Biomedical subjects

K M Rotchford

Publications and source records attributed to K M Rotchford.

3 recordsLinked to original sources

PubMed2002

Reasons for poor cataract surgery uptake - a qualitative study in rural South Africa.

OBJECTIVES: To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODS: A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS: Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant. CONCLUSION: Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.

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PubMed2002

Assessing diabetic control--reliability of methods available in resource poor settings.

AIMS AND METHODS: To examine the reliability of random venous or capillary blood glucose testing, random urine glucose testing, and a current symptom history in predicting a high HbA1c in Type 2 diabetic patients taking oral hypoglycaemic agents in a poorly controlled rural African population. RESULTS: For a cut-off point for HbA1c of > or = 8%, for random venous plasma glucose of > or = 14 mmol/L (present in 47.2% of subjects), specificity was 97.1% (95% CI 85.1-99.9), sensitivity 56.8% (48.8-64.5) and positive predictive value (PPV) 98.9% (94.2-99.9). HbA1c > or = 8% is predicted by a random capillary blood glucose of 17 mmol/L (present in 28.4% of subjects) with specificity 100% (90.0-100.0), PPV 100% (93.7-100.0) and sensitivity of 34.3% (27.2-42.1). HbA1c > or = 8% is predicted by the presence of heavy glycosuria (> or = 55 mmol/L) (present in 35.6%) with specificity 94.1% (80.3-99.3), sensitivity of 41.9% (34.1-49.9) and PPV 97.1% (89.9-99.6). Polyuria/nocturia (present in 31.3%) was the only symptom found to be associated with poor control, with a specificity for predicting HbA1c of > or = 8% of 81.5% (61.9-93.7), PPV 89.1% (76.4-96.4) and sensitivity 30.6% (22.9-39.1). CONCLUSIONS: Where resources are short, random glucose testing can be used to detect a significant proportion of those with the worst control with a high degree of specificity enabling primary care staff to modify treatment safely. Where facilities are limited capillary blood or urine testing with reagent strips, may be substituted for venous plasma testing in the laboratory. A symptom history was insufficient to replace biochemical testing, but where this is unavailable, urinary symptoms may be helpful.

Black People↗

PubMed2002

Diabetes in rural South Africa--an assessment of care and complications.

OBJECTIVES: To describe the diabetic population under care of the public health sector in a district in rural KwaZulu-Natal, to assess the nature of their care, their glycaemic control and the extent of their complications. SUBJECTS AND METHODS: Two hundred and fifty-three diabetic patients consecutively attending clinics for review were interviewed and examined, and where available a 12-month retrospective review of clinical records was performed. Random blood glucose, haemoglobin A1c (HbA1c) and urine albumin/creatinine ratio were assayed. RESULTS: Acceptable glycaemic control (HbA1c < 2% above normal population range) was found in only 15.7% of subjects (95% confidence interval (CI): 11.4-20.8%). Mean HbA1c was 11.3%. The prevalence of hypertension (blood pressure > or = 160/95 mmHg and/or prescribed antihypertensive medication) was 65.4% (CI: 59.0-71.1%). Of 129 patients who were prescribed antihypertensives, 14.0% (CI: 8.5-21.2%) were normotensive (< 140/90 mmHg). Severe obesity was present in 36.5% (CI: 30.4-42.9%). Rates of attendance for review and compliance with diabetic medications were high. Blood glucose monitoring was not regularly performed and medications were rarely modified. Complications were common and mostly undiagnosed. Retinopathy of any grade was found in 40.3% of patients (CI: 33.2-50.9%) and was severe enough to warrant laser photocoagulation in 11.1% (CI: 8.5-21.2%). Microalbuminuria was found in 46.4% (CI: 40.0-53.0%) and foot abnormalities attributable to diabetes in 6.0% (CI: 3.4-9.7%). CONCLUSIONS: Care and control of diabetes in this rural community is suboptimal. There is a need for primary care staff to focus on modifying prescriptions in the face of poor blood glucose control and/or uncontrolled hypertension. Additional training and support for nursing staff and education for patients will be central to achieving this level of intervention.

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