Hospital In South Africa Research Articles

Prevalence and factors associated with burnout among junior medical doctors at a South African tertiary public sector hospital.

burnout is a syndrome characterized by emotional exhaustion, depersonalization and emotional exhaustion that occurs due to exposure to stressful conditions over a long period. It can lead to poor job performance, apathy, and lack of productivity. This study looks at the prevalence of burnout in medical interns in a tertiary hospital in South Africa and the factors that may contribute to burnout. an analytical cross-sectional study was conducted. Medical interns working in Chris Hani Baragwanath Hospital in 2019 were invited to participate. The participants filled questionnaire that had demographic information, the Maslach Burnout Inventory Scale, a scale to rate the rotations that they believed contributed towards their burnout and factors they think contributed towards their burnout. Our data was analyzed using Stata. out of a possible 165 potential participants, 101 medical interns enrolled. 95% of the participants reported burnout. Statistically significant factors contributing towards burnout were lack of resources and poor relations with support staff and senior staff. The medical rotation that was reported by the participants to contribute most towards their burnout was internal medicine. burnout in this population of medical interns is alarmingly high. Higher than reported in similar studies in South Africa and internationally.

Impact of the Soweto football derby on the trauma emergency department at Chris Hani Baragwanath Academic Hospital, a tertiary level hospital in South Africa.

The Soweto Derby is one of Africa's largest football derbies. The two rival teams, Kaizer Chiefs and Orlando Pirates, both originate in Soweto, a sprawling township 20km outside Johannesburg. Soweto is infamous for the high levels of violent crime and trauma, but also for Chris Hani Baragwanath Academic Hospital (CHBAH), with one of the world's largest trauma emergency departments (ED). Research globally, describing the impact of sports events on public health care systems is conflicting, with evidence showing both increases and decreases in spectator related trauma. This paper seeks to describe the trauma burden during the Soweto Derby and add to the research concerning trauma relating to sporting derbies in low to middle income countries. To analyze the impact of the Soweto Derby on the trauma ED at CHBAH over a 24-hour period. A retrospective comparative study at the CHBAH Trauma ED of 13 Soweto Derbies played over a 5 year period between 2015-2019, compared to the corresponding non-Soweto Derby days of the preceding year. Patients were triaged according to the South African Triage Scale and Advanced Trauma Life Support (ATLS) principles. Data was organized into 3 time frames where the triage score and mechanism of injuries were compared: 1) 4 hours pre-match, 2) 2 hours during the match, and 3) 18 hours post-match. Thirteen Soweto Derbies and 2552 patients were included. The median age was 29 with males accounting for 73.4% of all trauma cases. Significantly more P1 patients presented during the Soweto Derby. Pre-match there were 3x less P1 patients presenting to the ED (4.7% vs 12%, p = 0.044). During the match, there was a 40% drop in males presenting to ED (5.95% vs 9.45%, p = 0.015). Post-match there was a significant increase in P1 patients treated (17.4% vs 13.5%, p = 0.021)), with the majority being young males. There was no increase in either female or paediatric visits to the ED. The Soweto Derby has a direct effect on the trauma burden at CHBAH, with more P1 patients presenting post-match. Young African males are disproportionally affected by severe trauma requiring increased health care resources in an already overburdened hospital.

An audit of the iron status of patients at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa.

Iron deficiency is a common disorder, especially in developing countries. Accurately assessing iron status remains challenging, particularly for patients with chronic diseases such as HIV and chronic kidney disease, prevalent in South Africa. This study aimed to determine how ferritin cut-offs affect iron status classification in adult patients treated at a tertiary hospital in South Africa. Additionally, it assessed the frequency of these conditions and the impact of age and gender on iron status. This retrospective study analysed iron profiles in adult patients from 01 October 2020 to 31 March 2021. Iron status was categorised into five groups: iron deficiency anaemia (IDA), anaemia of chronic disease, IDA with anaemia of chronic disease, iron deficiency without anaemia, and iron replete based on haemoglobin, transferrin saturation, and ferritin levels. The impact of using two different ferritin cut-off values (15 µg/L and 30 µg/L) was investigated. The study included 3221 complete iron profiles. There was a predominance of female patients (2.2:1 ratio). Anaemia of chronic disease was the most prevalent iron disorder (39%), regardless of ferritin cut-off. Using a higher ferritin cut-off of 30 µg/L significantly increased the detection rates of both IDA and iron deficiency without anaemia (p < 0.001). This study suggests that a higher ferritin threshold (30 µg/L) might improve diagnosis of iron disorders in settings with high inflammatory diseases. Further studies are needed to refine thresholds. Local guidelines should be adjusted to consider higher ferritin cut-offs, and longitudinal studies are recommended to evaluate long-term outcomes. This study confirms the use of higher ferritin cut-offs for enhanced detection of iron deficiency states. The findings also emphasise the ongoing need for establishing simple, standardised, and accurate methods for iron status classification.

