Winter Illnesses

Winter Illnesses

• Common cold

• Influenza

• Allergies

Possible causes of the increases in frequency of illnesses seen during winter:

• Decreased dietary nutrients

• Decreased levels of vitamin D

• Decreased levels of activity

• Close proximity to sick individuals

• Certain pathogens are more active in dry and cold air

Prevention

• Wash Hands

• Avoid exposure

• Exercise

• Balanced Diet

• Sleep

• Stress management

Travellers Being Warned Against Measles

SASTM Newsflash

People travelling to their favourite destinations in the summer have been cautioned agains t measles. Around 10 000 people have been diagnosed with measles this year in 18 EU countries out of which, 4 have died. "All children and young people planning on travelling in Europe should ensure they have had 2 doses of MMR [vaccine] before they go away. France, Germany and Spain are all experiencing quite big outbreaks of measles and there are problems elsewhere in Europe," says Dr Brendan Mason, a consultant epidemiologist.

In the UK, 275 cases have been confirmed been January and April this year, a number much higher than that of last year [2010] which was 33, for the same time period.

France has declared measles epidemic officially as 5000 people have contracted the disease in France in the 3 months from January to March alone, which is almost equal to the total cases reported in the country last year.

Turkey and Bulgaria have faced major outbreaks. Belgium, Germany, Denmark, Romania, the Russian Federation, Sweden, Norway and Switzerland have also reported more cases than they usually do.

Children between one and 4 have the highest probability of getting measles. Vaccination is the only way it can be prevented. In every 1000 people who are affected by measles, one dies.

Communicated by: ProMED-mail

South African Society of Travel Medicine (SASTM)

Colds and Flu

The terms “cold” and “flu” are often used synonymously, however they are actually 2 very different infections.

 

What is a Cold?

 

Other names:

• Acute coryza

• Upper Respiratory Tract Infection

 

Aetiology:

• The common cold refers to a viral infection of the upper respiratory tract. It is caused by a group of viruses called the Picornaviruses.

• The infection causes an inflammation of the mucous membranes lining the upper respiratory tract, resulting in an increase in the mucous production.

 

Symptoms:

• The onset of the symptoms is typically rapid, and the first symptom to develop is usually a sore throat.

• This is followed by itching or burning of the nose.

• Sneezing and rhinorrhoea (discharge of mucous from the nasal cavity, a “runny nose”), is usually the last symptom to develop.

• The discharge is typically watery and clear or white in colour during the first few days, however as the infection progresses the mucous becomes thicker.

• Children also often present with a cough. This may be a result of a postnasal drip irritating the larynx or due to increased mucous production within the lungs.

• The majority of children will appear fatigued and irritable during the infection as the body uses energy to fight the virus.

• Symptoms of the common cold last roughly a week.

• Lymphadenopathy is uncommon in viral infections.

 

Risk factors

• Contrary to popular belief, exposure to cold does not appear to have a significant effect on the chances of contracting a cold. However, there are a few factors which have been shown to increase a person’s susceptibility to developing symptoms in response to a Picornaviruse infection.

• Previous exposure to the virus or to a similar strain of the virus reduces the chances of developing symptoms in response to the infection. The immune system of a child is still developing and has not been exposed to as many pathogens as the immune system of an adult. Thus children are more susceptible to “catching a cold” than adults are.

• A lack of sleep and increased stress levels has also been shown to increase the risk of catching a cold.

• Children who are prone to allergic disorders, such as seasonal allergies, allergic asthma or allergic dermatitis, are at an increased risk of catching a cold.

 

Treatment

• Treatment for patients with the common cold is largely supportive.

• Nasal congestion and sinus pain may be managed by using nasal decongestants, however it is important to remember that a large majority of these have a rebound effect after prolonged use.

• Vapour rub products, are often used to help clear the airways.

• Sore throats or sinus headaches can be treated with mild analgesics.

• Avoid strenuous physical activity and encourage the caretakers to keep the child indoors and allow the child to rest and recuperate.

• A change in temperature and exposure to environmental allergens (such as dust and pollen), may aggravate the symptoms.

• Dairy appears to increase the mucous production, and should therefore be avoided during infection.

• Most importantly, the child needs to be carefully monitored in order to detect any secondary bacterial infection which may require antibiotics or further medical treatment.

 

Complications

• In immunosuppressed or weak individuals who are unable to fight the virus, the infection may spread to the lower respiratory tract.

• Secondary bacterial infection may develop and is characterised by a purulent discharge and the development of a fever.

• Children with asthma and respiratory disorders are at risk of complications associated with a flare up of respiratory systems, such as an asthmatic attack.

 

What is the Flu?

 

Other names:

• Influenza

 

Aetiology:

• Influenza is caused by the Influenza virus type A, B or C.

• The influenza virus results in inflammation of the lower respiratory tract.

• Outbreaks of influenza type A and B are most common during the autumn and winter months.

• Type C infections occur throughout the year, however the symptoms caused by type C are slightly different to those caused by types A and B.

• The Influenza virus is highly mutanogenic, in other words, it is able to mutate and evolve relatively quickly. This results in slightly different variations of the virus appearing each year.

• Unfortunately this means that one exposure to the virus does reduce the chances of developing symptoms after the next exposure.

