Family Medicine

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The prevalence of obesity and associated medical conditions in an urban Indian general practice.
(1986) David, C. A. D.
The prevalence of obesity and associated medical conditions amongst Indian patients attending an urban Indian general practice in Phoenix was investigated. Data were collected using standardized questionnaires and checklists. All obese patients, 18 years of age and older, who attended the Researcher's general practice were interviewed and examined, personally, by the Researcher. The study was conducted over a period of three months. In respect of identifying medical conditions associated with obesity, information from patients' records in the Researcher's general practice was utilized and where this was not available, a questionnaire to identify the aforementioned medical conditions, was administered to the patient. Data were collected, entered onto a collation sheet and analysed manually. The prevalence rate of obesity for males and females was found to be 4% and 13% respectively. The majority (88%) of obese subjects were married and were housewives. A large number (81%) had received a low level of education. The majority (91%) did not smoke. Most (95%) did not consume any alcohol. The majority of obese subjects (70%) came from families consisting of between four and seven persons. Most were in the third and fourth decades of their lives (65%), and engaged in very little physical activity. The majority (70%) had a diet consisting mainly of carbohydrates, especially refined carbohydrates. Dyspnoea was the most commonly occurring medical condition in these subjects (32%). Next ranked osteoarthrosis (23%); then varicose veins (10%); depression (10%); hypertension (9%); anxiety (6%); diabetes niellitus (4%); flat feet (2%); hernia (2%) and ischaemic heart disease (2%). Obesity is associated with much morbidity. Efforts should be directed towards preventive measures as well as identifying and treating those obese persons who are at risk of developing obesity - associated diseases.
Dietary factors in overweight adults.
(1986) Smith, R. J.
The often stated inability of many patients to lose weight or maintain weight reduction is a common complaint heard in general practice and the dietary reasons underlying the problem was studied. The study was carried out in a suburban general practice , and it was found that there is a high degree of dietary ignorance and dietary indiscretion in overweight people. This would therefore account in the majority of cases for the claims made by patients that they eat very little and yet cannot lose weight. Overweight/obesity is of multi-factoral aetiology and the dietary aspect plays a major role. Thus recommendations have been made to endeavour to correct the problem at general practice level, by supplying a protocol in an approach to weight control management and at a community level by the introduction of a comprehensive and multifaceted health programme aimed at education and implementation of good dietary behaviour.
Alcohol use and the availability of supportive services in a white urban community.
(1986) Miller, Atholl Jonathan.
This study identifies the alcohol intaKe patterns of 274 white patients attending an Urban General Practice. The average consumption rate was 6.5 drinKs per person per weeK (d/p/w). 40X of the surveyed group did not consume any alcohol. The drinkers averaged 11 dIp/wo 72X of the males drank and 501: of the females dranK. 4.31: of the population surveyed were drinking more than 28 dIp/wo Marital status made no real difference to consumption rates but unemployment (16 d/p/w) and being a manual labourer (11.7 d/p/w) did. People who had lost either their occupation (11.7 d/p/w) or a close family member (9.3 d/p/w) in the preceeding year had higher than average (6,5 d/p/w) consumption levels and these were increased further if they had identified an alcohol abuser in their family. This study also identifies the useful supportive services available to this particular community and its health care worKers with a brief discussion of the type of service prOVided and method of access to the service. The appendix contains a list of the services with the relevant address. telephone number and where possible the name of a contact person.
Health care of the geriatric Indian population of Port Shepstone.
(1986) Naidoo, D. M.
No abstract available.
Profile of sexually transmitted diseases at Addington Hospital, Durban.
(1986) Govind, Uttam.
During the period January 1985 to December 1985, 537 consultations were undertaken at the Special Clinic at Addington Hospital, 483 of these were specifically for venereal disease. The male to female ratio was 2.2:1. The majority of the patients treated were Coloureds. Most of the patients were in the age group of 20-35 years. The majority of the patients were unemployed. Gonorrhoea was diagnosed in 25.13% of the patients, followed by latent syphilis 19.52%. Chancroid was the commonest cause of genital ulceration and was diagnosed in 10.4% of the study population. N. Gonorrhoea was isolated in 42 patients; 40.5% of the isolates were resistant to penicillin, 66.6% to cotrimaxozole and 30.9% to ampicillin. The organism was sensitive to chloromycetin, erythromycin and tetracycline in most cases. All the penicillin resistant strains were sensitive to spectinomycin.