Autism Spectrum Disorder and Head Circumference in children under 5 years of age attending a public clinic in Johannesburg, South Africa

Abstract Introduction: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that is increasing in prevalence globally. There is an emerging field of research investigating the association between head circumference and ASD but there is a marked paucity of such data from Southern Africa. Aim: To describe the head circumference (HC) measurement of children diagnosed with ASD and to investigate associations between HC, ASD severity levels and associated comorbidities. Methods: A retrospective record review of children diagnosed with ASD attending a neurodevelopmental clinic at a large public hospital in South Africa was conducted. Demographic data and HC measurements from the first clinic visit were collected. The World Health Organization data set of head circumference norms were used as the comparator reference population. Statistical analysis was conducted using parametric, descriptive and inferential methods. Results: Data from 135 children diagnosed with ASD were included. The sample population had a mean age of 43 months (range 13-61 months) and 107 (79%) were males. Thirty (22.2%) patients in the cohort had a HC which was classified as macrocephalic. Almost half (46.7%) had an ASD severity level of three and 94 (69.6%), had been diagnosed with a comorbidity. In this study no significant association was found between macrocephaly and ASD severity. Conclusions: Measuring the HC during childhood is a cost-effective, simple and non-invasive procedure that may well assist professionals in raising suspicion of ASD at an early age. Early detection and intervention could optimise participation and integration for the individual living with this life-long neurodevelopmental disability.

A survey of nurse informatics competencies of professional nurses in clinical practice public hospitals in South Africa

BackgroundCompetence in nursing informatics is vital for efficient nursing care in today’s technologically-enabled healthcare environment. In South Africa little is known on the competence of professional nurses in clinical practice in nursing informatics. ObjectivesThe study examined the self-rated competence in nursing informatics among professional nurses practicing in clinical settings at two hospitals in the Western Cape, South Africa. MethodA cross-sectional descriptive survey was conducted with 205 professional nurses from two public hospitals in the Cape Metropole, Western Cape. The study participants completed the TANIC© scale, a self-administered nursing informatics questionnaire. Descriptive analysis was done for demographic variables and activities, with mean scores out of 4, interpreted based on the novice (1), advanced beginner (2), comfortable (3), and proficient (4) ratings. Confidence intervals were calculated for all nursing informatics competencies in the domains of computer literacy, clinical information management and information literacy and their sub-domains. ResultsThe respondents rated the computer literacy domain significantly higher than the other two domains (2.63/4 [95 %CI 2.5–2.76]), with average ratings approaching the ‘comfortable’ competency range. This was followed by clinical information management (2.09/4 [95 %CI 1.95–2.23]), and information literacy (2.05/4 [95 %CI 1.92–2.17]), with average ratings located in the ‘novice’ to ‘advanced beginner’ competency range. ConclusionThe study showed that practicing nurses have a limited level of nursing informatics competence, especially in the domains of clinical information management and information literacy. These findings support the need for educational programmes to extend beyond basic computer skills and prioritize continuous professional development in nursing informatics.

Evaluating a vertical nurse-led service in the integration of palliative care in a tertiary academic hospital.

