Masters Degrees (Family Medicine and Primary Care)

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Exploring programme design, evaluation of programme performance and describing the clinical outcomes of a public sector based ARV treatment programme in a semi-rural area in the Western Cape over the past 6 years (2004-2010)
(Stellenbosch : University of Stellenbosch, 2015-07-23) Grobbelaar, Cornelis Johannes; Hagemeister, Dirk; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
Background: A national roll-out of antiretroviral therapy in the public sector was started in 2004, and Paarl was one of the first sites to start these services in the Western Cape. Operational research is required to guide the continuous improvement of such services. This research aimed to describe the characteristics of the treatment cohort started at TC Newman CDC’s ARV clinic in Paarl, to determine the retention in treatment rate and to assess the clinical and virological outcomes. Methods: A retrospective descriptive and observational study was done at the TC Newman ARV clinic in Paarl. All adult HIV positive patients that were started on antiretroviral therapy in the given time period were included. Patient and treatment data had been collected in an electronic database (e-register) and were extracted and analysed. Results: Starters: Out of the 2469 patients that were enrolled for ARV treatment between February 2004 and December 2010, 2254 started locally (the rest transferred in). 64% of them were female (decreasing rate over the years). Strugglers: By June 2011 51.5% of patients were still on ARVs, 6.9% patients had died, 16.7% had been ‘transferred out’and 24.7% were reported as ‘Lost to Follow-up’. 40% of the attrition of the cohort occurred in the first 6 months, 70% in the first 18 months. Stayers: Of the 1172 patients retained after start at TC Newman CDC, 1023 (87.3%) were still on Regime 1 and 149 (12.7%) on Regime 2. Conclusions: The results of this treatment cohort (mortality, treatment retention and regimen durability) equal those in other published treatment cohorts, although very limited comparable data are available. However, the high ‘lost to follow-up’ rate is of concern and needs further investigation. Changes in the programme structure and environment tend to have an immediate effect on initiation numbers of new patients.
Exploring programme design, evaluation of programme performance and describing the clinical outcomes of a public sector based ARV treatment programme in a semi-rural area in the Western Cape over the past 6 years. (2004-2010)
(Stellenbosch : Stellenbosch University, 2012-12) Grobbelaar, Cornelis Johannes (Nelis); Hagemeister, Dirk; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
ENGLISH ABSTRACT: Background: A national roll-out of antiretroviral therapy in the public sector was started in 2004, and Paarl was one of the first sites to start these services in the Western Cape. Operational research is required to guide the continuous improvement of such services. This research aimed to describe the characteristics of the treatment cohort started at TC Newman CDC’s ARV clinic in Paarl, to determine the retention in treatment rate and to assess the clinical and virological outcomes. Methods: A retrospective descriptive and observational study was done at the TC Newman ARV clinic in Paarl. All adult HIV positive patients that were started on antiretroviral therapy in the given time period were included. Patient and treatment data had been collected in an electronic database (e-register) and were extracted and analysed. Results: Starters: Out of the 2469 patients that were enrolled for ARV treatment between February 2004 and December 2010, 2254 started locally (the rest transferred in). 64% of them were female (decreasing rate over the years). Strugglers: By June 2011 51.5% of patients were still on ARVs, 6.9% patients had died, 16.7% had been ‘transferred out’and 24.7% were reported as ‘Lost to Follow-up’. 40% of the attrition of the cohort occurred in the first 6 months, 70% in the first 18 months. Stayers: Of the 1172 patients retained after start at TC Newman CDC, 1023 (87.3%) were still on Regime 1 and 149 (12.7%) on Regime 2. Conclusions: The results of this treatment cohort (mortality, treatment retention and regimen durability) equal those in other published treatment cohorts, although very limited comparable data are available. However, the high ‘lost to follow-up’ rate is of concern and needs further investigation. Changes in the programme structure and environment tend to have an immediate effect on initiation numbers of new patients.