• This also means that vaccinations are seldom effective for longer than a year as each new strain requires a new vaccination.

• The use of vaccinations against the Influenza virus is therefore debateable. However children at risk of infection, whose health is compromised or in whom the virus has the potential to do more damage, are likely to benefit from annual Influenza vaccinations, when available.

 

Symptoms:

• The incubation period is around 2 days, after which the following symptoms begin to develop:

• Chills and fever with hot, moist and flushed skin.
• Pain and aching in the muscles and joints.
• Fatigue
• Headache
• Sore, itchy throat
• Irritating and non-productive cough.
• The eyes may appear red with inflamed conjunctiva and photophobia.

 • As the infection progresses, lower respiratory tract symptoms, such as a persistent and productive cough, become more pronounced. The cough may become suffocating and painful and in severe cases blood may be visible in the sputum.

Treatment

 • Again, treatment is largely supportive and includes pain management.

 • It is important to keep the child hydrated and warm and allow plenty of rest and recovery time.

 • Severe cases of the flu may be fatal and whilst the flu is common, it should not be taken lightly.

 • All children should be closely monitored for any signs of complications.

 • Should the symptoms not begin to clear within 5 days, or should there be any signs of secondary infection, encephalitis or pneumonia, then it is vital that the child receives prompt medical care by a suitably qualified healthcare practitioner.

Transmission of the Viruses:

 • Both viruses are transmitted via droplets of respiratory secretions or via contaminated hands or fingers. Thus the following measures are helpful in reducing the spread of infection:

•  Washing hands after sneezing
• Blowing the nose on disposable tissue paper and discarding the used tissue paper in the rubbish.
• Covering the nose and mouth during coughing and sneezing.

 • Children should be encouraged from a young age to follow the above guidelines.

 • It is also advisable that children remain at home whilst contagious (symptomatic) to prevent the spread to other children in the class or day care.

  

Dr. Carrie Minnaar (M.Tech Hom.)

 

  

References

 Dolin R. (2005) Influenza in Harrison’s Principles and Practice of Internal Medicine 16th Edition Edited by Kasper D.L., Braunwald E., Rauci A.S., Huaser S.L., Longo D.L. and Jameson J.L. London: McGraw-Hill, pp: 1066-

  

Merck Manual Seventeenth Edition (2005) Viral Infections Edited by Beers M.H. and Berkow R. Published by Merck Research Laboratories U.S.A. Pp: 1277-1289

  

Prescott C.J. (2006) Ear, Nose and Throat Disorders in Handbook of Paediatrics for Developing Countries Sixth Edition Edited by Harrisen V.C. Published by Oxford University Press, South Africa, Pp: 109-111

 

 

BREAKING NEWS! NEW CPR Protocol

The International Resuscitation Councils have announced a major change in the CPR Protocol. As of 2011 the following amendments are being agreed upon:

1. A patient who does not breathe is considered not to have heartbeat

2. Hence the checking of the pulse is no longer recommended

3. If a patient has breathing arrest, immediate CPR is required

4. During CPR, the helper FIRST administers the Chest compressions to supply the brain with immediate oxygen

5. Only then are mouth to Mouth Ventilations administered

6. Untrained Lay helpers are to be encouraged to assist by administering Chest Compressions ("fast and hard") while the trained First Aider administers the Mouth to Mouth ventilations

7. CPR is not to be interrupted every minute in order to reassess the breathing and/or pulse

8. CPR Rhythms remain unchanged:

      a. 1 Rescuer   30 Chest compressions : 2 Artificial Ventilations

      b. 2 Rescuers 15 Chest Compressions : 2 Artificial Ventilations

The old protocol is NOT incorrect, still it is believed that these amendments add to the effectiveness as well as to the simplicity of CPR.

Update on National Health Insurance

Health Minister Dr Aaron Motsoaledi has urged citizens who are concerned about the establishment of the National Health Insurance (NHI) to be patient as government is working around the clock on this issue.

"The problem is that many believe that NHI is just the release of a document. For us in health, we know that it also involves an extensive preparation of the health care system, while at the same time preparing a policy document and in this case, the reengineering of the Health Care System is very vital," Motsoaledi said.

Motsoaledi, who was presenting the department's R25.7-billion for 2011/12 on Tuesday, announced that additional earmarked funding has been allocated at provincial level for preparatory work for the NHI, which amounts to R16.1-billion over a three-year period.

He, however, pointed out that under the present health care system, whether public or private, no NHI can ever survive.

"I know that at face value, problems in the health system are said to be existing only in the public sector and the private sector must be left alone to some wayward phenomena called market forces, even though these market forces dismally failed to stop or more appropriately caused the most recent global economic collapse," Motsoaledi said.

He said while it is true that the public health care system is bedevilled by very poor management leading to poor quality care, adding to the very low resources available in the public health sector, the current overall health care system, both public and private, will be completely re-engineered.

"The present health care system is characterised by four very clearly identified negatives. It is unsustainable, very destructive, extremely costly and very hospicentric or curative in nature. For any intervention dealing with the cost of health care, like the NHI, to make any sense, a complete re-engineering is essential and it is an obligation placed upon our shoulders," Motsoaledi said.

Elaborating on the re-engineering of the health care system, Motsoaledi said it will be according to three main streams, with the first being a district based model, where a team of five specialist or clinicians shall be deployed in each district.

