Category: Nevin Manimala

S Afr Fam Pract (2004). 2026 Feb 19;68(1):e1-e9. doi: 10.4102/safp.v68i1.6226.

ABSTRACT

BACKGROUND: District hospitals (DHs) are essential providers of surgical care in low- and middle-income countries. Despite recommendations to strengthen DH surgical services, data on South African DH surgical capacity remain limited. This study describes the volume, scope and workforce of surgical services at a rural Eastern Cape DH over 7 years.

METHODS: A retrospective audit of all surgical procedures (January 2016-December 2022) was conducted using theatre register data. Patient demographics, procedure type and surgical provider were extracted to analyse trends in surgical volume, scope and workforce.

RESULTS: A total of 2616 operations were performed, predominantly in females (97%), with a median age of 25 years. Statistical process control analysis showed a significant upward shift in the mean monthly surgical volume from 27 to 41 procedures. The surgical scope expanded from 14 different types of procedures in 2016 to 25 in 2022, covering obstetrics, gynaecology, general surgery, orthopaedics and urology. Caesarean sections accounted for 82% of procedures. Family medicine registrars and specialists performed the highest number of procedures per person.

CONCLUSION: Surgical services expanded in both volume and scope, demonstrating the capacity of district-level facilities to meet essential surgical needs.Contribution: This study provides rare longitudinal data on rural South African DH surgical services, highlighting the critical role of decentralised family medicine training and senior staffing in supporting surgical expansion and strengthening district-level care.

PMID:41773406 | DOI:10.4102/safp.v68i1.6226

S Afr Fam Pract (2004). 2026 Feb 12;68(1):e1-e9. doi: 10.4102/safp.v68i1.6218.

ABSTRACT

BACKGROUND: Chronic pain is a major global health challenge that impairs quality of life through physical disability, psychological distress, and socioeconomic burden. Despite its prevalence, limited research examines its multidimensional impact in South African primary healthcare. This study evaluated the quality of life and factors influencing chronic pain in patients attending a primary healthcare clinic in Gqeberha, South Africa.

METHODS: A cross-sectional study was conducted among 208 adults with chronic pain attending Walmer 14th Avenue Clinic. Data were collected using the Brief Pain Inventory, capturing demographics, pain severity, interference, relief, and management. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed using SPSS v29.

RESULTS: Participants had a mean age of 50.2 years; most were female (71.6%). Back pain was most common (43.8%), while pelvic/groin pain was most severe. Pain relief was inadequate in 74% of participants, with 15.9% reporting none. Sleep was the most affected quality-of-life domain (72% interference). Predictors of higher pain interference included pain severity (p 0.001), pain relief (p = 0.003), marital status (p = 0.004), and employment status (p = 0.005). Disease-specific treatments and adjuvant therapies provided better relief than paracetamol, nonsteroidal anti-inflammatory drugs, or opioids.

CONCLUSION: Severe pain and inadequate relief are prevalent in primary healthcare. Improving access to adjuvant and disease-specific therapies, as well as addressing socioeconomic factors, is thus essential for enhanced patient outcomes.Contribution: This study highlights the interplay between chronic pain, sociodemographic factors, and quality of life in South African primary care and underscores the need for tailored, multimodal, resource-sensitive pain management strategies to inform policy.

PMID:41773405 | DOI:10.4102/safp.v68i1.6218

S Afr J Commun Disord. 2026 Feb 25;73(1):e1-e9. doi: 10.4102/sajcd.v73i1.1154.

ABSTRACT

BACKGROUND: Makaton, an unaided augmentative and alternative communication (AAC) method, is widely used by speech-language therapists (SLTs) in diverse clinical and educational settings. Despite its applicability across populations with complex communication needs, limited research has explored how South African SLTs perceive, use and experience Makaton. This gap is significant given South Africa’s multilingual context, resource disparities and the need for culturally relevant AAC strategies.

OBJECTIVES: This study aimed to explore South African SLTs’ perceived competencies and use of Makaton.

METHOD: This study employed a mixed-methods design. An online survey comprising closed- and open-ended questions was distributed to SLTs across South Africa. A total of 57 participants were included in the study. Quantitative responses were analysed using descriptive and inferential statistics, while qualitative responses were analysed thematically using Braun and Clarke’s six-phase framework.

RESULTS: While 87.7% of participants viewed Makaton as valuable, only 5.5% reported feeling very confident using it. No statistically significant difference between recommending Makaton to parents and team members (Wilcoxon signed-rank [WSR] = -1.386, p = 0.166). Four themes captured Makaton’s perceived value: (1) multimodal communication, (2) accessibility and practicality, (3) support for speech and language development and (4) inclusion and social interaction. Reported challenges included: (1) limited awareness and training, (2) financial and/or resource constraints, (3) poor consistency and carryover, (4) motor and/or cognitive limitations and (5) cultural and regional mismatches.