The prevalence of burnout and depression among medical doctors working in the Cape Town Metropole community health care clinics and district hospitals of the Provincial Government of the Western Cape : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2011-12) Rossouw, Liezel; Seedat, Soraya; Emsley, Robin A.; Suliman, Sharain; Hagemeister, Dirk; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
Aim: This study investigated burnout and depression among medical doctors in the context of work-related conditions and the role of resilience as a modifiable factor. Methods: A cross-sectional, observational study was conducted on all consenting medical doctors (N=132) working at Cape Town metropole primary health care facilities of the Provincial Government of the Western Cape. Data were collected from doctors at 27 facilities by means of a self-administered questionnaire battery containing socio-demographic information, the Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI) and the Connor-Davidson Resilience Scale (CD-RISC). Results: Of 132 doctors included in the analysis, 76 % experienced burnout, as indicated by high scores on either the emotional exhaustion or depersonalisation subscales. In addition, 27% of doctors had cut-off scores on the BDI indicating moderate depression, while 3 % were identified with severe depression. The number of hours, work-load, working conditions and system-related frustrations were ranked as the most important contributing factors to burnout. More experienced doctors and those with higher resilience scores had lower levels of burnout as evident by lower scores on the emotional exhaustion and depersonalisation domains of the MBI. Conclusion: Both burnout and depression are prevalent problems among doctors working at district level and in communities. Resilience appears to be protective and may be a useful target for future intervention.
A retrospective cohort study : the directly observed treatment short-course strategy (dots) and tuberculosis treatment outcomes at Vryheid during 2007 : facilty versus community based dots
(Stellenbosch : University of Stellenbosch, 2009-12) Kikamba, C. N.; Hagemeister, Dirk; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
ENGLISH ABSTRACT: 1. BACKGROUND AND SETTING The study was conducted at Vryheid in the Kwazulu-Natal province. The increasing number of TB patients at Vryheid hospital’s OPD and wards has prompted me to assess the effectiveness of TB treatment by comparing the treatment outcomes between community-based DOTS (COMDOTS) and facility-based DOTS (FACDOTS). 2 main primary health care clinics were selected for the research (Bhekuzulu and Mason clinics). 2. AIM This thesis evaluated the effectiveness and efficacy of DOTS strategy by comparing the outcomes of tuberculosis treatment of patients under DOTS at VRYHEID during 2007: facility based versus community based DOTS. 3. METHODS The research question of the study was “Does community-based DOTS offer better TB treatment outcomes than the facility-based group? This is a retrospective cohort study with a total sample size of 809 patients; retrieved from the records of 2 major clinics at Vryheid (TB registers) during 2007. A sample of 396 patients was required in each group to determine a difference of 10 % (with a power of 90%) between the two groups of the study: community-based versus facility-based. Mason clinic has mostly patients on facility-based DOTS whereas the patients involved in community-based approach were found at Bhekuzulu clinic. 4. RESULTS The 2 groups of the study (COMDOTS and FACDOTS) were comparable in terms of age and gender composition. 52% of patients in the community-based group completed their TB treatment and only 37.7% in the facility-based group. 14% of patients died in the community-based DOTS group versus 6.1% in the facility-based group. 4.5% of community-based group defaulted medications, as compared to 1.7% in the facility-based group. 34.8% of facility-based DOTS interrupted treatment whereas the percentage is lower in the community-based group (1%). The community-based group had a failure rate of 6% versus 3.7% in the facility-based. The majority of patients in both groups were diagnosed on the basis of X-rays (82% in the community- and 57.1% in the facility-based group). Patients for whom an HIV test result was available were extremely likely to be HIV positive in both groups (80% in the facility-based and 84.6% in the community-based group), however the number of available test results was low. Amongst the sputum-positive patients, the community-based group was shown to have a cure rate of 95 percent (versus 37.1% in the facility-based group). Patients in the community-based group remained longer on TB treatment than the ones in the facility-based group (5.7 vs 5.0 months). However, the community-based group had a higher percentage of retreatment cases (22.4% versus only 12.7% in the facility-based group). 5. CONCLUSION: This study suggests that community-based DOTS offers a better cure rate (95%) and completion of therapy (52%). The longer duration of treatment observed in the community-based group could be partly due to its relatively higher number of retreatment cases as compared to facility-based group. An extremely high HIV rate (> 80%) has also been found in the TB-patient population in both groups. Community-based DOTS offers an alternative way for patients who do not have easy access to the clinics, provided the government strengthens the system and takes over recruitment as well as monitoring and motivation (incentives) of community-health workers. There is also a growing concern with the relatively high number of patients defaulting or failing treatment in this group and further studies are needed particularly .retrospective to explore the matter.
