South African Family Practice <em>South African Family Practice</em>(SAFP) is a peer-reviewed scientific journal, which strives to provide primary care physicians and researchers with a broad range of scholarly work in the disciplines of Family Medicine, Primary Health Care, Rural Medicine, District Health and other related fields. SAFP publishes original research, clinical reviews, and pertinent commentary that advance the knowledge base of these disciplines. The content of SAFP is designed to reflect and support further development of the broad basis of these disciplines through original research and critical review of evidence in important clinical areas; as well as to provide practitioners with continuing professional development material.<p>(Note: In January 2003 <em>South African Family Practice</em> merged with <em>Geneeskunde – The Medical Journal</em> to form <em>South African Family Practice incorporating Geneeskunde</em>, and since January 2004 it is again only known as <strong>South African Family Practice</strong> (SAFP). As a result the numbering of the journal now begins from Volume 45 in 2003).<br /><em></em></p><p>Other websites related to this journal: <a href="" target="_blank"></a></p> Medpharm Publications Pty Ltd en-US South African Family Practice 2078-6190 By submitting manuscripts to SAFP, authors of original articles are assigning copyright to the SA Academy of Family Practice/Primary Care. Copyright of review articles are assigned to the Publisher, Medpharm Publications (Pty) Ltd, unless otherwise specified. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAFP for educational and research purposes without obtaining permission. Editorial: Air pollution and child health: What can health care professionals do? No Abstract. Gboyega A Ogunbanjo Copyright (c) 2019-02-21 2019-02-21 60 6 6 6 A "site" for sore eyes <p>It is known that not all red eyes are caused by infections. Furthermore, not all eye infections will react to antibiotic eye drops. Most cases of conjunctivitis are due to viral causes, do not require antibiotic eye drops and are usually self-limiting. Serious ophthalmic conditions such as infectious keratitis can lead to blindness; it is an emergency that requires specialist treatment. Also infectious<br />endophthalmitis has become more frequent with the use of intravitreal injections. Intravitreal antibiotics are needed to try and prevent visual loss. To ensure therapeutic local exposure ophthalmic antibiotic solutions should be applied frequently into the eye.</p><p><br /><strong>Keywords</strong>: conjunctivitis, eye infection, keratitis, antibiotic</p> George L. Muntingh Michelle Viljoen Copyright (c) 60 6 7 11 Prophylaxis - A key component in malaria control <p>With the summer holidays fast approaching, holidaymakers will be planning their trip across Africa and the globe. Patients need to be aware of the risks of mosquito bites and contracting malaria. Malaria is endemic in the Limpopo, Mpumalanga and Northern KwaZulu-Natal provinces, with several cases of travel or Odyssean malaria being reported around South Africa. Prophylaxis is key in reducing the risk of infection by malaria. The use of insect repellents, correct clothing, bed nets and environmental control,<br />complemented with chemoprophylaxis will greatly reduce this risk. The current South African guidelines to prevent a malaria infection include atovaquone-proguanil, doxycycline and mefloquine, with the latter drug recommended during pregnancy and when breast-feeding. Patients should be cautioned that despite implementing preventative measures, they should seek immediate medical attention if they develop ‘flu-like’ symptoms or a fever when returning from a malaria area. Appropriate prophylactic measures are key components in preventing a malaria infection and can be life-saving.</p><p><br /><strong>Keywords</strong>: malaria, prophylaxis, Anopheles, insecticides, South Africa</p> RL Van Zyl Copyright (c) 2019-02-21 2019-02-21 60 6 14 16 All headaches are not equal: A review of migraine as a state of brain dysfunction No Abstract. De Wet Wolmarans Sarel J. Brand Linda Brand Copyright (c) 2019-02-21 2019-02-21 60 6 17 25 Atopic Dermatitis <p>The aetiology of atopic dermatitis is multi-faceted and affects our first line host defence, the skin. Atopic dermatitis has a significant influence on a patient’s social and occupational functioning and can have long-lasting effects. The signs and symptoms of AD includes pruritus, erythema, fissuring, and lichenification – these are reduced by the use of moisturizing agents. Guidelines on how to manage atopic dermatitis aims to improve symptoms and achieve long-term disease control. Patient education remains as important as other treatment strategies and the pharmacist plays an integral role in educating patients on the management of their condition and adherence to therapy.