Parents say baby died due to (Chiawelo) clinic’s negligence

A Soweto couple has accused Chiawelo Clinic nurses of causing the death of their newly born baby after the mother gave birth in a toilet.

Agatha Ngubane (36) and Israel Mudau (37) are looking for looking for answers from the Gauteng Department of Health following the death of little Orifha Siphesihle Mudau. Ngubane she said she had gone into labour on February 9 and when she arrived at the clinic nurses at the reception told her to wait. “I arrived at the clinic at 6.30am and I was only attended to by 7.30am. “After waiting for more than an hour, a nurse came to me and asked me to lay down on the bed. She started examining me by assessing my blood pressure and listening for a heartbeat,” said Ngubane. “We both could not hear any heartbeat.” The nurse left the room, she said. While she was gone, Ngubane said she had gone to the toilet a number of times. …more

Small job losses if sugar content cut – Treasury


If the beverage industry reduces the sugar content of 37% of its products, the proposed sugary drinks tax could result in around 1,475 job losses.  Treasury official Warren Harris reported this to parliament yesterday while giving Treasury’s response to the many submissions made on the tax. The beverage industry has warned of tens of thousands of job losses should the tax be introduced. Treasury has proposed a 2,1 cent tax per gram of sugar on all sweetened drinks, but the first 4g per 100ml will be exempted as an incentive for producers to reformulate their drinks with less sugar. It plans for the tax – which it calls a health promotion levy – to come into effect as soon as the Rates Bill becomes law, Treasury Chief Director Mpho Legote said….more

Early Detection and Referral of Children with Malnutrition

Mid-Upper Arm Circumference (MUAC)

Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (olecranon process and the acromium).

MUAC is used for the assessment of nutritional status. It is a good predictor of mortality and in many studies, MUAC predicted death in children better than any other anthropometric indicator. This advantage of MUAC was greatest when the period of follow-up was short.

The MUAC measurement requires little equipment and is easy to perform even on the most debilitated individuals. Although it is important to give workers training in how to take the measurement, the correct technique can be readily taught to minimally trained health workers and community-based volunteers. It is thus suited to screening admissions to feeding programs during emergencies.

MUAC is recommended for use with children between six and fifty-nine months of age and for assessing acute energy deficiency in adults during famine.

The major determinants of MUAC, arm muscle and sub-cutaneous fat, are both important determinants of survival in starvation. MUAC is less affected than weight and height based indices (e.g. WHZ, WHM, BMI) by the localised accumulation of fluid (i.e. bipedal or nutritional oedema, periorbital oedema, and ascites) common in famine and is a more sensitive index of tissue atrophy than low body weight. It is also relatively independent of height and body-shape…..more

Study: Bachelor of Clinical Medical Practice (BCMP)

This exciting 3 year degree will provide you with the necessary knowledge, attitudes and skills to work in a district hospital as a Clinical Associate, under the supervision of a doctor.  The qualified Clinical Associates are registered with the Health Professions Council of South Africa with a defined scope of practice. Apply at Wits.

WONCA E-Update Friday 9th JUNE 2017

WONCA E-Update
Friday 9th June 2017

WONCA News – June 2017
The latest WONCA News (June 2017) is accessible via the WONCA website, with lots of WONCA news, views and events. Activities held to celebrate World Family Doctor Day (19th May) feature prominently this month.

From the President
This month Professor Amanda Howe looks back at her time in Australia, at the WONCA Rural Health conference in Cairns. As well as a really excellent conference, highlights for her included visiting colleagues in two different clinics – one on Horn Island off the North East coast of Australia, and an Aboriginal Community and Health Clinic at Yarrabah near Cairns. Both emphasised the need to prioritise community engagement as a way of redressing the impacts of social disadvantage and improving public health: and showed her (again) the importance of family doctors who can work in a setting where they are both part of the community and may be surgeon, obstetrician and emergency care providers – as well as the community’s family doctor.

World Family Doctor Day (FDD)
Many of WONCA’s Member Organizations celebrated World Family Doctor Day on 19th May, and we were inundated with reports and photos of various events held throughout the world. We’ll be featuring some in more detail in the coming weeks, but WONCA News has all the photos and the reports on line at .