The team will consist of a principal obstetrician, a paediatrician, a family physician and an advanced midwife, while a senior primary care nurse will specifically focus on maternal and child mortality.

Motsoaledi said he has consulted all the deans of the eight medical schools in the country, the professional associations of paediatricians, obstetricians, family physicians, the Colleges of Medicines of South Africa responsible for specialist training and the nursing fraternity during the recent nursing summit, who supported the initiative.

He said his intention is that by the end of this calendar year, they should be far ahead in implementing this initiative, which will include the creation of the posts at district level, something that has never existed before and will be completely new in the public service.

"We are absolutely determined to make sure that this model is implemented. Once appointed, these teams will deal with guidelines and protocols at our antenatal care clinics, labour wards, post natal health care, and paediatrics and child health clinics.

"They will follow up on every case of mortality to make sure that ...meetings are held for every single incident, to deal with the cause at hospital level immediately rather than waiting for research studies and results later.

"The specialist teams will deal with training of interns, as well as community service doctors and medical officers. They will also focus on midwives and their practice in helping to bring down maternal mortality.

They will also assist primary health care nurses on following up on patients in their communities, especially for post natal care," said an optimistic Motsoaledi.

The second stream includes a school health programme, which will be launched with the Ministers of Basic Education and Social Development.

Mostoaledi said a task team established about two weeks ago is working around the clock to deal with these issues.

"This stream of Public Health Care (PHC) will deal with basic health issues like eye care problems, dental problems, hearing problems, as well as immunisation programmes in our schools ... It will move further on to deal with more complex problems like contraceptive health rights, which will include issues such as teenage pregnancy and abortions ... and HIV and Aids programmes among learners. Added to this will be [information on] drugs and  alcohol abuse in schools," Motsoaledi explained.

He noted that the task team consisted of all relevant stakeholders from the three departments, nongovernmental organisations (NGOs) dealing with children, universities and individual experts.

"When the team has completed its work, we will start implementation in the poorest schools ... which are also far from the nearest health centres."

The third stream will be a ward based PHC model, which will deploy at least 10 well trained PHC workers per ward.

"This method is being put to good use in Brazil, where 30 000 ... community health care agents have been deployed to various communities. I was also highly encouraged when the Minister of Health in India announced during the Moscow gathering last month that in his country, they are deploying 800 000 such cadres and they call them health care activists.

"A total of 251 teams have already been deployed and in just three months, have reached 41 000 families and, in the process, discovered that 18% of the screened people had TB," Motsoaledi said, pointing out that in the past they would never have picked up the cases and would have waited for them to show up in healthcare institutions when it was already too late.

He emphasised that the re-engineering of PHC system into three streams will consolidate PHC as the country's primary mode of health care delivery.

"It will encourage prevention of disease and promotion of health in contrast to the present obsession with treatment of individual disease when it is already too late for many individuals and at great cost to the fiscus and the GDP of our country.

"It is because of this hugely curative and costly health care system that some so-called experts believe NHI is an impossible dream."

Edited by: Bua News

The validity of medical certificates

Do your employees suffer from chronic Friday or Monday flu? Are they ill every other weekend and never hand in a sick note because it was only one day? What about that “clinic note” handed in, confirming a check-up, which resulted in a claim for paid sick leave at the end of the month? What about the medical certificate which was issued a day before the employee’s return from being ill for a week. And then there is also the occasional medical certificate that is completely illegible, from a strange doctor, and from a strange area, which is not even close to the employee’s home or workplace.

What are your rights with regards to accepting or refusing medical certi ficates and requiring one for the Monday or Friday flu?

If an employee is off sick for more than 2 consecutive days, OR for one day, but on 2 or more occasions in an 8 week period, you are entitled to request a medical certificate. An employer also has the right to refuse a medical certificate if the certificate is not valid. A medical certificate is only valid if:

• It states that an employee was UNFIT TO WORK for the duration of the employee’s absence on account of SICKNESS or INJURY; and

• It is issued and signed by a medical practitioner or another person who is certified to diagnose and treat patients AND who is registered with a professional council established by an act of parliam ent.

A medical certificate stating that the employee(patient) informed the doctor of his illness or that the doctor “saw” the patient, will not suffice, as the practitioner did not declare, in his professional opinion, that the employee(patient) WAS UNFIT TO PERFORM HIS DUTY – thus, unpaid leave. Clinic notes will also only be valid, if signed by a medical practitioner authorised to make a diagnosis and not if signed by the nurse or only stamped by the clinic. Check-ups, fetching of medicine, tests and examinations will not enable the employee to claim for paid sick leave, as it does not render him UNFIT TO PERFORM HIS DUTIES DUE TO ILLNESS OR INJURY – again, unpaid leave.

Unfortunately, the last-day-of-illness medical certificate has to be accepted if the medical professional s tated that, in his opinion, the employee (patient) was unfit to fulfil his duties due to illness. In this instance, warn the employee that in future, a medical certificate has to be obtained sooner than the last day of illness.

A Medical practitioner will be a doctor, dentist, psychologist with a Master degree, registered at the HPCSA, or if the practitioner is registered in terms of the Allied Health Services Profession Act.