Groote Schuur Hospital is a large Academic Hospital in South Africa that is in the process of integrating palliative care (PC) via a vertical nurse-led doctor-supported (VNLDS) service that was initially established to deliver clinical care. PC integration should occur across multiple dimensions and may result in variable degrees of integration between levels of the healthcare system. This research evaluates the VNLDS through a theory-driven evaluation to describe how the service affected integration. A mixed-method sequential design consisting of a narrative literature review on the theory of integration and PC, retrospective quantitative data from a PC service delivery database, qualitative data from semi-structured interviews and document analyses. It was structured in three phases which assisted in confirming and expanding the data. Statistical analyses, deductive thematic coding and documentary analyses were conducted according to the conceptual framework of PC integration. The PC integration process was facilitated in the following ways: (i) the service provided good clinical PC; (ii) it was able to integrate on a professional level into specific diseases, such as cancer but not in all diseases; (iii) developing organizational structures within the service and (iv) the observed benefit of good clinical care increased the value stakeholders assigned to PC, thereby driving the adoption of PC. However, there are still clinicians who do not refer to PC services. This gap in referral may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Observed PC service delivery is core to integrating PC across the healthcare system because it challenges normative barriers. However, the VNLDS could not achieve integration in leadership and governance, education and hospital-wide guidelines and policies. Whole system integration, foregrounding organizational commitment to PC excellence, is core to integrating PC. The VNLDS service has effectively linked PC in specific disease profiles and normalized the PC approach where healthcare workers observed the service. These integrational gaps may be grounded in assumptions and misconceptions about PC, especially at the organizational level.

Patient satisfaction with complete dentures received from an urban district hospital

To assess some of the factors that may contribute to patient satisfaction with a complete denture service provided by a district hospital in South Africa. The participants were patients who had received mucosa borne complete dentures at least one year previously. A questionnaire recorded demographics and treatment details either in person or telephonically. All patients were also asked to score a variety of factors related to satisfaction on a validated visual analogue scale. Associations were sought between patient demographics, treatment procedures and satisfaction. Sample size analysis required a sample size of 180 to detect at least a medium effect size, and 76 to detect large effect sizes. However, it was not possible to increase the sample size beyond 157 in the time available. Several associations were observed that were statistically significant, but most were of small effect. Even though 75% were upset at having lost their teeth, 64% reported that they had not minded wearing dentures. Overall, there were high levels of satisfaction, irrespective of the treatment procedures used. There were few meaningful associations between patient characteristics and satisfaction scores. It was clear that the patients had adapted well to their dentures. Patient satisfaction and patient adaptability are subject to many factors, and how patients cope, and what factors help remains unknown. It is clear the provision of this complete denture service in the public sector improved these patients’ quality of life and that patients can adapt to mucosa-borne dentures provided in a public setting.

Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa

ObjectivesSouth Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. MethodsWe conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. ResultsWe recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). ConclusionsGuidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.

A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial)

BackgroundThe patient's experience of their postoperative recovery is an important perioperative outcome, with the 15-item quality of recovery scale (QoR-15) recommended as a standardised outcomes measure. Desflurane has a faster emergence from anaesthesia compared with other volatile anaesthetics, but it is uncertain whether this translates to better subjective quality of recovery. The hypothesis for this study is that patients receiving desflurane for maintenance of anaesthesia would have better postoperative quality of recovery than patients receiving isoflurane. MethodsMale and female adult patients undergoing ophthalmological surgery under general anaesthesia were randomly allocated to receive desflurane or isoflurane for maintenance of anaesthesia. The primary outcome was to compare postoperative QoR-15 scores. Secondary outcomes included comparing preoperative QoR-15 scores, volatile agent consumption, and time spent in the recovery room. ResultsData from 164 patients were analysed (80 desflurane, 84 isoflurane). Median (Q1, Q3) postoperative QoR-15 scores were not significantly different (desflurane: 145 [141, 148], isoflurane: 144 [139, 147], 95% confidence interval 0–3, P=0.176, minimal clinically important difference=8). Median (Q1, Q3) volatile agent consumption was 15.4 (12.5, 19.3) ml hr−1 in the desflurane group, and 7.4 (5.9, 9.7) ml hr−1 in the isoflurane group. Median (Q1, Q3) time spent in the recovery room was significantly shorter in the desflurane group (desflurane: 18 [13, 23]; isoflurane: 25 [19, 32], 95% confidence interval −10 to 5, P<0.001). ConclusionsThis study found no difference in quality of recovery between patients who received desflurane or isoflurane for maintenance of general anaesthesia during ophthalmological surgery. A shorter time in the recovery room was not associated with improved QoR-15 scores. Clinical trial registrationNCT04188314.