Education for Primary Care
Professor Val Wass, Chair of WONCA’s Working Party on Education, has advised us of an announcement from “Education for Primary Care”. As it becomes increasingly apparent that learning in the context of family medicine and the community can impact positively on career choice for primary care, they are pleased to offer free access for a limited period of time to an article from Elizabeth Newbronner and her colleagues in the North of England offering further evidence of how this can be achieved
Creating better doctors: exploring the value of learning medicine in primary care
Elizabeth Newbronner, Rachel Borthwick, Gabrielle Finn, Michael Scales & David Pearson
Education for Primary Care Published Online: 24 Jan 2017

New Chair for the Spice Route Movement
The Spice Route Movement – the young doctor movement for South Asia – has a new Chair. Dr Santosh Kumar Dhungana from Nepal has recently taken over from Dr Bhavna Matta of India, and he is one of this month’s featured doctors in WONCA News. He is currently working in Bayalpata Hospital, Achham, Nepal, where he is the medical director. This hospital is located in a very remote area of far west Nepal, where the government health care structure is almost non-existent.

The hidden truth of patient engagement

When it comes to patient engagement design, how do we know where to begin? Stacey Chang compares the task to zebras in the African savanna, whose stripes have a distinct utility. When in a herd, the overlap of stripes creates a confusing pattern, making it difficult for predators to distinguish between one zebra and another. When that herd moves, the pattern becomes even more confusing, and establishing a singular starting point for a predator becomes practically impossible…..more

What U.S. Hospitals Can Still Learn from India’s Private Heart Hospitals

In 2008, we explored the emergence of private heart hospitals in India whose outcomes rivaled those of top U.S. hospitals (low infection and readmission rates for coronary artery bypass grafting [CABG], angioplasties, and other cutting-edge procedures) at between 1/10 and 1/20 of the cost. We described how Indian hospital leaders exhibited a near-obsessive drive to offer the highest quality services at the lowest possible price. We concluded that even though India is far from a model of social justice in health care, American hospitals could learn a great deal from the organizational focus and structure of their Indian counterparts. We additionally wanted to challenge the preconceived notion in policy discussions that high health care costs were a consequence of high quality and that patients and providers could not economize without diminishing the clinical quality of care…..more

Diabetic Foot Ulcers: Wound Management

AHRQ Guideline

Areas of Agreement and Difference

A direct comparison of recommendations presented in the above guidelines for wound management of diabetic foot ulcers (DFUs) is provided.

Areas of Agreement

Wound Dressings

IWGDF and SVS/APMA/SVM make strong recommendations for the use of dressing products that maintain a moist wound bed, control exudate and avoid maceration of surrounding intact skin. The guideline developers agree that available evidence does not support the use of any single dressing type (e.g., hydrogels, hydrocolloids, foam dressings, alginates, honey) over another. Dressing selection should therefore be guided by the characteristics of the individual wound, acquisition cost, and ease of use. IWGDF adds comfort to this list. IWGDF recommends against the use of antimicrobial dressings with the goal of improving wound healing or preventing secondary infection. The UHMS guideline does not address wound dressings.


IWGDF and SVS/APMA/SVM agree that sharp debridement of slough, devitalized/necrotic tissue and surrounding callus material should be performed at regular intervals. According to SVS/APMA/SVM, considering the lack of evidence for superiority of any given debridement technique, initial sharp debridement is suggested, with subsequent choice of method based on clinical context, availability of expertise and supplies, patient tolerance and preference, and cost-effectiveness. IWGDF similarly notes that, even though professional opinion is united in support of the use of debridement, the experimental evidence to justify debridement in general and of any particular method of debridement is not strong. Nevertheless, IWGDF makes a strong recommendation on the basis of low-quality evidence for the use of sharp debridement, taking relative contraindications such as severe ischemia into account. The UHMS guideline does not address debridement.

Hyperbaric Oxygen (HBO2) Therapy

There is general agreement among the three guideline developers that HBO2 therapy may be an appropriate adjuvant intervention for selected patients. IWGDF makes a weak recommendation on the basis of moderate-quality evidence for the consideration of systemic HBO2 therapy in order to accelerate healing of DFUs. Further blinded and randomized trials are required to confirm its cost-effectiveness, as well as to identify the population most likely to benefit from its use, notes the guideline developer. SVS/APMA/SVM suggests the use of HBO2 therapy in patients with DFUs who have adequate perfusion that fails to respond to 4 to 6 weeks of conservative management. Considering the cost and the burden of prolonged daily treatment, the developer encourages careful patient selection and suggests the use of transcutaneous oximetry to help stratify patients and predict those most likely to benefit.