Altered certificates will of course be rejected from the start, as well as illegible certificates.

The Health Professions Council of South-Africa’s (HPCSA’s) guidelines for a medical certificate shortly state that:

• it has to stipulate the name, address and qualifications of the medical practitioner,

• name of the patient, date and time of the exam,

• if the diagnosis was made in his professional opinion or if the patient informed him of the illness,

• the illness itself,

• if the patient is totally or partially unfit for duty and

• the recommended period of sick leave.

The patient has to consent to the details of the illness being stated in the medical certificate, and if withheld, a simple “illness” is sufficient.

Employers must also take into consideration that if they signed a collective agreement which states that medical certificates from traditional healers will be accepted, employers will have to accept these certificates.

If an employer normally accepted medical certificates from a traditional healer, the employer will be forced to accept similar medical certificates in the future.

Fraud is common practise when it comes to medical certificates. Take the time to phone the suspicious practitioner and confirm the appointment when in doubt. You’ll be amazed how often these practitioners don’t e xist or ever heard of the employee.

Always be careful where you put your condoms

Classic - had to share

How to fight aging

Did you know that just walking for 30 minutes, 3 or 4 times a week is enough to combat aging?

According to researchers at the University of California, one of the principle causes of deterioration of the human organism’s physical faculties is its diminished ability to metabolize glucose. And they howed that even leisurely exercise, like taking a walk, plays an important role in keeping glucose metabolism functioning smoothly.

Do you spend the whole day sitting at your desk or in front of a computer screen? Why not get up occasionally and do a few minutes of physical exercise? Don’t worry about what other people think.  In some Japanese companies, it is even become a collective habit. Every twenty minutes a bell sounds, and everybody gets up to do some stretching exercises, after which they sit down again as if nothing had happened. Japanese managers are convinced that their employees are more productive when they are relaxed.

Grapefruit

Grapefruit is low in calories and provides a good source of potassium, folic acid, fibre, and vitamin C. Grapefuit also contains phytochemicals, including lycopene, liminoids, flavonoids, and glucarates.

Studies have shown that grapefruit pectin, like other fruit pectin, is effective in lowering cholesterol. The edible portion of 1 whole grapefruit contains about 3.9%, or roughly 7.5 grams of pectin. Eating approximately two grapefruits per day would significantly lower the risk of heart disease by 20%.

The red and pink fleshed grapefruits contain a larger amount of lycopene than the other varieties. Lycopene is an important phytocemical that battles cancer, heart disease, and macular degeneration.

Source: http://www.everynutrient.com

Painkiller sales suspended

Johannesburg - Healthcare company Adcock Ingram Holdings [JSE:AIP] on Friday confirmed that it had suspended promotion and sales of its dextropropoxyphene (DPP)-containing medicines in SA.

Shares of the drugmaker tumbled 2.3% to R64.98 after it said South Africa would ban drugs containing the pain-killer dextropropoxyphene, or DPP, on safety concerns.

The US Food and Drug Administration (FDA) withdrew DPP from the US market on November 19, after the FDA determined that the benefits of DPP for pain relief at US recommended doses outweighed the safety risk and as such the regulator requested that suppliers voluntarily withdraw any drugs containing DPP from the US market.

According to media reports, new research showed the drug was linked to serious abnormal heart rhythms.

In June 2009, the propoxyphene-containing products were banned in the European Union because of fatal overdoses. The UK banned it in 2005.

DPP is a compound with pain-relieving properties that is found in three of Adcock Ingram's drugs - Synap Forte, Lentogesic and Doxyfene, the group said.

Synap Forte is a popular medicine to relieve pain, particularly after operations and for back pain.

Following the FDA announcement, Adcock Ingram said it engaged in discussions with the Medicines Control Council (MCC) of the department of health relating to the implications of the US data to patient safety in South Africa.

"Adcock Ingram has now become aware that the MCC has resolved, inter alia, that all DPP containing medicines be withdrawn from the South African market," it said.

Adcock Ingram noted that its drugs containing DPP contributed approximately R200m to its revenue for the financial year ended September 30 2010.

"Adcock Ingram has not, as yet, received any formal communication from the MCC regarding withdrawal of its DPP containing medicines," it said.

HIV / AIDS news

South Africa could cut the number of new HIV infections to below 200000 a year by 2020, more than one-half of the current level, with the right policies, but reaching the goal will be costly, a report on Friday said.

South Africa has the most infected people of any country in the world with 5,7-million with HIV, according to data from the United Nations Programme on HIV/Aids (UNAids). Around 18% of South Africans aged between 15 and 49 are infected.

"This situation poses huge financial dangers and risks for the country, particularly at a time when South Africa is feeling the negative effects of the global economic recession," the report said.

The report recommends drawing up and funding more effective plans for prevention, treatment and halting the transmission of the virus from infected parents to their children.

Even if it implements these plans, a further five-million more South Africans will be infected with HIV over the next two decades, according to the report from the Centre for Economic Governance and Aids in Africa and the Results for Development Institute.

The government has allocated several billion dollars a year for treatment, prevention and drugs aimed at keeping HIV infections in check.

Total costs over the next two decades to reduce the number of new infections are estimated to be as much as $102-billion if the country steps up spending on drugs, increases the number of those receiving treatment and plans to prevent the spread of the disease, the report said.

