E-Doc Interactive

Conferences and Meetings: HPCSA interim Tariff Guideline meeting

At a well-attended, mostly cordial three-hour meeting with prominent stakeholders, the HPCSA’s Tariff Committee recently presented interim feedback regarding proposed guideline tariffs for medical practitioners and dentists, Pretoria. Prof Usuf Chitke, Chairperson of the Tariff Committee, reported that the eighty organisations’ submissions on the topic were still under analysis, and simultaneously expressed the HPCSA’s gratitude for all parties’ participation. Emphasising the Committee’s objective to engage with stakeholders, Chitke said that the meeting was a ‘real and genuine attempt, on the part of the Tariff Committee, to be as participative and inclusive as possible’.

Disease Management: How good are we in South Africa at managing HIV?

HIV, or more specifically, South Africa’s HIV pandemic, is undoubtedly the biggest challenge facing the South African healthcare system. Other significant challenges include the state of delivery in public hospitals; healthcare inflation in the private sector (driven by its focus on specialist services) and how to fund the myriad of expensive technologies that can improve care (but often only marginally).

HIV/AIDS treatment can be a guideline to improve NCD-interventions

PrÃ©cis: Learning from the HIV/AIDS experience to improve NCD interventions, by Soeren Mattke

The central issue

As was the case in the successful fight against the HIV/AIDS epidemic, non-communicable diseases (NCDs) also require a balanced use of prevention and treatment. So far the focus has largely been on prevention, but investigation on how lessons learned in combating HIV/AIDS, should be applied to improving access to NCD-treatment and simultaneously attempt to involve the pharmaceutical industry.

Background

Theoretically speaking, like the successful ARV-treatment for HIV/AIDS, it should be possible to provide similar broad access to treatment for NCDs. These drugs are well-researched and an active drug development pipeline exists. There are, however, fundamental obstacles and the burden of NCDs far exceeds that of HIV/AIDS by its magnitude. The rapid increase of NCD-diseases has become an insurmountable problem in under-resourced health care systems, as they are forced to deal with the double burden on communicable and non-communicable diseases.

Editorial comment: Immunising - as important as ever

Dr David Cameron*

Can you imagine a tribe of wingless insects with short stumpy legs crawling about your scalp and sucking your blood? It sounds rather scary but in a fascinating article on head lice, you will learn everything you wanted to know, but were afraid to ask about these interesting little creatures (Head lice). Like everything in life, head lice are part good news and part bad news. They are not as bad as you think and may even do you some good. So don’t look the other way. Explore the myths and misconceptions, the management and methods of getting rid in a safe and effective manner of these unwelcome visitors.

Diabetes: Pre-pregnancy care for diabetes

Miriam Brennan*

Diabetes is the most common pre-existing medical disorder that complicates pregnancy. It affects one in 250 women and is associated with a greatly-increased risk of adverse consequences for both mother and baby.

Malnutrition: Teaching mothers - saving lives, part 3: Paediatric malnutrition

Sally-Jane Cameron*

In Part 1 of the Teaching Mothers series, the alarming infant mortality statistic for South Africa showed that we as nurses have a role that extends beyond our place of work and area of expertise. We cannot leave health education to the over-worked and over-stretched primary care staff. We come into contact with mothers in all aspects of our daily lives, and we need to grab these teachable moments as part of our social responsibility for the health of our community.

HIV/AIDS hotline

Frequently-asked questions to the National HIV & TB Health Care Worker Hotline

*Annoesjka Swart

Q: How should I deal with a viral load of >50 copies/ml?

Annoesjka Swart

A: Viral load monitoring is very important to the success of antiretroviral therapy (ART). If the viral load is undetectable, then the virus cannot mutate and develop resistance. In the public sector viral loads are done 4 – 6 months after initiating ART, and then annually thereafter.

A viral load >50 copies/ml while a patient is receiving ART should be an indication for urgent action to improve adherence. The viral load should be repeated three months after adherence support is stepped up and an ART change must be considered if there is not complete viral suppression at the three month follow-up viral load.

Treatment success is defined by a decline in viral load to <50 copies/ml within six months of commencing ART and sustained thereafter.

Treatment failure is defined by a confirmed HIV viral load of >1000 copies/ml in two measurements taken 1 – 3 months apart. Inadequate patient adherence remains the most common cause for treatment failure. Other reasons include: prior use of single-dose nevirapine for PMTCT, especially when ART is initiated within six months of the PMTCT dose; drug interactions that decrease the levels of ARVs; and transmitted resistance, which is currently uncommon in South Africa (<5%).

Sr Sally-Jane`s Q and A: Supplementation in pregnancy

Q: Are iodine supplements safe for women in general, and, in particular, during pregnancy and breastfeeding?

Sr Sally-Jane Cameron

A: Iodine deficiency is a problem that is faced around the world. It is essential for the synthesis of thyroid hormones but, as it is not manufactured by the body, it must come from dietary sources. Most foods are very low in iodine but since the introduction of iodised salt and other fortified foods, iodine deficiency is rare in South Africa. However, there is some concern that, due to the move away from iodised salt and decrease in dietary iodine, some women might be starting their pregnancies at an already-deficient level.

Vaccination: Routine vaccination in South Africa

In order to ensure access to routine recommended vaccinations for infants and children, the SA Department of Health established the Expanded Programme on Immunisation (EPI) in 1976. Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles.³ South Africa became the first country in Africa to introduce the Rotavirus and pneumococcal vaccines in its EPI, which is viewed as a significant step towards achieving the millennium development goal (MDG4).⁴ The MDG4 is to reduce under-five child mortality by two thirds between 1990 and 2015.

Infection control: Threadworms

*Gavin Atkin

Threadworms (Strongyloidiasis), also known as pinworms, are common worm infestations in humans.

Threadworm infection is common in children. They look like pieces of white cotton and measure 5-10mm long, and may be found on the outside of a bowel motion or around the anus. They are easily treated with medicines.