HBO2 therapy for the treatment of DFUs is the focus of the UHMS guideline. The developer makes recommendations for its use according to the grade of the DFU in the Wagner wound classification system. UHMS explains that, despite consensus between foot and ankle surgeons and hyperbaric physicians that the Wagner grade is archaic and inadequate, most of the historical and contemporary studies and most reimbursement determinations with regard to the use of HBO2 for DFUs are based on the Wagner DFU wound appearances. In order to reduce the risk of major amputation and incomplete healing, UHMS suggests adding HBO2 to the standard of care in patients with Wagner Grade 3 (deep tissue involvement and abscess, osteomyelitis, or tendonitis) or greater DFUs who have just undergone surgical debridement of the infected foot as well as in patients with Wagner Grade 3 or greater DFUs that have shown no significant improvement after 30 or more days of treatment. The developer suggests against using HBO2 in patients with Wagner Grade 2 or lower DFUs.


Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives


BACKGROUND Community health workers (CHWs) can play important roles in primary health care delivery, particularly in settings of health workforce shortages. However, little is known about CHWs’ perceptions of barriers and motivations, as well as those of the beneficiaries of CHWs. In Rwanda, which faces a significant gap in human resources for health, the Ministry of Health expanded its community health programme beginning in 2007, eventually placing 4 trained CHWs in every village in the country by 2009. The aim of this study was to assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme, as perceived by the CHWs and their beneficiaries.

METHODS As part of a larger report assessing CHWs in Rwanda, a cross-sectional descriptive study was conducted using focus group discussions (FGDs) to collect qualitative information regarding educational background, knowledge and practices of CHWs, and the benefits of community-based care as perceived by CHWs and household beneficiaries. A random sample of 108 CHWs and 36 beneficiaries was selected in 3 districts according to their food security level (low, middle and high). Qualitative and demographic data were analyzed.

RESULTS CHWs were found to be closely involved in the community, and widely respected by the beneficiaries. Rwanda’s community performance-based financing (cPBF) was an important incentive, but CHWs were also strongly motivated by community respect. The key challenges identified were an overwhelming workload, irregular trainings, and lack of sufficient supervision.

CONCLUSIONS This study highlights the challenges and areas in need of improvement as perceived by CHWs and beneficiaries, in regards to a nationwide scale-up of CHW interventions in a resource-challenged country. Identifying and understanding these barriers, and addressing them accordingly, particularly within the context of performance-based financing, will serve to strengthen the current CHW system and provide key guidance for the continuing evolution of the CHW system in Rwanda.

See article

Equipping family physician trainees as teachers: a qualitative evaluation of a twelve-week module on teaching and learning


BACKGROUND: There is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and learning capacity-building module was introduced into a new master’s programme in family medicine at Stellenbosch University, South Africa. We report on the influence of this module on graduates after the first six years.

METHODS: A qualitative study was undertaken, interviewing thirteen graduates of the programme. Thematic analysis of data was done by a team comprising tutors and graduates of the programme and an independent researcher. Ethical clearance was obtained.

RESULTS: The module influenced knowledge, skills and attitudes of respondents. Perceptions and evidence of changes in behaviour, changes in practice beyond the individual respondent and benefits to students and patients were apparent. Factors underlying these changes included the role of context and the role of personal factors. Contextual factors included clinical workload and opportunity pressure i.e., the pressure and responsibility to undertake teaching. Personal factors comprised self-confidence, modified attitudes and perceptions towards the roles of a family physician and towards learning and teaching, in addition to the acquisition of knowledge and skills in teaching and learning. The interaction between opportunity pressure and self-confidence influenced the application of what was learned about teaching.

CONCLUSIONS: A module on teaching and learning influenced graduates’ perceptions of, and self-reported behaviour relating to, teaching as practicing family physicians. This has important implications for educating family physicians in and for Africa and indirectly on expanding capacity to educate health care professionals in Africa.

See Article

Sicily statement on evidence-based practice

A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers (“Signposting the future of EBHC”). Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide ‘best practice’. 

Sicily statement on evidence-based practice. BMC Medical Education, 5(1), 1. Available from: [accessed Jun 3, 2017].

Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review



Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.


The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes?


Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively.


Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm.


The literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak.

See Article

Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial.



Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice.


To determine whether telephone triage (GP-led or nurse-led) reduces clinician-patient contact time on the day of the request (the index day), compared with usual care.


A total of 42 practices in England recruited to the ESTEEM trial.


Duration of initial contact (following the appointment request) was measured for all ESTEEM trial patients consenting to case notes review, and that of a sample of subsequent face-to-face consultations, to produce composite estimates of overall clinician time during the index day.


Data were available from 16,711 initial clinician-patient contacts, plus 1290 GP, and 176 nurse face-to-face consultations. The mean (standard deviation) duration of initial contacts in each arm was: GP triage 4.0 (2.8) minutes; nurse triage 6.6 (3.8) minutes; and usual care 9.5 (5.0) minutes. Estimated overall contact duration (including subsequent contacts on the same day) was 10.3 minutes for GP triage, 14.8 minutes for nurse triage, and 9.6 minutes for usual care. In nurse triage, more than half the duration of clinician contact (7.7 minutes) was with a GP. This was less than the 9.0 minutes of GP time used in GP triage.


Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.

Article here

The Psychology of Social Sharing: How to Shape Your Content According to What People Want to Share

image06-tb-1324x0There is no magic formula to going viral.

Even if some blogs make getting shared big-time look effortless there simply is no 100% foolproof method to ensure that your content will reach huge audiences and inspire them to pass it on.

And that’s a good thing because it means those strategies cannot be abused.

However, going viral isn’t just a matter of throwing content at the wall and seeing what sticks. You can help yourself succeed by shaping your content to encourage social sharing on your social network of choice.

Keep reading to learn what drives people to share, and how to present your content to succeed on Facebook, Pinterest, Twitter, or LinkedIn….more


7 Benefits of High-Intensity Interval Training (HIIT)


While most people know that physical activity is healthy, it’s estimated that about 30% of people worldwide don’t get enough. Unless you have a physically demanding job, a dedicated fitness routine is likely your best bet for getting active. Unfortunately, many people feel that they don’t have enough time to exercise. If this sounds like you, maybe it’s time to try high-intensity interval training (HIIT)…….more

Report on Doctors for Primary Health Care Symposium held on the 28th of March 2017


South Africa’s two-tiered healthcare system has resulted in unequitable health outcomes, with the privileged few having disproportionate access to health services.

The Community Service Policy (CSP) was introduced in 1998 as an intervention to achieve better distribution of human resources for health in underserviced areas and to provide an enabling environment for new professionals to acquire experience. All health professions are legally required to complete a year of community service which entails remunerative work in the public sector. South Africa has since developed the Human Resources for Health (HRH) strategy (2012-2017) which takes into consideration the World Health Organisation (WHO) recommendations on the recruitment and retention of health professionals in rural and remote areas. These recommendations include rural health education interventions, enhanced regulation of rural practice, financial incentives and professional and personal support for health workers in remote and rural areas.

South Africa is in the process of working towards National Health Insurance (NHI), a health financing system designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status (National Department of Health, 2015). This will be phased in over a 14 year period, through four key interventions, namely: a complete transformation of healthcare service provision and delivery; the total overhaul of the entire healthcare system; the radical change of administration and management; and the provision of a comprehensive package of care underpinned by a reengineered primary health care.

It is within this context that a series of seminars were envisioned, starting with the Community Service for Health Professionals Summit held in April 2015. Its aim was to initiate stakeholder engagement for the systematic review of the CSP using available evidence from a number of independent studies. The summit set out to understand community service in the context of the National HRH Strategy, to review the last 15 years of experience of community service doctors and dentists, to review the objectives of the CSP in South Africa, to review the guidelines and provincial implementation of the CSP in South Africa and to make appropriate recommendations.

The second seminar “Doctors for PHC Symposium” was held in the City of Tshwane at the Foundation for Professional Development’s (FPD) Head Offices on 28 March 2017. The symposium was hosted by FPD and the National Department of Health. The symposium  focused on all categories of health professionals, but mainly on doctors’ roles in a multi-disciplinary public sector primary health care (PHC) team.

This year’s symposium set out to achieve the following objectives:

  • To review studies on the placement of doctors in a public sector PHC setting
  • To identify models and strategies to optimise the role of doctors in a multi-disciplinary team
  • To identify knowledge gaps and areas for research.

See Report on the Doctors for PHC Seminar 2017