"South Africa is beginning to make important inroads in its efforts to slow the number of new infections and bring life saving treatment to those who need it", said Robert Hecht, one of the report's authors and managing director of the Results for Development Institute.

UNAids said that access to treatment for the human immunodeficiency virus (HIV) - an incurable viral infection that causes Aids and infects around 33,4-million people around the world - has increased 12-fold in six years, and 5,2-million people are now getting the drugs they need.

Sub-Saharan Africa remains the region hardest hit by HIV, accounting for 67% of all people living with the virus worldwide, 71%of Aids-related deaths and 91% of all new infections among children.

African nations whose populations have been devastated by Aids have made big strides in fighting HIV, with new infections down 25% since 2001 in some of the worst hit places, a recent UN report said.

Wear yellow with Lance - 2 October 2010

This Saturday, Lance Armstrong will be wearing yellow to raise awareness of the 28 million people living with cancer worldwide—and we invite you to join him and thousands of others in wearing your support.

Right now, cancer kills more people than AIDS, malaria and tuberculosis combined—but incredibly; cancer is not at the top of the world’s agenda.

Together, we can change that. Supporters like you have already made yellow the universally recognized symbol of the fight against cancer, and on October 2, LIVESTRONG Day, you can use that symbol to join in a global statement of strength and courage.

Wear yellow with Lance on LIVESTRONG Day—Saturday, October 2.

There’s a great tradition at our LIVESTRONG Challenge events: thousands of supporters wear yellow and cheer on participants as they head towards the finish line.

That home stretch has become known as the Yellow Mile. It represents solidarity and support for the fight against cancer—and it’s a powerful moment to witness the whole community standing together as one.

In just four days, you can help Lance extend that Yellow Mile all around the globe. The more people who wear yellow on LIVESTRONG Day, the closer we’ll move towards ending the stigma against cancer—and, one day, to a world completely free from the disease.

Join Lance and supporters in more than 50 different countries by wearing yellow on LIVESTRONG Day.

Let’s show the world that we’re tough enough to take on cancer—and win.

Thanks,

LIVESTRONG

Billions to be spent to upgrade hospitals: Minister

Published 27 Sep 2010 Article by: Sapa0 Comments South Africa will spend billions to improve health care by renovating dilapidated hospitals, Health Minister Aaron Motsoaledi said on Monday.

"We will put massive investment -- it will be more than what the country spent during the soccer World Cup," Motsoaledi told reporters at Inkosi Albert Luthuli Hospital in Durban.

Motsoaledi, doctors, engineers and Development Bank of SA (DBSA) representatives were attending a workshop aimed at preparing for the revamp of Durban's King Edward VIII Hospital.

The hospital was one of five that would receive a massive, billion-rand face lift, Motsoaledi said.

The other hospitals were Nelson Mandela Academic Hospital in the Eastern Cape, Dr George Mukhari and Chris Hani Baragwanath Hospitals in Gauteng and the Limpopo Academic Hospital.
"The revitalisation is [part] of the ten point programme which is needed in preparation of the National Health Insurance (NHI). I am here to start that process."

He said they had decided to involve all health stakeholders in the revitalisation programme.

"This has never been done before. We are discussing how it can be done and we will be forming task teams."

Motsoaledi said the actual cost of revamping hospitals would be known after the teams had started their work.

Dr Massoud Shaker, provincial health department head of infrastructure, said the project manager for King Edward would be appointed before the end of the year.

DBSA divisional executive Lucy Chenge said her bank would be a partner and "possibly finance it".

The World Health Statistics 2010

The World Health Statistics 2010 (based on 2009 data) has been released recently.

Country outcomes are listed in tables and includes outcomes of each of the MDG’s.

It covers per country and per region:
Mortality and burden of disease, Cause-specific mortality and morbidity, Selected infectious diseases: number of reported cases, Health service coverage, Risk factors (drinking water, tobacco, LBW, etc), Health workforce, infrastructure and essential medicines, Health expenditure, Health inequities and Demographics.

It shows the following, amongst others, for South Africa:
• Life expectancy has declined from 59 in 1990 to 52 in 2008 for males, and from 68 to 55 for females.
• By 2008, SA is reported as having 8 doctors per 10 000 population, 41 nurses per 10 000 and 3 pharmacists per 10 000.
• As far as the availability of essential medicines are concerned, no data is available for the public sector, but the private sector is reported as having 71% of selected generic medicines available.
• In terms of health expenditure:
o SA spent 8.5% of GDP on health in 2000, and 8.6% of GDP in 2007.
o Government spent 10.9% of its total budget on health in 2000, and 10,8% of its total budget on health in 2007.
o The % of private expenditure has decreased slightly over the same period from 59.5% to 58.6%, of which 93.9% are reported as “out-of-pocket” spend in 2007
o On a per capita basis, SA has increased total health spend from $803 to $1148 at average exchange rate of which $290 and $375 are government per capita spend. (figures in PPP also available)

For the African continent, the following are pertinent:
• “Despite … gains, the coverage of critical interventions such as oral rehydration therapy (ORT) for diarrhoea and case management with antibiotics for acute respiratory infections (ARIs) remains inadequate. As a result, diarrhoea and pneumonia still kill almost 3 million children under 5 years old each year, especially in low-income countries.”
• “While there were some improvements in the WHO African Region, less than 50% of TB cases were reported in this region in 2008.”
• “In the WHO African Region (where HIV prevalence among adults was the highest) only 45% of pregnant women in need in low-income and middle-income countries received treatment…”
• “Non-communicable diseases and injuries caused an estimated 33 million deaths in developing countries in 2004 and will account for a growing proportion of total deaths in the future. Tackling risk factors such as tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol (while also dealing with the socioeconomic impact of cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) will depend not only upon effective healthcare services but also upon actions taken in a variety of policy domains.”

