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BACKGROUND:  Type 2 diabetes mellitus (T2D) is a public health challenge, affecting 90% of all patients with diabetes, globally. Compliance to treatment guidelines among healthcare professionals (HCPs) is low, thus resulting in inadequate quality of patient care and poor health outcomes among patients. AIM:  To examine the availability of equipment, guidelines, screening and education offered to patients with T2D and compare between clinics and community health centres (CHCs). SETTING:  Tshwane Metropolitan Municipality, Gauteng Province, South Africa. METHODS:  A cross-sectional descriptive study utilised a self-administered questionnaire to collect data from nurses and doctors responsible for treating patients with T2D, from May to June 2022. About 250 eligible HCPs were recruited during routine morning meetings in 22 clinics and six CHCs. RESULTS:  More than 80% of HCPs reported having basic equipment except for ophthalmoscopes, Snellen charts (67%), tuning forks (64%), electrocardiograms (ECG) (46%) and monofilaments (12%). SEMDSA guidelines were reported by 16% of the participants, Diabetic Foot Care Guidelines were reported by 54% and Dietary Guidelines for Diabetic Patients by 55%. Furthermore, 91%, 71% and 69% of HCPs reported that ECG, microalbumin-creatinine and foot examinations were not always performed, respectively. About 66% and 17% always offered individual educational and group sessions, respectively. CONCLUSION:  Equipment availability and compliance with treatment guidelines, patient education and screening of chronic complications are inadequate.Contribution: The study highlights the poor adherence to treatment guidelines and inadequate equipment in health facilities. These shortcomings could lead to missed opportunities for early diagnosis of complications and ultimately poorer patient outcomes.

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BACKGROUND:  There is a noticeable gap in access to audiology services in South Africa, and the gap is intensified in rural areas. Often, primary healthcare (PHC) facilities have an unequal ratio of audiologists to patients in need. Telehealth can expand the range of hearing healthcare services. OBJECTIVES:  This study aimed to determine whether, for infants, tele-diagnostic Auditory Brainstem Response (ABR) assessment results conducted within a mobile clinic van are comparable to face-to-face diagnostic ABR results in rural Winterveldt, Pretoria North, South Africa. METHOD:  The study utilised a quantitative, prospective cross-sectional comparative within-subject design. Each participant received both face-to-face and mobile tele-diagnostic ABR tests, which were then compared to evaluate the feasibility of mobile tele-diagnostic ABR testing. The Student's t-test was used to determine whether there was a difference between face-to-face and tele-diagnostic tests, and Bland -Altman plots were used to assess the level of agreement between the ABR testing results. RESULTS:  There was a strong correlation (p  0.001) between face-to-face and mobile tele-diagnostic ABR test results for both neurological and audiological ABR tests. The study found that there was no statistical significance between face-to-face and tele-diagnostic ABR measures; additionally, the results were within clinically acceptable and normative measures. CONCLUSION:  Tele-diagnostic ABR offered within a mobile clinic van is feasible as it produces similar and clinically acceptable results when compared to the traditional assessment method.Contribution: This feasibility study is a positive indicator that tele-diagnostic ABR testing through a mobile clinic van may be considered to accelerate the delivery of hearing healthcare services to the infant population in rural communities.

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Background: Testicular torsion (TT) is a urological emergency that needs early diagnosis and intervention to prevent testicular death and necrosis. This study aimed to determine the efficacy of testicular scintigraphy (TS) in confirming the clinical diagnosis of TT and how this imaging method correlates with the surgical findings. Methods: A retrospective cohort review of clinical data was performed for 68 patients referred for TS from January 2016 to December 2021 to rule out possible TT. The final diagnosis was confirmed at surgery for all those with TS positive for TT. Results: The median age of the patients was 18.5 years, interquartile range of 15-31 years. Commonly presenting symptoms were pain (99%) and swelling (68%). Only 6% had history of trauma. TT was diagnosed by technetium-99m (99mTc)-pertechnetate in 35 (51%) patients all of whom underwent surgical exploration. Of this group, 7 (20%) had manual detorsion intraoperatively (intermittent torsion), in 20 (57%) missed (complete) torsion was confirmed and 8 (23%) had a necrotic testis. Of the remaining 33 patients with results negative for torsion, 10 were normal and 23 were diagnosed with either epididymitis 13/23 (57%), orchitis 3/23 (13%) or 7/23 (30%) with epididymo-orchitis. TT was more common in patients under 15 and 15-19 years (P<0.05). The mean presentation time was 5 days with a range of 1-30 days. Conclusions: The 99mTc-pertechnetate scan remains an effective investigation in the diagnosis of TT and may serve as a gate-keeper for surgery even in patients who present late for treatment.