Impact of the COVID-19 pandemic on ophthalmic surgery at a tertiary hospital in South Africa

Background: The coronavirus disease 2019 (COVID-19) pandemic impacted the provision of ophthalmic care.Aim: This study aimed to quantify the pandemic on the number of ophthalmic surgeries.Setting: The study was conducted at a South African tertiary academic hospital.Methods: A retrospective comparative analysis of eye surgeries 1 year pre- and post- onset of the COVID-19 lockdown (27 March 2019 to 26 March 2021) was conducted. Theatre surgical records were analysed 1-year pre- and post-lockdown. All surgical procedures were recorded and subcategorised into cataract, cornea, glaucoma, oncologic, orbital, oculoplastic, strabismus, trauma, vitreoretinal, and other. Trauma surgeries in the post-pandemic year were sub-analysed based on the level alcohol restriction level.Results: Total surgeries decreased from 3521 to 1551 (P 0.001). Using multivariate analysis, the incidence rate ratio (IRR) for all surgeries during the pandemic was 0.47 (P 0.001) with a significantly reduced IRR during the first wave of 0.427 (P = 0.003) and a non-significant change during wave two; IRR 1.25 (P = 0.36). All surgical subgroups decreased significantly except oncology, insignificant decrease from 211 to 180 (P = 0.12). Trauma significantly decreased during periods of total alcohol bans; IRR of 0.50 (P 0.001). An insignificant decrease was found during periods of partial ban with an IRR of 0.83 (P = 0.06) compared with periods without alcohol restrictions.Conclusion: Post lockdown, the total number of surgeries decreased in all subgroups except oncology. Alcohol bans significantly decreased trauma surgeries.Contribution: This article provides valuable insight, which may inform public health policy.

Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study

BackgroundDiabetes foot sepsis (DFS) is the leading cause of amputation of lower extremities. Over 50 % of patients who have had major lower extremity amputation due to DFS are dead within 4 years following the procedure. AimTo determine the life expectancy of patients following amputation for DFS at a regional hospital in South Africa. MethodsWe conducted an audit of patients who had DFS and were admitted over a 5-year period. The duration from admission to time of death was recorded in days. Occurrence of death was confirmed from family members of the deceased using structured telephonic interview questionnaires. Categorical findings were summarized using actual counts and percentages and compared using either the Chi-square or Fisher's exact test. We used the mean with standard deviation or median and range to compare parametric and non-parametric continuous data, respectively. The Shapiro-Wilk test was used to test normality of data. Multivariate logistic regression was done to establish factors that were strongly associated with the mortalities. Adjusted survival curves were added to compare the rate of occurrence of mortality between males and females with age as a confounder. Statistical significance was set at a p-value below 0.05. Results197 were found of which 100 % of participants had Type 2 diabetes mellitus and 63.5 % were males. Associated comorbidities included hypertension in 73.6 %, obesity in 66 %, alcohol use in 64.5 % and smoking in 58.4 %. 190 participants had an amputation and 19.3 % died. ConclusionDFS was more common in males and 96 % of the patients had an amputation. Mortality rate within 4 years following amputation was 19.3 % and was higher in females and individuals with multiple comorbidities.

Core competencies in critical care for general medical practitioners in South Africa: A Delphi study.

Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. A final list of 153 core competencies in critical care was identified. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.

Pregnancy outcomes of women presenting with stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks

ObjectiveTo determine the pregnancy outcomes of women who had 2017 American College of Cardiologists stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks in a tertiary hospital in South Africa. Study designA retrospective cohort study involving the review of medical records of 127 participants with stage 1 hypertension and 128 control with blood pressure (BP) less than stage 1 hypertension before 20 weeks’ gestation. Main outcome measuresThe primary outcome measure was progression to stage 2 hypertension (BP ≥ 140/90 mmHg). Secondary outcome measures were a combination of maternal variables (postpartum BP ≥ 140/90 mmHg, use of antihypertensives within 24 h postpartum, pulmonary oedema, and maternal death within 24 h postpartum) and perinatal variables (fetal growth restriction, gestational age at delivery, fetal compromise, abruptio placenta, birth weight, Apgar score in 1 and 5 min). ResultsThe study and control arms were similar in age, parity, and comorbidities (p > 0.05). The following maternal outcomes were worse (p < 0.001) in the study compared to control arm: progression to stage 2 hypertension (46 % vs 1.6 %), postpartum systolic BP ≥ 140 mmHg (33.9 % vs 1.6 %), postpartum diastolic BP ≥ 90 mmHg (22.1 % vs 1.6 %) and use of antihypertensives within 24 h postpartum (27.6 % vs 0.8 %). Other outcome measures did not differ between the two groups (p > 0.05). ConclusionsStage 1 hypertension occurring before 20 weeks’ gestation increases the risk of progression to stage 2 hypertension in pregnancy and the use of antihypertensive drug therapy within 24 h postpartum.