Health Awareness Topics for October

( Month of October : Mental Health Awareness Month)

1 – International Day for older persons
1 – National inherited disorders day

6-10: Eye Care awareness week

8 – International day for Nature Disaster reductions

11 – 16 National Nutrition Week

10 – World Mental health day

12- 20 – World Bone and joint week
12 – arthritis awareness day

14 World Sight Day

15 – National Foetal Alcohol Syndrome Day

16 – World Food day

17 – World Trauma day
17 – World Spine Day
17 – International day for eradication of poverty

20 – National Down Syndrome Awareness
20 – World Osteoporosis day

21 – 25 Infection Control Week

23 – National Iodine Deficiency Disorder day

24 - World Polio Day

29 – World Stroke Day

Cosatu released Economic Policy

Cosatu released its Economic Policy document today (“A Growth path towards full employment”). Its views on nationalisation, changes in taxation, ownership, etc were widely reported in the media (http://www.timeslive.co.za/Politics/article658469.ece/Highlights--Cosatus-key-economic-policy-proposals).

The views on healthcare were, however, not so widely reported. It includes the following:

COSATU supports the DoH’s 10 Point Plan, but states that nevertheless, there is a need for the advisory committee on NHI to urgently conclude on path of transition towards the NHI, and mandate the National Treasury to translate the commitment to the NHI into Rands and Cents, by making the necessary budgetary allocations to phase in the system.

The key challenges facing the healthcare sector are :

1. Staff shortages;
2. availability of medicines (incl improved efficiency between warehouses, hospitals and clinics); Infrastructure backlogs;
3. Inadequate systems ( ICT, Management, Administrative support);
4. availability of equipment.
   
   • 70% of the case load in the public health system is now taken up by HIV/ AIDS cases, crowding out the capacity to treat other medical conditions.
   • There is a disconnection between national policy and the allocation of resources (e.g. a hospital CEO doesn’t meaningfully control staff, budget or procurement).
   • Under-regulation of the private health sector and overconcentration of resources. In this, COSATU proposes that “the state should minimize and where possible eliminate the profit motive, build internal capacity and should reverse reliance on Private Public Partnerships.”
   
   The COSATU proposals include:
   • Integrate Community Care Workers into the public service. The state should lead the process of training, particularly the training of nurses and doctors and resist the incursion of the profit motive in the process, Department of Health to establish a Nursing Directorate (Increase the Nurse/people ratio from 4 (per 1000 people) to 8 per 1000 and the ratio of physicians to 1000 people to 1 over the short to medium term from the current 0.69
   • Improved administration (incl an ICT system for efficient record keeping and information flows).
   • Improved medicine delivery systems to patients.
   • Review the pay structure, conditions of employment and career development in the health system.
   • The state should establish a pharmaceutical company:
   “The pharmaceuticals sector is also dominated by a few large players and plays an important role in the health system. In line with the need to address health disparities, a state-owned pharmaceutical company needs to be set up in order to produce medicines on a non-profit basis. This is important especially in the light of the HIV/AIDS pandemic and the vulnerability of the Southern African region to diseases. The state pharmaceutical company therefore puts the democratic state in a powerful position to have impact on the health profile of the Southern African population, not just South Africans and will reduce the vulnerability of the region from being exploited by multinational pharmaceutical companies.”
   
   The full document is available at: http://us-cdn.creamermedia.co.za/assets/articles/attachments/29577_cosatu_booklet.pdf

Do not let medication trip you up

Did you know that certain medicines can increase the risk of falls in the elderly? This is according to a report by the Medical Control Council. Knowing which medicines are a problem could prevent a serious accident.

Take action:
If you're 65 or older, or a loved one is, then it's important to take note of the following: sedatives and tranquillisers seem to be particularly problematic in terms of falls and consequent fractures. Antidepressants, antihypertensives, hypoglycaemic agents and alcohol may also increase the risk. Discuss the use of these medicines with your doctor – especially if you're at risk, or already suffering from, osteoporosis.

Foetal Alcohol Syndrome

What is Foetal Alcohol Syndrome?
Foetal Alcohol Syndrome refers to a group of abnormalities in growth and development that occur in children whose mothers consumed excessive amounts of alcohol whilst pregnant.

Incidence
• The World Health Organisation describes foetal alcohol syndrome as the most preventable cause of mental retardation worldwide.
• Previous studies have indicated that South Africa has one of the highest incidences of foetal alcohol syndrome in the world.
• The Western Cape had an incidence of foetal alcohol syndrome of around 7.5% in children in 2001. The Northern Cape had an incidence over 10% in children.
• Higher incidences of foetal alcohol syndrome are associated with higher levels of poverty and lower levels of education.
• High risk communities in South Africa have at least a 4 fold higher incidence of foetal alcohol syndrome than high risk communities in developed countries.