A survey of wound care knowledge in South Africa
(Stellenbosch : Stellenbosch University, 2010-12) Coetzee, Francois; Hagemeister, Dirk; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective To determine the scope of knowledge possessed by fifth year medical students, general practitioners (GP’s) and surgical registrars, concerning chronic wound management. Design Cross sectional study Methods Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at three universities and general practitioners attending refresher courses. Result. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GP’s and 47 surgical registrars completed questionnaires. The overall median (25th–75th percentiles) knowledge scores for registrars, GP’s and students were 65%;(55%–70%), 55%;(45%–65%) and 45%;(35%–50%) respectively. Whereas the scores of registrars and GP’s did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GP’s attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound-care was only mild to moderate, with more GP’s than registrars requesting literature. Conclusions Very little, if any training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country; however it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.
A survey of wound care knowledge in South Africa
(Stellenbosch : University of Stellenbosch, 2015-07-23) Coetzee, Francois; Hagemeister, Dirk; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
Abstract Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective To determine the scope of knowledge possessed by fifth year medical students, general practitioners (GP’s) and surgical registrars, concerning chronic wound management. Design Cross sectional study Methods Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at three universities and general practitioners attending refresher courses. Result. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GP’s and 47 surgical registrars completed questionnaires. The overall median (25th–75th percentiles) knowledge scores for registrars, GP’s and students were 65%;(55%–70%), 55%;(45%–65%) and 45%;(35%–50%) respectively. Whereas the scores of registrars and GP’s did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GP’s attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound-care was only mild to moderate, with more GP’s than registrars requesting literature. Conclusions Very little, if any training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country; however it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.
A survey to assess the prevalence of Hepatitis B in the adult HIV positive population of the TC Newman ARV centre, Paarl
(Stellenbosch : Stellenbosch University, 2011-08) King, Jeanmari; Botha, Jeanmari; Hagemeister, Dirk; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.
ENGLISH ABSTRACT: Background: Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) co-infection in South Africa is estimated between 5-17%; however research determining this prevalence is lacking. With co-infection there is increased risk of liver cirrhosis, end stage liver disease, death as well as higher rates of chronic Hepatitis B infection. Chronic HBV develops in 20% of HIV positive individuals when compared to less than 5% in HIV negative individuals. This also further complicates Highly Active AntiRetroviral Treatment (HAART). Methods: A retrospective observational quantitative, cross-sectional, analytical study was done at the TC Newman Antiretroviral (ARV) centre in Paarl. All adult HIV positive patients that were started on antiretroviral therapy for the time period the new protocol was implemented were analyzed according to their Hepatitis B Antigen (HBsAg) result as well as for any association with gender, CD4 and age. The new protocol stated that all patients who were to start ARV’s had to be tested for Hepatitis B by testing their HBsAg. Results: A total of 498 participants were identified of which 40% were male and 60% were female. The HBsAg positivity rate was established at 7.6%. A higher prevalence was found among men as well as in the age group 50-59 years and those with a CD4 of 50/μL and less. Conclusions: With a prevalence of almost 8% there should definitely be a recommendation towards routine testing of HIV positive patients for Hepatitis B. If not before commencing ART then at least when switching from a regimen containing Lamivudine (3TC) or Tenofovir (TDF) to a regimen not containing these drugs in order to prevent acute flare ups of hepatitis.
What was the trend of the adolescent pregnancy delivery rate at Paarl Hospital over the past 10 years (1999-2008)?
(Stellenbosch : Stellenbosch University, 2011-12) Lesch, Eugene; Hagemeister, Dirk; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
ENGLISH SUMMARY : Background: Despite government strategies to reduce the number of unintended or unplanned pregnancies, the number of adolescent pregnancies in South Africa continues to rise. The aim of this study was to determine the adolescent pregnancy delivery rate at Paarl Hospital and to see what the trend was over a 10 year period (1999-2008). Methods: A retrospective observational study was done and the data was obtained from the birth register at Paarl hospital and therefore information of pregnancy statistics over the 10 year period. This research study included adolescent females giving birth at age 19 years and younger. Results: Of the 40576 mothers giving birth at Paarl Hospital from 1 January 1999 until 31 December 2008 8182 (20.16%) were adolescents (age 19 years and younger at the time of delivery). Adolescents younger than 15 years of age were a total of 200 (2.4%) of the total adolescents giving birth and showed an upward trend over the 10 year period. The trend of adolescents’ age 15-19 years of age at delivery had stabilized since 2001. Conclusions: Adolescent pregnancies are a relevant and significant point of concern in the Paarl area, which is important not only because of its associated socioeconomic problems but also for the health implications such as HIV/AIDS.

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