South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Pragmatic Clinical Trial
Fasting plasma glucose and risk factor assessment: Comparing sensitivity and specificity in identifying gestational diabetes in urban black African women.
Identifying women with gestational diabetes mellitus (GDM) allows interventions to improve perinatal outcomes. A fasting plasma glucose (FPG) level ≥5.1 mmol/L is 100% specific for a diagnosis of GDM. The International Association of Diabetes and Pregnancy Study Groups acknowledges that FPG <4.5 mmol/L is associated with a low probability of GDM. ⋯ Universal screening using FPG ≥4.5 mmol/L had greater sensitivity and specificity in identifying GDM-affected women and required fewer women to undergo a resource-intensive diagnostic OGTT than risk factor-based selective screening. A universal screening strategy using FPG ≥4.5 mmol/L may be more efficient and cost-effective than risk factor-based selective screening for GDM in black SA women.
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South Africa (SA) has an increasingly high rate of unintended pregnancies among adolescents, which are coupled with poor contraception knowledge. We highlight a systematic review that evaluated the effects of prevention interventions for unintended adolescent pregnancies, and provide implications for practice that are relevant to the SA context. The findings suggest the need for multifaceted interventions that are aligned with adolescent sexual and reproductive health best practices to address the unmet contraception knowledge gap, as well as unintended pregnancies among adolescents.
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Multicenter Study
Medicine-use evaluation of doxazosin prescribing to inform formulary recommendations.
It is estimated that >50% of all medicines are inappropriately prescribed, dispensed or sold. In 2018, the Western Cape Government Health (WCGH) Provincial Pharmacy and Therapeutics Committee (PPTC) endorsed an investigation of doxazosin use in provincial public sector healthcare facilities using a medicine-use evaluation (MUE). This was based on potential inappropriate prescribing, high usage and high costs associated with doxazosin. ⋯ MUEs are an untapped resource for medication-use monitoring and practice improvement. MUEs offer a distinct, cost-effective approach to improve medicine use in all settings. This MUE revealed a relatively minor concern with doxazosin prescribing. MUEs can be beneficial to inform formulary changes and re-evaluate medication-use restrictions.
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Multicenter Study Observational Study
A multicentre prospective observational study of the prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in Western Cape Province, South Africa.
Preoperative anaemia has been shown to be an independent risk factor for postoperative morbidity and mortality. Iron deficiency is the leading cause of anaemia globally. There are limited data describing the burden of perioperative anaemia and the relative contribution of iron deficiency in South Africa (SA). ⋯ Preoperative anaemia was common in this study, and more than half of the affected patients had moderate to severe anaemia. Iron deficiency was responsible for almost 40% of cases. Iron supplementation was under-utilised in the preoperative period as a means of increasing haemoglobin. The introduction of system-wide policies would empower perioperative physicians to mitigate the risk associated with preoperative anaemia in the Western Cape.
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Observational Study
We need to target trauma: A prospective observational study in Eastern Cape Province, South Africa.
Emergency medicine accounts for a large proportion of medical care in many low- and middle-income countries. A better understanding of the burden of disease will guide training and resource allocation priorities, but lack of electronic medical records and standardised data collection systems makes it difficult to obtain this information. ⋯ From the proportion of presenting individuals sampled, we can conclude that a large proportion of care delivered in ECs in the Eastern Cape is for trauma. Local clinical capacitation efforts must focus on trauma training.