The prevalence of infertility in women attending a general practice in Katlehong.
(1987) Mgiba, Phosakufa Wilson.
A study to determine the prevalence of infertility in females in a patient population attending a general practice in Katlehong was done over seven weeks in 1985. In this study 40.6% out of a total of 143 patients interviewed were found to be infertile. Contributing factors to infertility included an advanced age of patients and use of intra-uterine contraceptive devices. Pelvic inflammatory diseases, fibroid uteri, fixed retroverted uteri and a poor socio-economic status of patients were also found to be associated with infertility. The above factors associated with infertility in females are discussed and recommendations directed to the reduction of infertility are submitted.
Isoenzyme polymorphism in entamoeba histolytica : an epidemiological survey in a rural South African population.
(1989) Gathiram, Vinodh.; Jackson, Terry F. H. G.; McLeod, I. N.
Isoenzyme characterisation of Entamoeba histolytica into pathogenic and non-pathogenic zymodemes substantiated previously held views that this parasite con5titutes two distinct strains or even sub-species that are morphologically identical but vary in their pathogenicity. A reappraisal of the epidemiology of amoebiasis and investigation of the patho-physiological relationships between these pathogenic and non-pathogenic zymodemes and their host was therefore indicated. Only pathogenic zymodemes were isolated from hospitalised patients with amoebic liver abscess (ALA) and amoebic dysentery (AD). In the amoebiasis endemic peri-urban population of Durban, I. histolytica occurred at an overall prevalence of 10%. Carriers of non-pathogenic zymodemes constituted 9% of the population. A key observation was that asymptomatic infections with pathogenic zymodemes occurred at a prevalence of 1%. Higher prevalence of E. histolytica occurred in association with poor sanitary conditions. Furthermore., both pathogenic and non-pathogenic zymodemes tended to cluster into family units suggesting person-to-person transmission of the parasite by the faecal-oral route. Although invasive amoebiasis occurs far more frequently in males than females (8:1) both pathogenic and non-pathogenic zymodemes are equally distributed in male and female E. histolytica cyst passers. Ninety percent of carriers of pathogenic zymodemes spontaneously cleared their infections and remained asymptomatic throughout the study period of 2 years while 10% developed AD which required treatment with metronidazole. No spontaneous changes in zymodemes from the non-pathogenicto the pathogenic type was observed in a longitudinal study. The serological response of asymptomatic carriers of pathogenic zymodemes (100% seropositive) was identical to that of patients with ALA or AD with a high proportion (94-100%) of them being strongly seropositive. The prevalence of seropositivity amongst subjects who were not infected by E. histolytica (13% seropositive) was not statistically different (p>0,5) from that of the random population of this endemic area (19% seropositive) and carriers of non-pathogenic zymodemes (21% positive); the prevalence of strongly seropositive reactions among this group was only between 2-4%. It is concluded that a positive serological response is directly due to past or present contact with pathogenic zymodemes. This is further substantiated by the observation that the proportion of seropositive subjects was found to increase dramatically in a population near Cape Town where an outbreak of invasive amoebiasis (ALA and AD) occurred indicating a high prevalence of pathogenic zymodemes in this community. Another community in northern Transvaal (Gazankulu) where ALA and AD does not occur was, as expected, uniformly seronegative. Axenic growth of pathogenic zymodemes was possible but could not be accomplished with the non-pathogenic zymodemes. Even though monaxenic growth together with Trypanosoma cruzi was possible with both strains, the pathogenic zymodemes tended to grow more prolificly. No zymodeme changes from non-pathogenic to pathogenic and vice versa were observed with such changes in culture conditions. Cyst production by the pathogenic zymodemes in vivo was confirmed experimentally, thereby demonstrating the ability of pathogenic E. histolytica to independently complete their life-cycle thus giving it the ability to propagate itself successfully as a species.
Knowledge and utililization of contraception amongst teenagers attending an urban Indian general practice.
(1991) Jugnundan, Prakash.