CONCLUSION: While Makaton is positively regarded by SLTs, limited training, confidence and implementation support hinder consistent use.Contribution: Expanding access to training and embedding Makaton in professional education may enhance AAC service delivery in the multilingual South African context.

PMID:41773397 | DOI:10.4102/sajcd.v73i1.1154

Afr J Prim Health Care Fam Med. 2026 Feb 17;18(1):e1-e8. doi: 10.4102/phcfm.v18i1.5073.

ABSTRACT

BACKGROUND: Family Medicine (FM) is vital in delivering comprehensive and continuous care essential for robust primary healthcare systems. However, it remains underappreciated in many settings, particularly in sub-Saharan Africa.

AIM: This study aimed to assess the perceptions of FM among first-year medical students at Aga Khan University (AKU), Kenya.

SETTING: A cross-sectional survey was conducted between August 2024 and September 2024 among the first-year medical students at AKU. All were invited to participate via email.

METHODS: An 18-item questionnaire focused on three areas: perception and choice of medicine as a career, perception of FM and choice of FM as a career. Descriptive statistics were used to analyse the data collected.

RESULTS: Of the 59 first-year medical students, 49 participated (83% response rate). While 88% acknowledged FM’s importance, only 35% understood a family physician’s role. Only one participant indicated that they would choose FM as a career, while 61% were uncertain. Reasons for not considering FM included a lack of interest, limited knowledge and negative experiences with FM physicians. Only 16% reported that interactions with FM physicians and the first-year curriculum significantly improved their understanding of FM; many respondents disagreed that the first-year curriculum content advanced their understanding of FM.

CONCLUSION: Integration of FM into undergraduate curricula could promote students’ interest. Additional research is needed to explore perceptions among medical students at different levels of their training and across different medical schools in our region.Contribution: This study establishes baseline perceptions of family medicine among first-year Kenyan medical students, identifying how knowledge gaps and limited curricular exposure undermine interest in the specialty.

PMID:41773389 | DOI:10.4102/phcfm.v18i1.5073

Afr J Reprod Health. 2026 Mar 2;30(4):131-137. doi: 10.29063/ajrh2026/v30i3.12.

ABSTRACT

Male circumcision is an accepted HIV prevention measure in high-incidence countries and is now part of global HIV prevention programs. We interviewed 63 mothers at four major hospitals in Bunia, North-Eastern Democratic Republic of Congo (DRC) between February and March 2014, about their circumcision practices for their sons, including reasons and timing. All participants indicated that their son’s father was circumcised and that they have or will circumcise their son. The most common reason given was adherence to social norms. Only 12.7% mentioned prevention of sexually transmitted infections, including HIV. The mean age of circumcision was 2.5 ± 1.8 years, with reasons including greater strength to tolerate surgery (34.9%) and better pain tolerance (27.0%). All responses were recorded, entered into Microsoft Excel, and analyzed to calculate the mean, average, and standard deviation statistics. Few mothers planned circumcision in the newborn period. These findings suggest that circumcision in the DRC is culturally driven rather than motivated by HIV prevention and typically occurs after the newborn period. Parental education on optimal timing is needed to reduce surgical risks and maximize health benefits.

PMID:41773384 | DOI:10.29063/ajrh2026/v30i3.12

Clin Ter. 2026 Mar-Apr;177(2):376-383. doi: 10.7417/CT.2026.2018.

ABSTRACT

BACKGROUND: Cerebral palsy (CP)is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. Play is an occupation of childhood. Through play children improve performance skills. Research shows that play therapy has a positive effect on improving motor skills in children. Games in a way stimulate the nervous system and make the child active, they create vitality and nerve readiness which cause excitement and interaction of sensory and perceptual parts and decision making in children.

OBJECTIVE: The primary objective was to determine adherence to a structured play-therapy program in children with CP. The secondary objective was to explore changes in hand/upper-extremity function following the program.

METHODS: This pilot, single-arm clinical trial recruited 12 children (5-13 years) with hemiplegic or diplegic CP from Sneha Kiran Spastic Society, Mysore. The intervention comprised institution-based play therapy (45 minutes/day, 5 days/week for 6 weeks) with a home component (2 days/week). Adherence was calculated as the percentage of prescribed sessions completed, with ≥75% predefined as adherent. Upper-extremity function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the program.

RESULTS: Institutional adherence ranged from 59% to 96% (mean 86.4%); 11/12 children met the ≥75% adherence threshold. Home adherence was lower (0%-83%). QUEST scores increased from 47.65 ± 14.47 (pre) to 48.51 ± 14.61 (post), with a statistically significant pre-post change on Wilcoxon signed-rank testing (Z = -1.992, p = 0.046).