Allopathic Medicine Practitioners’ perspectives on facilitating disclosure of traditional medicine use in Gauteng, South Africa: a qualitative study

BackgroundTraditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients’ willingness to disclose TM use.MethodsThis qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories.ResultsThe data revealed four major categories: ‘providing a suitable atmosphere for disclosure,’ ‘encouraging patients to disclose TM usage to AMPs,’ ‘patient autonomy,’ and ‘AMP training’. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM.ConclusionThis study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure.

Higher Sensitivity of Xpert MTB/RIF Ultra Over Tuberculosis Culture for the Diagnosis of Spinal Tuberculosis With Open or Computed Tomography-Guided Biopsies.

Diagnostic specimens for spinal tuberculosis (STB) are mostly collected via open surgery. Percutaneous computed tomography (CT)-guided biopsies are used in times of limited surgical availability. However, poor diagnostic accuracy of Mycobacterium tuberculosis (Mtb) culture has been reported with this method, due to limited sample volume and the paucibacillary nature of STB. We evaluated Xpert MTB/RIF Ultra on open and CT-guided biopsies as compared with the gold standard Mtb culture and histopathology. We conducted a prospective diagnostic accuracy study of Xpert Ultra, as compared with tuberculosis culture and histopathology, in adults with signs and symptoms of STB at a tertiary academic hospital in South Africa from November 2020 to December 2021. Diagnostic testing was performed on 31 patients with available samples. Xpert Ultra had a sensitivity of 94.7% (95% CI, 75.3%-99.7%) and specificity of 100% (95% CI, 75.7%-100.0%) against a reference standard of Mtb culture and histopathology. Xpert Ultra had high diagnostic accuracy in open and CT-guided biopsy samples with sensitivity and specificity of 100% and 100% (open) and 89% and 100% (CT), respectively. Mtb culture had limited specificity for CT-guided biopsies (43%; 95% CI, 15.8%-74.9%). HIV-1 coinfection did not affect Mtb abundance measures by Xpert Ultra or culture. Xpert Ultra was also superior to culture for STB diagnosis in patients concurrently treated for pulmonary tuberculosis. Xpert Ultra detected more STB cases than culture for CT-guided biopsy samples. There was also no difference in sensitivity for open biopsies, irrespective of HIV-1 status, making it an important tool for rapid diagnosis, especially during times or in locations where open surgery is not possible or concurrent pulmonary tuberculosis treatment is initiated.

Access and use of digital technology by patients with psychosis at a hospital in South Africa.

There is growing interest in the use of digital information and communication technology (ICT) for mental health care purposes. Information and communication technology tools may enhance mental health literacy and help-seeking behaviour. To describe the access to, use and perception of ICT in people with schizophrenia and other psychotic disorders. The study was conducted at an urban psychiatric hospital in Durban, KwaZulu-Natal (KZN) province, South Africa. Participants completed questionnaires on their socio-demographic characteristics and access to, use and perception of ICT. Multiple ordinal logistic regressions were used to test the association between socio-demographic factors and ICT use and perception. Of the 165 participants (mean age = 41 years ± 14.2), 54.5% were male, 37.6% were employed, and most (93.3%) lived in an urban area. Most participants (93%) had access to the internet in past 3 months and a smartphone (89.8%). Age (AOR 0.94, p = 0.06, CI = 0.88-1.00) and marital status (AOR = 0.26, p 0.02, CI = 1.62-253.74) were associated with internet use, while age (AOR = 0.95, p 0.03, CI = 0.9-1.00), marital status (AOR = 3.64, p = 0.05, CI = 1.03-12.90), income (AOR = 4.02, p < 0.01, CI = 1.69-9.54), employment status (AOR = 0.16, p < 0.01, CI = 0.06-0.44), and living with HIV (AOR = 5.41, p < 0.01, CI = 1.39-21.07) were associated with frequency of internet use. Older participants had lower odds of using a mental health care app (AOR = 0.93, p = 0.02, CI= 0.88-0.99). Those with higher incomes had increased odds of seeking mental health information digitally (AOR = 4.33, p = 0.03, CI = 1.13-7.54). People living with psychosis do have access to digital technology although pattern of use maybe influenced by sociodemographic factors. This study provides baseline data on digital technology use in Africa.