During the six month period June to December 1990, 300 Indian teenagers attending the urban general practice of the researcher were interviewed. Data pertaining to age, sex, knowledge and utilization of contraceptives were recorded. The results showed that the majority of teenagers (57%) had a good knowledge of contraceptives. Utilization, however remained low. Most (56%) knew where their local Family Planning Clinic was, but only a small percentage (15%) attended. Recommendations directed towards implementing increased utilization of various contraceptive methods and decreasing teenage pregnancies are submitted.
Utilisation and knowledge of contraception in attenders at Alice in Ciskei.
(1991) Mbete, J. M.
No abstract available.
Disability grant assessments at Nqutu, Kwazulu-Natal.
(1994) Mhlambi, Sibusiso D. L. A .
No abstract available.
Knowledge and utilisation of contraception in Indian females attending an urban general practice.
(1995) Singh, Suriyabala Kissoon.; Naidoo, B. N.; Moodley, Jagidesa.
459 Indian female patients between the ages of 16 and 50. attending the practice of the researcher were asked to complete a confidential questionnaire on the knowledge and utilisation of contraception. The results of the study revealed that the majority of the participants were literate and possessed some knowledge of contraception. The contraceptive choice was the Pill with many participants also favouring the use of the intra uterine device. Condoms were used by only ten percent of the group while the use of the injection - Depot Provera - was negligible. Most peri menopausal women had completed their families and had undergone Tubal Ligation even though a fair number had the intra uterine device in place and also had continued using the Pill as their contraceptive.
Cigarette smoking among Indian matriculants at ex-House of Delegates schools in Northern Kwa-Zulu Natal.
(1995) Bayat, Mahomed.; Pillay, Basil Joseph.
A descriptive study of cigarette smoking in a sample of Indian matriculation students was undertaken in Northern Kwa-Zulu Natal in order to establish the prevalence of cigarette smoking; reasons for developing cigarette smoking behaviour; to determine knowledge about and attitudes to cigarette smoking and also to establish students' awareness of antismoking organisations and to make recommendations based on the findings. Data was collected by the researcher who administered questionnaires at various schools previously under the jurisdiction of the House of Delegates, in the towns of Newcastle, Dannhauser, Glencoe and Dundee. There were 55 smokers in the sample (N =326), ie., a prevalence rate of 16,9%. Among the males 52 (36,1%) were smokers and 3 (1,8%) females smoked. Fifty four (98,2%) smokers had commenced smoking above the age of 10 years. Twenty seven (53%) smoked at home and 12 (24%) smoked at school. Experimentation occured among 46 (83,6%) smokers prior to actual smoking with 52 (94,5%) smokers having friends who also smoked. Advertisements influenced 10 (18,2%) smokers while 11 (20%) were influenced by teachers and 9 (16,7%) were influenced by family members. Smokers received more pocket money than non-smokers. More family members of the smokers were also smokers as opposed to non-smokers. Fourty nine (89,1%) smokers believed that smoking was harmful to themselves while 41 (74,5%) said it was also harmful to others. The association between smoking and lung cancer was well known by 49 (90,7%) smokers but the association with heart disease and other cancers was not as well known. There was very little awareness among both smokers and non-smokers about anti-smoking programmes and organisations. Alarmingly there was hardly any formal health education on the dangers of smoking in schools. The conclusions are that the prevalence of cigarette smoking among Indian matriculants in the study area was 16,9% and that teachers, friends, family members and advertisements are influential in cigarette smoking behaviour. There is a need for education on the dangers of smoking in schools; and parents and teachers must take congnisance about smoking at home and in schools.
Profile of the asthma clinic at Addington hospital, Durban.
(1996) Lubbinge, A. W.; Pillay, Basil Joseph.
A study was done about the Asthma Clinic at Addington Hospital to show the characteristics and demography of the patients attending the clinic during the study period of one year. Some of the aspects studied were: the onset and duration of asthma, concomitant allergies, smoking behaviour, evaluation of treatment, casualty attendance, hospital admissions and compliance in attending the clinic. Therapy of the patients was aimed at control of inflammation and brocho constriction. Preventative pumps were used in 96% of the patients. The aim was to make the patient symptom free, to live a normal life and to prevent short term and long term complications of asthma. A comparison was made between three different groups of patients. a) non-smokers, b) smokers and ex-smokers, c) non-compliance in attending the clinic. It was found that the non-smoking group showed clinical improvement in lung functions, although not statistically significant.