How Alcohol affects the Developing Foetus
• Alcohol exposure affects the development and function central nervous system and endocrine system of the foetus.
• Alcohol exposure can also cause abnormal gene expression in the foetus.
• The consumption of alcohol affects the blood flow to the uterus. As the blood flow is decreased, the oxygen nutrient delivery to the foetus is compromised. Without sufficient oxygen and nutrients, the growth and development of the baby is affected.
• The majority of the development happens during the 1st trimester. Alcohol consumption during the 1st trimester is therefore very dangerous and can result in a number of developmental disorders.
• The 2nd and 3rd trimester involves mostly growth for the foetus. Excessive alcohol consumption during the 2nd and 3rd trimester results in slowed growth of the foetus. This can result in a low birth weight and smaller stature as the child grows.
• Oxidative stress on the developing foetus as a result of the alcohol also plays a role in the abnormal growth and development of the foetus.

The Effects of Foetal Alcohol Syndrome
• It is very difficult to estimate the extent of the effects that alcohol consumption during pregnancy has on a foetus. One reason for the difficulty is the natural variations in intelligence and development of children as a result of genetics and environment.
• Whilst children with severe foetal alcohol syndrome are easily identified, milder cases may never be recognised. We will never know what the child’s potential may have been if the mother had not consumed alcohol during pregnancy.
• Foetal alcohol syndrome can have a far-reaching impact on the community. If these children are not correctly diagnosed and managed then they are less likely to progress in school and are at risk of repeated failure in academic and learning environments. If these children drop out of school they are more likely to turn to crime, drugs and violence, than other children. This has a long term impact on the health, safety and economy of the community.

Signs and Symptoms
• Children who are born with foetal alcohol syndrome have a number growth and developmental disorders ranging in severity. Milder cases of FAS may never be diagnosed.
• Children with severe foetal alcohol syndrome will be smaller than children of the same age.
• FAS children will also have a lower IQ than other children.
• These children will display abnormal behavioural characteristics. These include very short attention and concentration spans which are often associated with hyperactivity (as seen in Attention Deficit Disorder).
• FAS children also frequently display signs of aggression and can be very difficult for teachers and caregivers to handle.

Diagnosis
The diagnosis of FAS is based on the presence of the following abnormalities:

Size:
• Low weight
• Small height
• Small occipito-frontal circumference

Appearance:
• Small inner canthal distance
• Decreased length of the palpebral fissure
• “Railroad track” ears
• Strabismus
• Ptosis
• Flat nasal bridge
• Anteverted nares
• Thin border of upper lip
• Hirsutism
• Oral clefts

Behaviour:
• Attention-deficit disorder
• Hyperactivity

Coordination:
• Fine motor dysfunction

Cardiac:
• Cardiac abnormalities such as a cardiac murmur and cardiac malformations

Safe levels of Alcohol during Pregnancy
• There is still much debate as to what exactly the safe levels of alcohol consumption during pregnancy are.
• Therefore the best advice for women, is not to drink at all during pregnancy.
• Studies have indicated that 2 drinks a day, or 1 binge drinking session of 6 or more drinks, is sufficient to cause foetal alcohol syndrome

Treatment
• There is no way to reverse the effects of foetal alcohol syndrome.
• The child’s growth and development cannot be accelerated or improved.
• Developmental disorders can be managed with occupational and speech therapy, physiotherapy and other classes which teach language, motor, learning and social skills. Managing the difficult behaviour can be very trying for caregivers, teachers and parents.
• A skilled group of professionals is needed to improve the child’s behaviour, social skills, learning and development.
• Unfortunately most of these cases occur in poorer communities where access to the appropriate care for the child is limited.
• Furthermore, the parents of children with foetal alcohol syndrome are often alcoholics and often live in poverty. These parents are unable to care for their child properly and the child is unlikely to have access to the necessary therapies.

Prevention
• Alcohol related damage may be done to the foetus before the women realise that they are pregnant.
• Women of childbearing age should be counselled on the possible effects of alcohol consumption on a developing foetus.
• Women who are alcoholics or who partake in excessive alcohol consumption should be educated on the use of contraception in order to prevent accidental or unwanted pregnancies.
• Effective prevention involves preventing alcoholism, reducing poverty and preventing unplanned pregnancies. Achieving this is complex and difficult and involves designing and implementing effective protocols and strategies for awareness campaigns and community education. It also includes increasing the resources and staff to manage the prevention strategies.

Dr. Carrie Minnaar (M.Tech Hom.)

Swimmer's Ear

What is Swimmer’s Ear?

• Swimmer’s ear refers to otitis externa as a result of water exposure.
• Otitis externa is the medical term for inflammation of the lining of the external ear. “Otitis” refers to inflammation of the lining of the ear and “externa” refers to the external part of the ear.

Otitis externa can be acute or chronic
• Acute otitis externa is usually a result of a bacterial infection.
• Chronic otitis externa is less painful, but is more difficult to treat. It is most commonly due to fungal infections. Chronic swimmer’s ear may be more common in children with eczema and allergies.