Building Consensus on the Point-of-Care Ultrasound Skills Required for Effective Healthcare Service Delivery at District Hospitals in South Africa: A Delphi Study

Background: Despite the widespread availability of ultrasound machines in South African district hospitals, there are no guidelines on the competency in point-of-care ultrasound (POCUS) use required by generalist doctors in this setting. This study aimed to define the required POCUS competencies by means of consensus via the Delphi method. Methods: An online Delphi process was initiated in June 2022, using the existing American Academy of Family Physicians’ ultrasound curriculum (84 skillsets) as the starting questionnaire. Panelists were selected across the country, including two from district hospitals in each province and two from each academic family medicine department in South Africa (N = 36). In each iterative round, the participants were asked to identify which POCUS skillsets were essential, optional (region-specific), or non-essential for South African district hospitals. This process continued until consensus (&gt;70% agreement) was achieved on all of the skillsets. Results: Consensus was achieved on 81 of the 84 skillsets after 5 iterative rounds (96.4%), with 3 skillsets that could not achieve consensus (defined as &lt;5% change over more than 2 consecutive rounds). The final consensus identified 38 essential, 28 optional, and 15 non-essential POCUS skillsets for the South African district hospital context. Conclusions: The list of essential POCUS skillsets provided by this study highlights the predominance of obstetric- and trauma-based skillsets required for generalist healthcare workers in South African district hospitals. The findings will require priority setting and revalidation prior to their implementation across the country.

The Costs of Running an Orthopaedic Theatre Per Hour at a Tertiary Hospital in South Africa

The Costs of Running an Orthopaedic Theatre Per Hour at a Tertiary Hospital in South Africa

The impact of hypothermia in a tertiary hospital neonatal unit

Background. Neonatal hypothermia, defined as a body temperature &lt;36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care. Objectives. This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa. Methods. A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records. Results. The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p&lt;0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p&lt;0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p&lt;0.0001). Conclusion. The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.

Impact of novel software on laboratory expenditure at an academic hospital in South Africa.

Countries across the globe report an increase in expenditure associated with medical laboratory testing. In 2020, the United States Department of Health and Human Services reported that laboratory test expenditures increased by $459 million US dollars (USD) from $7.1 billion USD in 2018. In South Africa, laboratory testing expenditure in the public sector increased from $415 million USD in 2014 to $723 million USD in 2021. This study aimed to evaluate the impact of an innovative software, electronic gatekeeping (EGK), on medical laboratory test expenditures at Nelson Mandela Academic Hospital, in the Eastern Cape, South Africa. In this cross-sectional study, an interrupted time series analysis technique was used to evaluate trends in expenditure during a 48-month study period. To measure the impact of EGK on laboratory expenditure, we analysed laboratory expenditure over two study periods: a period of 24 months occurring before EGK implementation (01 June 2013 to 31 May 2015) and a period of 24 months occurring during EGK implementation (01 June 2015 to 30 May 2017). There was a significant reduction (211 928 fewer tests) in the number of tests performed during the intervention (434 790) compared to before the intervention (646 718). Laboratory test expenditure was $1 663 756.72 USD before the intervention period and $1 105 036.88 USD during the intervention period, demonstrating a cost savings of $558 719.84 USD. Electronic gatekeeping is a cost-effective intervention for managing medical laboratory expenditures. We recommend that the health sector scale up this intervention nationally. Using an interrupted time series interval, the authors determined that EGK is a cost-effective intervention for managing medical laboratory expenditures at a tertiary hospital. This study's findings can promote and contribute to improved laboratory systems and test investigations.