Twenty four hour ambulatory blood pressure monitoring in general practice.
(1997) Rugnath, Thirjbahadur.; Vythilingum, S.
Objectives: To assess the role of ambulatory blood pressure monitoring in the diagnosis of hypertension in general practice. Background: Hypertension is usually diagnosed by casual office blood pressure readings. However, ambulatory blood pressure monitoring has shown that a significant proportion of patients diagnosed as hypertension in fact do not have hypertension. Method: Sixty four Indian patients diagnosed as having mild to moderate hypertension by casual measurements were subjected to a twenty four hour ambulatory blood pressure monitoring. A blood pressure load of >35% was classified as true hypertension and < 35% as white coat hypertension. White coat hypertensives were compared to the hypertensive group with respect to various demographic characteristics, and to correlate ambulatory blood pressure monitoring and casual blood pressure readings. Results: A prevalence of 23.44% white coat hypertension was found. In addition, the demographic profile of such patients show a preponderance of non-obese females (73.33%), the majority of whom are on concomitant medication (60%). A poor correlation was found between the casual office blood pressure readings and the twenty four hour ambulatory blood pressure readings in the white coat hypertensives as compared to the hypertensive group. Conclusion: White coat hypertension is common in patients diagnosed as having mild to moderate hypertension by casual blood pressure readings. There are no reliable clinical indicators to identify patients with white coat hypertension. Ambulatory blood pressure monitoring has been shown to be a useful method for differentiating white coat hypertensives from true hypertensives.
Profile and management of patients presenting with asthma in outpatients at a community hospital in Escourt.
(1997) Loot, S. M. H.; Pillay, Basil Joseph.
Much work has been done in urban areas to implement national guidelines in the treatment of asthma. There is however a dearth of studies done in rural and semi-rural areas. For this reason this study on the profile and management of patients presenting with asthma at a community hospital was undertaken in Estcourt. The study involved interviewing patients presenting with asthma at an outpatient clinic. The questionnaire and patient records were used. The questionnaire was designed by the author to detect precipitating factors leading to exacerbation of asthma and to assess whether national guidelines were been followed by doctors treating these patients. A hundred patients were interviewed. Eighty seven percent of these patients' treatments were not in keeping with national guidelines. In only 11 % of these patients had a doctor used a peak flow meter in the assessment of the patient. Three percent of patients had an understanding of their disease because of relatives who were medical workers. Patients complained that their illness was not explained to them and-they were not shown methods of coping with an acute attack. In many cases patients and health workers did not appreciate the seriousness of an attack. This is demonstrated by the study which showed seventy four percent of participants did not receive prophylactic treatment such as inhaled steroids or sodium chromoglycate although all were chronic sufferers of asthma. Of the thirty one patients admitted in 1997, twenty five had presented to outpatients in 1997 in the same month of their admission. This proves that the seriousness of their condition was not detected by the health workers attending to them. Recommendations are made in keeping with national guidelines to improve services in the Estcourt area in order to reduce morbidity and mortality in patients suffering from asthma and to increase patient satisfaction.
Cannabis use : social risk factors and knowledge of health risks in a sample of adolescents.
(1997) Van Niekerk, Antoinette Elisabeth.; Schlebusch, Lourens.
A study was conducted at a Durban high school which has a mixture of socioeconomic classes and races. All grade 10 pupils present on the day of the study were asked to complete a questionnaire under examination-like conditions. The aim was to determine the prevalence of dagga smoking as well as the pupils' knowledge of the effects and health risks of dagga smoking and the prevalence of associated features such as alcohol use, cigarette smoking and sexual activity. Dagga smoking was found to occur commonly (22.9%) and to be mainly a white male group activity. There was a strong association with cigarette smoking and alcohol abuse and a general lack of knowledge concerning the adverse health effects of dagga smoking. Peer pressure and relief of stress were cited as the commonest reasons for dagga smoking. More information and life skills training is required for this group of students as well as further research into substance abuse related topics in general.
A follow-up study of the respiratory health status of automotive spray painters exposed to paints containing isocyanates.
