pearson’s correlation 0.899 and p<0.001). Sub-scores for the Assist (ICC 0.784) and Arrange (ICC 0.704) stages had lower inter-rater reliability than the sub-scores for Ask (ICC 0.920), Alert (ICC 0.925) and Assess (ICC 0.931). Conclusion: The ABC tool is sufficiently reliable for the assessment of BBCC in clinical settings or research studies. Minor revisions may further improve the reliability of the tool, particularly for the sub-scores measuring Assist and Arrange.