</p><p><br /><strong>Keywords</strong>: Atopic dermatitis, pruritus, filaggrin, FLG gene, microbiome, Th2 cells</p> D. Engler F. Makola N.M. Magongwa Copyright (c) 2019-02-21 2019-02-21 60 6 26 33 Allergic skin conditions - causes, clinical features and treatment <p>Allergic skin conditions are caused by allergens. When an allergen is responsible for triggering an immune system response, this results in an allergic skin condition. Some of these allergens are physical agents which evoke an immune response by way of contact with the skin and some are food-stuffs and drugs taken systemically. Allergic skin conditions include urticaria and angio-oedema, allergic contact dermatitis, atopic dermatitis, hand dermatitis, photoallergic reactions and phototoxic reactions. These conditions are briefly discussed in this article.</p><p><br /><strong>Keywords</strong>: Allergic skin conditions, allergy, allergens</p> Hendrick M. Motswaledi Copyright (c) 2019-02-21 2019-02-21 60 6 34 37 Factors influencing post-partum women’s choice of an implantable contraceptive device in a rural district hospital in South Africa <p><strong>Background</strong>: A single-rod subdermal contraceptive implant containing 68 mg of etonogestrel, ImplanonNXT®, was introduced to the South African healthcare system in 2014. Initially the new device was well received but later uptake tapered off. A need was identified to determine the factors that influence women’s choices with regard to the use of ImplanonNXT® in order to improve its uptake. The aim of this study was to explore the factors that influence women’s choice of ImplanonNXT®.<br /><strong>Method</strong>: A qualitative study was performed, using semi-structured interviews to explore patients’ knowledge, attitudes and beliefs regarding ImplanonNXT®. Ten patients were interviewed at Knysna Hospital.<br /><strong>Findings</strong>: There was confusion amongst women about the harms and benefits of using ImplanonNXT® and it became apparent contraceptive counselling during pregnancy greatly affects the choices they make. Other factors that influenced the participants’ choice with regard to contraception included social influences, preference for familiar methods and the side<br />effect profile of the various options. Perceptions of the adverse side effects of the implantable device added to confusion and fear of this method, which influenced women’s ideas about the use of ImplanonNXT®. Poor communication and reluctance from clinic staff to discuss ImplanonNXT®<br />during antenatal visits contributed to poor knowledge about the implantable device and its side effects.<br /><strong>Conclusion</strong>: Clearer communication during antenatal visits with pregnant women may address some of the fears and beliefs that surround its side effects, workings and efficacy. The fear of possible side effects should be a focus for counselling and education, as it predominantly contributes to women’s confusion and fear of the device. Further research is needed to<br />address this as well as evaluate if interventions such as better counselling and a dedicated team approach can change the attitudes and beliefs of post-partum women towards the ImplanonNXT® device in the South African district health system.</p><p><br /><strong>Keywords</strong>: long acting reversible contraception, barriers, post partum, perceptions, choice</p> Francois Potgieter Paul Kapp Francois Coetzee Copyright (c) 2019-02-21 2019-02-21 60 6 174 180 Knowledge, attitudes and practice of healthcare providers regarding contraceptive use in adolescence in Mahalapye, Botswana <p><strong>Introduction:</strong> Adolescent pregnancy is a global public health problem, for which healthcare providers (HCPs) play a critical role to prevent unintended pregnancy. This study investigated the knowledge, attitude and practice (KAP) of HCPs towards the use of contraceptives in adolescents.