(1997) Randolph, Bernard Winston.; Lalloo, Umesh Gangaram.
In order to evaluate the respiratory health status of spray painters exposed to paints containing hexamethylene diisocyanates (HDI) and to obtain more insight into the relationship between occupational exposures to isocyanates and chronic obstructive airway diseases, a follow up study on 33 of an original cohort of 40 randomly selected workers was undertaken. The original investigation was conducted by the author in 1989. The subjects were studied using a standardised American Thoracic Society (ATS) approved respiratory health questionnaire, baseline pre and post shift spirometry and ambulatory peak flow monitoring. Bronchial hyperresponsiveness tests using histamine (PC20) were performed. Immunological tests including IgE, RAST (HDI), and house dust mite evaluations were also made. The subjects were stratified into exposed (n=20), partially exposed (n=5) and no longer exposed (n=7) groups. One subject was excluded from the group analysis because of his indeterminate isocyanate exposure. Warehouse assistants (n=30) in a non-exposed occupation were used as controls. The worker's compliance with safety regulations and the employers provision of safety requirements was assessed by means of a questionnaire. The environmental conditions in the workplace were measured by the evaluation of the isocyanate concentrations at the worker's breathing zone. Spray booth efficiency was measured using measurements of airflow velocities and airflow patterns within the booth. Longitudinal changes in respiratory health status was assessed by comparison with baseline data studied in 1989. The exposed group showed the largest mean cross-shift declines of 297 ml (± 83.8) in forced expiratory volume in one second (FEV1). The decline in the partially exposed group was 282 ml (± 102.7) and 54 ml (± 140) in the no longer exposed group. The results of the first study, when compared with the second study, showed a mean cross-shift decline in FEV1 of 130.5 ml. (± 203) (p=0.0002) and 297ml. (± 323) (p=0.0001) respectively. Furthermore, of the spray painters examined, 10 (25%) showed clinically significant cross-shift declines in FEV1 viz. decreases >250 ml in the first study (n=40) compared with 9 (45%) in the second study (n=33). In contrast to the HDI exposed spray painters, a closely matched control group (n=30) showed a mean cross-shift increase in FEV1 of 17.4 ml ( ± 63.04). Only 2 subjects had a diagnosis of asthma which was made in childhood and not related to occupation. The mean annual baseline decline in FEV1 was greatest in the exposed group 41.25 ml (25% showed a decline greater than >90 ml per annum). These values exceeded the predicted annual declines for both smokers and non smokers due to age. The decline in the no longer exposed group was 7.85 ml per annum. Immunological tests showed no correlation with declines in FEV1 . This study demonstrates the difficulties in correlating immunological status with clinical and lung function findings in workers exposed to HDI, as a means of predicting occupational asthma. Although measurements in cross-shift declines in FEV1 appear to be a suitable predictor of occupational asthma, in some cases it was found that the forced expiratory flow rate (FEF 25-75 %) was a more sensitive predictor of early changes in the small airways. The mean isocyanate concentration in the spray painter's breathing zone was 14.65 mg/m3 (±12.219), exceeding the current South African Occupational Exposure Limit - Control Limit (OEL-CL) of 0.07 mg/m3 for isocyanates. Fifty per cent of the subjects suffered from eye irritation and 40% had dermatitis of the hand. This was expected since none of the spray painters wore goggles or gloves. Whilst no subject had evidence of clinical asthma related to spray painting, a large proportion demonstrated significant cross- shift changes in lung function implying short- term adverse effects of exposure. In addition longitudinal declines in lung function which was worse in those who continued spray painting in the follow-up study, is of major concern. The lack of cases of clinical or occupational asthma may be due to the healthy worker effect. Recommendations include, routine spirometric lung function testing of all spray painters, the use of high volume-low pressure spray guns and the wearing of positive pressure airline masks complying with the South African Bureau of Standards (SABS) safety standard. In terms of current legislation it was further recommended that spray booths be regularly monitored, including the measurement of HDI concentrations, airflow velocities and airflow patterns within the booth and the implementation and enforcement of stricter control measures. Workers demonstrating excessive declines in both cross-shift and longitudinal spirometry, require special attention.
The impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs, and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal.
(2005) Shamagonam, James.; Jinabhai, Champaklal Chhaganlal.; Reddy, S. P.
Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice.
Perceptions around managed health care service delivery in private medical care in the Republic of South Africa.
(2008) Scott, Mitchell Robert.; Chetty, Morgan.; Naidoo, S. S.
Introduction: This study aimed to explore private General Practitioners' perceptions of Managed Health Care CMHC) for health service delivery in the Republic of South Africa (RSA). The specific objectives were to review perceptions regarding issues in MHC including ethics of care, quality of care, design ofMHC programmes and regulation and monitoring ofMHC. The study also reviewed demographic profile of respondents and associations between demographic profile and perceptions. A literature survey indicates that MHC was introduced in a Western context as a means ofregulating cost of healthcare. Models ofMHC generally involve a need to obtain authorization and a restriction of services available. There are ongoing debates about MBC and in particular the potential conflict between managing healthcare provision using business and profit principles and the principles of other stakeholders in health care. Providers, such as General Practitioners, are concerned that their autonomy and their ability to offer best possible care for their patients may be compromised. Patients feel that their ability to access optimal care is not a primary consideration in a model of MBe. The popularity ofMBC in the United States of America is declining and MBC companies have been making financial losses on the Stock Market. MBC has been introduced in South Africa and there has not been any recent assessment of healthcare provider perceptions of the model. This study aimed to address this gap in literature. Methods: The study design was mixed with quantitative and qualitative components. The study population was all private General Practitioners in RSA as this population would have most experience of MBC. The data collection tool was designed by the researcher and comprised closed-ended questions and one open-ended question around perceptions of MBe. Demographic data, and other data relating to experience of MBC, was collected on a separate questionnaire. Questionnaires were posted to a representative sample of private General Practitioners; this constituted 30% of all active private General Practitioners. Results and discussion: The response rate was poor at 13.6%. Respondents generally had negative perceptions of MHe. They cited problems with ethics ofMBC, quality of service and felt that it affected their ability to act independently. They felt that MHC should be monitored by an independent regulatory body and that there should be more teaching around differing models of healthcare. There were no significant associations between gender, place of work, experience oftvtHC and perceptions. However, there was a significant correlation between doctors employed by Iv1HC companies and perceptions. A major limitation of this study was the predominant use of quantitative methodology. A qualitative methodology, using focus group discussion, may have highlighted major issues and following initial qualitative methods a quantitative tool could have been developed. The low response rate is of concern. Respondents may be biased and may have only responded if they felt strongly about the subject. However, respondents did raise some important issues, especially with regards to ethics which must be explored further. There should be ongoing research into differing models of healthcare provision (for example private-public partnerships). Medical school curricula should include training around models of healthcare. Consideration should be given to monitoring MBC using an independent monitoring authority.
Medical practitioners’ reactions towards family medicine as a speciality in South Africa.
(AOSIS, 2008) Naidoo, Cyril.; Esterhuizen, Tonya.; Gathiram, Premjith.
Background: Family physicians are trained to treat a wide range of diseases, treatment being centred on the patient, family and community irrespective of age, gender, or ethnic or racial background. To deal with inequalities in health care, the South African government introduced the concept of a district health system in 1997. It was only in August 2007, however, that family medicine was legislated as a speciality. This study was undertaken prior to the enactment of this legislation. Method: A descriptive quantitative study using a self-administered questionnaire was undertaken. A convenience sampling technique was used (N = 60) to assess the reactions of medical practitioners towards the impending legislation. Results: Overall, 60% of the sample was in favour of the legislation. There were no significant differences between those working in the private and public sectors or between generalists and specialists. With regard to those not in favour of the legislation compared to those in favour of the legislation, a significantly increased number answered the following statements in the affirmative: (i) ‘I already carry out the functions of a family physician’ (p = 0.001), (ii) ‘They [specialist family physicians] will not be as qualified as specialists in other categories’ (p = 0.005), (iii) ‘It will have a negative impact on general practice’ (p < 0.001), (iv) ‘It will increase competitiveness’ (p = 0.021), (v) ‘It will not have any effect on patient care’ (p = 0.010) and (vi) ‘There is no need for such a speciality’ (p = 0.001). Conclusion: We concluded that the majority were in favour of the legislation being implemented.

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