CONCLUSION: There was good adherence to play therapy (84.6%) in children with hemiplegic and diplegic cerebral palsy with age group of 6 to 12 years. There was significant improvement in hand function after 6 weeks of play therapy. Therefore, play therapy can be implemented in children with cerebral palsy. Larger controlled studies are warranted to confirm effectiveness and to address barriers to home adherence.

PMID:41773379 | DOI:10.7417/CT.2026.2018

Clin Ter. 2026 Mar-Apr;177(2):341-351. doi: 10.7417/CT.2026.2014.

ABSTRACT

BACKGROUND: Post-Operative Delirium (POD) is common post-operative complications that is under-recognized though it is clinically significant. Delirium management can vary according to the local and the policies of the Centre, hospital and countries but it is management is mostly to treat the predisposing and precipitating factors given that it is consider a medical emergency. It is associated risk to post-operative outcomes in cardiac surgery is limited and understanding its effect might help shed the light to more robust screening and management in CCU and ICU center which could improve the survival and morbidity rate post-cardiac surgery operations.

METHODS: We conducted a retrospective cohort study at Al-Azhar University Hospitals including adult patients who underwent cardiovascular surgery. Eligible procedures comprised coronary artery bypass grafting, aortic surgery, valve surgery, or combined procedures. Exclusion criteria were: age <18 years; preoperative history of dementia or cognitive impairment; non-direct vision procedures (including aortic stent implantation and transcatheter aortic valve implantation); cardiovascular surgery combined with other thoracic surgeries; preoperative coma; repeat surgery within 3 days; death within 3 days after surgery; and incomplete clinical data. POD was assessed during the postoperative period using routine Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) screening, with diagnoses aligned to 11th Revision of the International Classification of Diseases (ICD-11) criteria. The primary outcomes were all-cause mortality at 30 days and 1 year. Secondary outcomes included postoperative morbidity indicators: intensive care unit (ICU) readmission, major complications (infection, stroke, and acute kidney injury), and duration of ICU and hospital stay. Associations between delirium and postoperative outcomes were analyzed using multivariable statistical models with adjustment for relevant clinical covariates.

RESULTS: Among records of 152 patients, 37 (24.3%) of them were diagnosed with POD and 115 showed no POD. Patients in POD group were significantly older (69.56±5.85 vs 66.79±5.18 years), more obese (BMI 27.01±1.85 vs 25.63±2.37), had lower educational attainment (2.7% vs 22.6%), and they had a higher CCI (5.67±0.91 vs 4.37±1.55) compared with the NO-POD group respectively. Factors associated with the risk of POD were advancing age (OR=1.002), lower educational level (OR=1.279), CCI (OR=1.587), duration of anesthesia (OR=1.031), volume of blood transfusion (OR=1.001), duration of the bypass (OR=1.037), and duration of the surgery (OR=0.137), while factors associated with a lower one-year survival rate were delirium itself (p<0.001), age (p=0.002), volume of blood transfusion (p<0.001), CCI (p<0.001), duration of the surgery (p0.037), ICU length of stay (p=0.002), and readmission to the ICU (p=0.001).

CONCLUSION: POD is under-recognized postoperative serious complication, it decreases the 30 days and 1 year and increase the post-op morbidities (ICU readmission, major complications, Length of ICU and hospital stay) specially in patients with preoperative co-morbidities.

PMID:41773375 | DOI:10.7417/CT.2026.2014

Clin Ter. 2026 Mar-Apr;177(2):333-340. doi: 10.7417/CT.2026.2013.

ABSTRACT

BACKGROUND: Oxidative balance is known to be disrupted when individuals are exposed to heavy metals especially lead and chromium, which facilitate vascular dysfunction. Smoking adds to this load by producing free radicals which further augment the oxidative stress. A combination of these effects in elderly hypertensive patients can exacerbate cellular damage and degrade the vascular resilience. These outcomes can also be altered by differences in environmental exposure and physical activity of urban and rural populations.

OBJECTIVE: To determine serum levels of lead (Pb), chromium (Cr) and malondialdehyde (MDA) in urban and rural hypertensive elderly smokers, and to determine the effects of physical activity on oxidative stress.

METHODS: A cross-sectional comparative study was conducted on 80 hypertensive smokers aged 50-70 years (40 urban and 40 rural). Serum Pb and Cr concentrations were determined using atomic absorption spectrophotometry, while MDA was measured by the TBARS method. Demographic, lifestyle, and activity data were obtained through structured questionnaires. Statistical analysis included t-test, χ², and Pearson correlation using SPSS version 26.