<br /><strong>Results:</strong> Of the 101 eligible for the study, 79.2% HCPs from the selected clinics and hospital responded. The majority (91.2%) of respondents felt confident to explain to adolescents how to use old contraceptive methods such as oral contraceptives or IUCD, less than half of the respondents (41.3%) were confident to explain how to use new contraceptive methods such as transdermal contraceptive patches or vaginal rings. Medical doctors felt more confident to prescribe new contraceptive methods compared with nurses, both vaginal rings (p-value = 0.0006) and transdermal contraceptive patches (p-value = 0.0003). More than two-thirds of the respondents disagreed that beliefs influenced their ability to offer contraceptive services to adolescents, half of the respondents strongly disagreed that it was morally wrong for adolescents to use contraceptives. Although three-quarters of respondents strongly agreed (median = 5, [IQR 5–6]) that they were comfortable with prescribing contraceptives to adolescents, only 23% of the respondents very much prescribed or always<br />prescribed contraceptives to adolescents.<br /><strong>Conclusion:</strong> Most of the HCPs prescribed contraceptives irregularly, and had limited knowledge about newer methods. To change HCPs’ KAP, in addition to continuing medical education (CME), the establishment of family planning clinics for adolescents and more undergraduate contraceptive teaching for medical and nursing students could result in the increased utilisation of contraceptive services by adolescents.</p><p><br /><strong>Keywords:</strong> attitude, contraceptive in adolescents, healthcare providers, knowledge, Mahalapye Botswana, practice <strong></strong></p> ST Tshitenge K Nlisi V Setlhare R Ogundipe Copyright (c) 2019-02-21 2019-02-21 60 6 181 186 An evaluation of the medical internship programme at King Edward VIII hospital, South Africa in 2016 <p><strong>Background</strong>: In 2005, the Health Professions Council of South Africa (HPCSA) extended the duration of the internship programme to ensure that all young medical graduates are adequately prepared to work at a district hospital during their year of community service. King Edward VIII hospital (KEH) is an HPCSA accredited training hospital, which has been training interns for many years. The aim of this study was to assess intern perceptions of their training at the hospital.<br /><strong>Methods</strong>: This cross-sectional, descriptive study was conducted at KEH in November 2016. A questionnaire was used to collect data, which were analysed descriptively.<br /><strong>Results</strong>: Only 53% of interns completed the questionnaire. Although teaching and supervision were provided in all domains, perceptions of the quality ranged from excellent to poor. The majority of interns worked the 64–80 hours per month commuted overtime as required by the HPCSA. However, less than 10% expressed positive views regarding the condition of the facilities and infrastructure.<br /><strong>Discussion and conclusions</strong>: The findings of this study were generally positive with regard to teaching, supervision and hours worked, mostly in accordance with the requirements of the HPCSA. However, a response rate of 53% as well as the single location of the study may limit generalisability and a larger study involving interns across the country is recommended.</p><p><br /><strong>Keywords</strong> hours worked, internship, South Africa, supervision, training</p> Andrew Ross SS (Cyril) Naidoo Siyabonga Dlamini Copyright (c) 2019-02-21 2019-02-21 60 6 187 191 Optimum INR intensity and therapeutic INR control in patients with mechanical heart valve prosthesis on warfarin oral anticoagulation at Dr George Mukhari academic hospital: a three-year retrospective study <p><strong>Background</strong>: Available evidence suggest that the optimum prothrombin time-international normalised ratio (PT-INR) intensities recommended for anticoagulation of patients with mechanical heart valve prosthesis may not apply to all race groups. Optimal PT-INR target ranges and effectiveness of warfarin oral anticoagulation were determined among black South African patients fitted with St Jude bileaflet mechanical heart valve prosthesis (SJBMHVP) at Dr George Mukhari Academic Hospital (DGMAH).<br /><strong>Methods</strong>: A convenience sample of 95 medical records of patients fitted with SJBMHVP from 1994 until 2013 was reviewed. Optimum PT-INR target ranges were estimated using two different methods: the classical two PT-INR target level method and the alternative, PT-INR specific incident rate method. The quality of warfarin anticoagulation was assessed using the fraction in therapeutic range method.