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Background: Pregnancy anaemia is a significant public health concern in South Africa (SA), particularly in rural areas, but little is known about its prevalence and risk factors in rural areas. The objective of the study was to determine the prevalence and identify risk factors of pregnancy anaemia in the public health facilities of Limpopo Province (LP), SA. Methods: A cross-sectional study was conducted among a consecutive sample of 211 pregnant women attending antenatal care at Seshego Hospital and its feeder health centre (May to June 2019). Anaemia was defined as haemoglobin (Hb) <11 g/dL and classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL) and severe anaemia (<7 g/dL). A multiple logistic regression analysis was used to identify predictors of anaemia. Results: The mean age of the women was 28.4 ± 5.7 years (range from 18 to 41 years). Over half (52%) had secondary education, 65% were unmarried, 72% were unemployed, 34% were nulliparous, 15% were human immunodeficiency virus (HIV) infected and 67% were in the third trimester. The anaemia prevalence was 18.0% and was significantly associated with parity, HIV status and body mass index (BMI) in a multivariate logistic regression analysis. Conclusion: This study found that less than one-third of pregnant women were affected by anaemia, associated with parity, HIV infected and BMI. It is essential to promote routine screening for anaemia, health education and prompt treatment of infections to reduce this burden. In addition, further studies on risk factors for anaemia during pregnancy in both urban and rural communities should be conducted to strengthen these findings.

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Objectives: To investigate patient satisfaction regarding healthcare services at a district hospital. The research question was: what is the level of patient satisfaction regarding service delivery? Design: An observational cross-sectional descriptive study conducted in September 2019. Settings: A district hospital in Botswana serving a population of 90 000. Outpatients from the Eye clinic, Casualty and Outpatient Department, Sexual Reproductive Health clinic and Infectious Diseases Control Centre were selected for the study. Participants: 240 stable outpatients over 17 years selected through consecutive sampling participated voluntarily after giving informed consent. Main outcome measures: The level of satisfaction was measured using 19 questions on five-point Likert scales ranging from strongly disagree 1, disagree 2, unsure 3, agree 4 to strongly agree 5. A binary outcome was created into satisfied and unsatisfied using the mean score as the cut-off point. Age, gender, employment, education and departments were independent variables. Results: 65% (95% CI: 58-71%) were satisfied but unsatisfied with: doctor's politeness (66.9%; 95% CI: 60-73%), explaining (67.8%; 95% CI: 61-73%), privacy (65.6%; 95% CI: 59-72%), skills (67.4%; 95% CI: 61-73%), confidence (67.4% 95% CI: 61-73%), compassion (66.5%; 95% CI: 60-72%) and waiting time (49.2%; 95% CI: 42-57%). Department visited predicted satisfaction (p=0.002); those from the Eye clinic and Sexual Reproductive Health clinic were satisfied compared to others. Conclusion: Satisfaction was generally high but lower regarding specified services and departments visited. There is a need for targeted interventions. Studies are needed to explore reasons for lower satisfaction in Casualty, Outpatient Department and Infectious Diseases Control Centre. Funding: None declared.

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BACKGROUND: The aim of the study was to determine the prevalence and determinants of chronic non-communicable disease (NCD) risk factors in a rural community in the Limpopo Province of South Africa. METHODS: This survey was conducted using the WHO "STEPwise approach to the surveillance of non-communicable diseases" (STEPS) methodology. Participants were residents of the Dikgale HDSS site and standardised international protocols were used to measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable intake and, physical activity) and physical characteristics (weight, height, waist and hip circumferences and blood pressure-BP). Fasting blood glucose, triglyceride, cholesterol and HDL-C were determined in 732 participants. Data were analysed using STATA 12 for Windows. RESULTS: The prevalence of current smokers amongst the participants was 13.7%, of which 81.3% were daily smokers. Alcohol was consumed by 16.3% of the participants. The majority of participants (88.6%) had low daily intake of fruit and vegetables and low physical activity (66.5%). The prevalence of hypertension amongst the participants was 38.2%. Overweight, obesity and high waist circumference were prevalent in females. The cardio-metabolic risk profile was not significantly different between men and women. People who were older than 40 years, overweight or obese and those who consumed alcohol were more likely to be hypertensive. Smoking was associated significantly with older age, males, never married and divorced people. Alcohol consumption was associated with older age, males, low educational status and low income. CONCLUSION: High levels of risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for health interventions to control these risk factors at the population level in order to reduce the prevalence of NCDs.

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