Signs and Symptoms of Swimmer’s Ear
• The first symptom is usually itching and irritation of the external ear.
• As the condition progresses the ear becomes painful and swollen.
• Occasionally there may be a light discharge from the ear. If present, the discharge is usually clear and not very thick.
• The child may also complain of a blocked sensation in the affected ear, especially if there is swelling and a discharge.
• On examination, the patient will report pain when pressing on the tragus and pulling the ear lobe or auricles.
• The ear canal will appear red and inflamed when viewed through the otoscope.
• Occasionally the hearing may also be affected, however this resolves as the symptoms resolve.

Pathogenesis
• As the water enters the ear and becomes trapped in the ear, it causes the lining of the external ear to swell and become inflamed.
• Ear canals should be dry with a healthy amount of wax production to trap foreign particles and keep the earcanal free of pathogens.
• When the ear canal is wet and swollen it is more prone to infections. Secondary infections resulting from swimmer’s ear are usually bacterial or fungal infections.

Transmission
Swimmer’s ear is not a contagious condition and children with swimmer’s ear therefore do not need to be kept away from other children. The child may be booked off school if the condition is particularly painful and is affecting the child’s ability to concentrate and carry out his or her activities.

Diagnosis
• The diagnosis of swimmer’s ear is based on history and exposure to water, as well as clinical presentation and examination.
• In complicated cases that are not resolving, doctors may take a swab of the ear to identify the pathogen involved.

Complications
• A secondary bacterial infection may be a complication of swimmer’s ear. The most common bacterial causes of an outer ear infection are streptococcus and staphylococcus bacteria.

• Signs of a bacterial infection of the external ear include:
* Severe pain in the ear
* Severe swelling of the ear which may even extend to the side of the face
* A thick, purulent or yellow discharge from the ear
* Local swollen lymph nodes
* Fever and chills
* Pallor
* Nausea & Vomiting

• Fungal infections of the external ear may also occur as a result of trapped water in the ear. Fungi thrive in warm, dark and wet conditions. The predominant symptoms in these cases are severe itching and irritation as well as pain.
• Rarely the infection may spread elsewhere in the body.

Treatment
• Supportive treatment for swimmer’s ear is important and involves pain management. For children the most commonly recommended analgesics is ibuprofen.
• Applying warmth can also soothe the pain and inflammation and increase the drainage of the discharge. A warm facecloth or hot water bottle can be used, but caution must be taken not to burn the ear or skin.
• Swimming may slow the recovery time and children are usually advised to keep their ears dry until the symptoms have resolved.
• The inflammation is usually self limiting and in uncomplicated cases the symptoms should resolve within 3 to 7 days.
• Secondary bacterial infections are treated with antibiotics and secondary fungal infections are treated with antifungal medication.
• Antibiotics may be administered orally or in the form of ear drops.
• Ear grommets or a ruptured ear drum are contraindications for administering medicine, such as antibiotic ear drops, into the ear.
• It is also important that children with swimmer’s ear do not use ear buds or any other item in the ear to scratch or rub the ear. Ear buds can compact the wax, forming clumps of ear wax which can trap water, and can further irritate the ear canal.

Prevention
• The best way to prevent swimmer’s ear is to avoid getting the ears wet.
• Children with repeated swimmer’s ear who do not want to avoid swimming may benefit from using ear plugs whilst swimming. Special ear plugs are available for use during swimming to keep the water out of the ears. Children may also be advised to refrain from swimming under the water and must be taught to dry their ears properly after swimming.
• Children should not use ear buds to clean their ears.
• After water exposure children should try turning their heads so that the ear is facing downwards (ear to shoulder). This position can be held for a few minutes to encourage the water to run out and should be done on both the left and right sides. To improve the drainage of water out of the ear the auricle of the ear can also be pulled gentle in different directions whilst the ear is facing downwards. Ears should then be dried properly with a towel.
• Grommets, or ear tubes, are sometimes inserted into children’s tympanic membranes to allow the drainage of the middle ear. These children may be at risk of swimmer’s ear and complications such as otitis media if they spend a lot of time underwater. It is advisable that these children use appropriate ear plugs whilst swimming to prevent water from entering their ears.
• Swimming in polluted or dirty water can increase the risk of ear infections. Children should be advised
against swimming in unclean or contaminated rivers or damns, especially if they are prone to swimmer’s ear.
• Using 3 drops per ear of a 50/50 alcohol and white vinegar mixture before and after swimming can help reduce the risk of swimmer’s ear. Alcohol and vinegar restore the pH balance of the ear, have antiseptic properties and increase the rate of evaporation of water in the ear canal.

UPDATES TO NOTE
The following changes in Legislation were passed that could impact on Occupational Health and Safety Practitioners

Commencement of Amendments to the:
•Domestic Violence Act
•Magistrates' Court Act
•Maintenance Act

Amendments have been made to the Policies and Regulations published under the following Acts:
•Health Professions Act
•National Education Policy Act
•National Environmental Management Act

Compensation for Occupational Injuries and Diseases Act and Regulations (130/1993)
•Standard Assessment Rate Changes 2009 and 2010

Health Professions Act and Regulations (56/1974)
• Amendment of Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act, 1974
• Regulations relating to Fines which may be Imposed by a Committee of Enquiry against Practitioners found Guilty of Improper or Disgraceful Conduct under the Health Professions Act, 1974