<br /><strong>Results</strong>: Optimum PT-INR target ranges for all participants fitted with SJBMHVP in the aortic position was estimated to be 2.0–3.5 and 2.6–3.5, respectively, by the classical and alternative methods. That of the patients with mitral valve replacement was estimated to be in the range 2.6–3.5 by the classical method and that of patients with double heart valve replacement was estimated to be &lt; 3.5 by both methods. The quality of warfarin anticoagulation of participants with SJBMHVP replacement was<br />found to be inadequate as indicated by percentage time in treatment range (TTR) of 49.7% for all study participants compared with the ideal TTR of 70% and above.<br /><strong>Conclusion</strong>: Optimum Caucasian-based PT-INR intensities recommended for oral anticoagulation of patients fitted with mechanical heart valve prosthesis are applicable to black patients fitted with SJBMHVP at DGMAH.</p><p><br /><strong>Keywords</strong>: black South African patients, heart valve prosthesis, optimal PT-INR, time in treatment range, warfarin oral anticoagulation</p> S. Ntlokotsi MF Moshesh P Mntla OA Towobola MA Mogale Copyright (c) 2019-02-21 2019-02-21 60 6 192–196 192–196 Quality of primary care physicians’ communication of diabetes self-management during medical encounters with persons with diabetes mellitus in a resource-poor country <p><strong>Background</strong>: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self- management education provided by primary care physicians to people with diabetes mellitus.<br /><strong></strong></p><p><strong>Methods</strong>: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American Association of Diabetes Educators seven domains of diabetes self-management. Cronbach’s reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA.<br /><strong></strong></p><p><strong>Results</strong>: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problemsolving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-management<br />education provided by the physicians was not associated with any of the physician characteristics.</p><p><strong>Conclusion</strong>: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries.</p><p><br /><strong>Keywords</strong>: diabetes self-management, patient–physician communication, primary care physicians, resource-poor countries, Nigeria</p> OS Ojo SO Malomo AO Egunjobi AOA Jimoh MO Olowere Copyright (c) 2019-02-21 2019-02-21 60 6 197 206 Challenges experienced by healthcare workers in managing patients with hearing impairment at a primary health care setting: A descriptive case study <p><strong>Background</strong>: There has been little research on the experiences of healthcare workers (HCWs) with deaf/hearing impaired (HI) clients. Anecdotal evidence suggests that HCWs experience challenges, but little is reported on how they manage these challenges. Interactions with and care of deaf/Deaf and HI patients by clinicians has yielded several questions around communication and assessment strategies, as well as comparative quality of health care for deaf/Deaf and HI clients. This research was intended to further the understanding and knowledge of these aspects of health care of deaf/Deaf and HI clients.<br /><strong>Methods</strong>: The study design is a qualitative, descriptive case study. Data were collected using semi-structured interviews with individual HCWs and focus-group discussions with groups of participants. Participants were invited staff members at Retreat Community Health Centre (RCHC) in Cape Town. Convenience sampling was used to select participants, and interviews were conducted until saturation was reached. Data were studied and analysed using the phenomenological method.<br /><strong>Results</strong>: HCWs reported that they serve very few Deaf or HI clients. However, themes of language barriers, resilience, preconceptions, improvisation and innovation, interpreters and recommendations emerged. Difficulties in communication were acknowledged, but HCWs insisted that these barriers are not insurmountable.<br /><strong>Discussion and conclusion</strong>: A few preconceptions and gaps in knowledge and awareness were revealed. HCWs also tended to rely on escorts and other interpreters. The dominant recommendations are that HCWs should receive training in sign language (SL) and/or that SL interpreters be available at facilities. Despite using words and phrases such as ‘frustrating’ and ‘more effort’, participants’ concluding remarks reiterate that their experiences are positive, suggesting a notable resilience.</p><p><br /><strong>Keywords</strong>: attitude, beliefs, deaf, hearing impaired, healthcare workers, knowledge</p> S Orrie T Motsohi Copyright (c) 2019-02-21 2019-02-21 60 6 207–211 207–211