South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Young South Africans experience high rates of HIV infection. While nationally scaled medical male circumcision (MMC) can help to curb HIV infection rates in countries such as South Africa (SA), MMC uptake has not been consistent or universal, suggesting variable acceptability among men. Both MMC and traditional male circumcision (TMC) are practised in SA. For male circumcision to be most effective for HIV prevention, it should be performed prior to sexual debut with complete removal of the foreskin. ⋯ MMC was the preferred option for young men in Soweto compared with those in Cape Town, and this translated into practice. Despite knowledge of the benefits of early MMC, many participants delayed uptake, potentially reducing the MMC benefits before sexual debut. Programmes promoting circumcision should consider the influence of local practices. To realise full HIV prevention benefits, efforts should be made to ensure that circumcision is promoted, and that all circumcision is safe, performed prior to sexual debut, and contextually responsive.
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COVID-19 is prevalent in sub-Saharan Africa. The healthcare response to the pandemic depends upon a mentally and physically healthy workforce. Infectious disease outbreaks cause high psychosocial stress among healthcare workers, which may impact negatively on workplace functioning. ⋯ Depression, anxiety, post-traumatic stress, and other mental health conditions were noted among healthcare workers exposed to COVID-19 and other outbreaks. Although no effectiveness studies were identified, certain proposed interventions may be implemented by healthcare leaders. Further research is recommended.
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Hypotension is a common presentation following an overdose of quetiapine. Adrenaline is often used as the vasopressor of choice for hypotension not responding to intravenous fluids. We present a case of quetiapine overdose with hypotension unresponsive to high-dose adrenaline. ⋯ Alpha-2- and β2-agonism can reduce sympathetic outflow and cause vasodilation, respectively, further exacerbating the hypotension. Noradrenaline is the preferred vasopressor of choice for hypotension caused by quetiapine overdose, as it has less affinity for α2- and β2-receptors, but maintains α1-receptor agonism. Drugs with a similar mechanism of inducing hypotension should also be treated with noradrenaline as the vasopressor of choice.
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South Africa (SA) has one of the highest rates of intimate partner violence (IPV) in the world. It is also in the midst of a demographic transition in which the number of people aged >60 years is expected to double by mid-century. Despite the confluence of these two public health issues, there are no published studies on the epidemiology and risk factors for IPV in older SA women. ⋯ This study is the first of its kind in the SA context, and shows that IPV is a persistent threat for women across the lifespan. It suggests that IPV may manifest differently in older women compared with women of reproductive age, necessitating future qualitative and quantitative studies that examine the correlates, causes and points of intervention unique to this growing population.
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All children with burn injuries experience pain at some time during their management and recovery. Burn pain is challenging to manage, owing to a combination of factors. The process of achieving adequate analgesia involves the correct scripting of medication based on the doctor's knowledge, the correct fulfilling of that script, and patient compliance. ⋯ Burn-injured children commonly receive inadequate analgesia in our setting. The reasons for this are multifactorial. The correct dose and the correct drugs for burn-related background pain are deficits in the knowledge of doctors who deal with this common problem. Furthermore, even if the correct drug and dose are prescribed, the correct volume of medication is often not issued by the pharmacy. This study highlights barriers to achieving adequate analgesia in children with burns being managed as outpatients. Potential strategies to overcome barriers include improving education with regard to pain management and burns at an undergraduate and postgraduate level, and improved supply chain management.