RESULTS: Urban participants exhibited significantly higher mean serum lead and MDA levels compared with rural participants (p < 0.05), whereas chromium differences were nonsignificant. MDA correlated positively with Pb (r = 0.26, p = 0.020) and negatively with physical activity (r = -0.14, p = 0.227). The standardized beta coefficients disclosed that serum lead was the strongest positive predictor (β = 0.55, t = 5.01, p < 0.001) and serum chromium came in the second position (β = 0.21, t = 2.11, p = 0.038). The physical activity showed a strong negative correlation with oxidative stress (β = -0.36, t = -3.87, p < 0.001), which supports the protective effect of physical activity against lipid peroxidation caused by metals.

CONCLUSION: Exposure to lead is a significant source of oxidative stress among hypertensive smokers as they grow old especially in urban settings. The exercise can contribute to reducing this oxidative load, thus the importance of maintaining an environment, as well as lifestyle change in the prevention of cardiovascular risks.

PMID:41773374 | DOI:10.7417/CT.2026.2013

Clin Ter. 2026 Mar-Apr;177(2):312-319. doi: 10.7417/CT.2026.2010.

ABSTRACT

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) remains a major nosocomial pathogen with dynamic and evolving antimicrobial resistance (AMR) profiles, particularly in resource-constrained settings. This study aimed to analyse 15-year trends in antimicrobial susceptibility of P. aeruginosa isolates at a tertiary care centre in South India to inform local empiric therapy and stewardship strategies.

METHODS: A retrospective observational study was conducted between 2010 and 2024, analysing P. aeruginosa isolates from 54,208 clinical specimens. Isolates were identified using standard microbiological protocols, and antibiotic susceptibility was assessed by Kirby-Bauer disc diffusion, interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Annual susceptibility rates were analysed using descriptive statistics and linear regression to assess temporal trends.

RESULTS: Among 17,517 culture-positive specimens, 2,225 (12.7%) were P. aeruginosa, predominantly from pus (52%) and respiratory samples (34.8%). Aminoglycosides (amikacin, tobramycin) exhibited the highest overall activity, with >70% susceptibility in later years. Significant improvements were observed in meropenem and piperacillin-tazobactam susceptibility over time, while imipenem showed a significant decline. Ceftazidime-avibactam, introduced in 2016, showed a steady increase to 51% in 2024. Conversely, imipenem demonstrated a significant decline (β = -0.83%/year, p = 0.0279). Ceftazidime, although initially low (3.5% in 2015), showed modest recovery by 2024 (32.2%).

CONCLUSION: Over 15 years, P. aeruginosa at this South Indian centre demonstrated both encouraging reversals in resistance to key β-lactam agents and concerning declines in others like imipenem. High and sustained aminoglycoside efficacy supports their selective use in empirical regimens. These findings highlight the critical role of ongoing local surveillance, antimicrobial stewardship, and integration of advanced diagnostics to combat evolving AMR in high-burden settings.

PMID:41773371 | DOI:10.7417/CT.2026.2010

Clin Ter. 2026 Mar-Apr;177(2):285-294. doi: 10.7417/CT.2026.2007.

ABSTRACT

BACKGROUND: Postgraduate medical students face a unique combination of academic, clinical, and personal challenges that expose them to heightened psychological stress. Understanding how stress interacts with coping strategies, self-compassion, emotional regulation, and psychological flexibility is crucial for designing interventions that promote resilience and well-being.

METHODS: A cross-sectional study was conducted among postgraduate medical trainees in a tertiary care institution in India. Participants completed validated tools including the Postgraduate Stressor Questionnaire (PSQ), Self-Compassion Scale (SCS), Brief COPE Inventory, Difficulties in Emotion Regulation Scale (DERS), and the Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using descriptive statistics, independent t-tests, and chi-square tests to compare domains across groups. Between‑group differences on AAQ‑II were trivial in magnitude (Cohen’s d ≈ 0.10) with overlapping 95% CIs. Given the sample (N=80), post‑hoc sensitivity suggests limited power to detect effects smaller than d≈0.45; thus, the null may reflect true similarity or insufficient power. Nearly half exceeded the >25 cut‑off, indicating a cohort‑level challenge rather than group‑specific differences.

RESULTS: The majority of participants were below 27 years of age, with balanced gender distribution and a predominance of unmarried students. Performance pressure emerged as the most significant stressor (p=0.003). Group A demonstrated significantly higher self-kindness and overall self-compassion, while Group B showed higher self-judgement and maladaptive coping, including substance use (p=0.004). Emotion regulation difficulties were more pronounced in Group B, particularly in emotional awareness and clarity (p=0.025). Psychological flexibility, as measured by AAQ-II, was comparable between groups with no significant difference.

CONCLUSION: Postgraduate medical students experience high stress levels, predominantly due to performance pressure. Self-compassion appears to be a protective factor, enhancing adaptive coping and emotional regulation, whereas maladaptive coping strategies exacerbate stress-related difficulties. Institutional support combined with self-compassion-based interventions may strengthen resilience and safeguard mental health in this vulnerable group.

PMID:41773368 | DOI:10.7417/CT.2026.2007