Prof F Venter

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Prof. Priya Soma-Pillay

“Every two seconds, somewhere in the world, a baby is born preterm and every 40 seconds, a preterm baby dies.”

Introduction

Preterm birth, defined as childbirth before 37 weeks of gestation continues to be a significant global health issue with serious short and long-term consequences for both infants and their families. An estimated 13.4 million babies were born preterm in 2020, with approximately one million infants dying from preterm complications.1 Preterm infants are particularly vulnerable to complications due to impaired respiration, difficulty in feeding, poor body temperature regulation and a high risk of infection. Often, where babies are born dictates if they will survive. One in 10 extremely preterm neonates (< 28 weeks) survive in low-income countries compared to more than 9 in 10 in high-income countries.1 Inequalities related to race, ethnicity, socioeconomic and educational status, and access to quality healthcare services determine the likelihood of death and disability.

Preterm birth is the leading cause of under-five deaths and accounts for 1 in 5 of all deaths of children under 5 years of age. One-third of newborn deaths are babies born preterm and three-quarters of all stillbirths (28 weeks or more) are preterm in high and middle-income countries.

Rates and causes of preterm birth

 Thirteen percent (154 800) of babies born in South Africa in 2020 were born preterm and this rate has been a flat line (unchanged) over the last decade.2 The neonatal mortality rate from 2019 to 2020 was 12 per 1 000 live births. Preterm birth was the cause of almost 50% of all neonatal deaths, according to the South African Maternal, Perinatal and Neonatal Health Policy published in 2021.3

Preterm birth rates globally have remained unchanged over the last decade. The highest reported rates are in southern Asia and sub-Saharan Africa.1 In 2010 13.3% of babies in southern Asia were born premature; this figure was 13.2% in 2020. In sub-Saharan Africa 10.1% of babies in both 2010 and 2020 were premature. The Born Too Soon: 2023 Decade of Action on Preterm Birth Report has highlighted 4 global issues (the “four” Cs) that have affected efforts to improve preterm birth outcomes in the last decade1:

Conflict – By the end of 2022, over 100 million people were driven from their homes by war, violence, or human rights abuses. Worldwide, 61% of maternal deaths, 51% of stillbirths and 50% of newborn deaths occurred in countries that required UN humanitarian aid in 2023. Surviving newborns are particularly vulnerable to lifelong risks.

COVID-19 – The pandemic destabilized health services for women and newborns. Separation of newborns from caregivers threatened high-impact practices like kangaroo mother care (KMC) and exclusive breastfeeding. A recent study found that if universal coverage of KMC was achieved, more than 125 000 newborn lives could have been saved, with fewer than 2000 deaths from COVID-19.2

Dr Amy Booth

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As health care professionals, we often do not realise that the work we do causes harm to the environment and planet on a daily basis. In this plenary session, Dr Amy Booth will give an overview of the biggest global health threat of the 21st century: climate change. She will then turn the issue around and outline, in a South African and primary care context, how our everyday clinical practices have an impact on the environment and contribute towards climate change. Finally, she will present some solutions to how this issue can be addressed. It is up to all health care professionals to take responsibility for the impact they are having on the environment if we want to continue to provide health care in a sustainable manner, on a healthy planet.

Dr Sagie Naidoo

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Gender-Based Violence is a huge burden for the South African community.  Women and children are sexually assaulted and raped with regular frequency and SA has been dubbed the rape capital of the world.  Statistics show that there are some 40 000 rape cases reported to the South African Police Services annually.

All of these victims are examined by health care practitioners with the overwhelmingly majority of cases by registered medical practitioners and a few by specially trained forensic nurses and a forensic report, namely the J88 document, is completed as part of the police investigation which forms part of the case docket.  The health care practitioner will use the completed J88 as an aide memoire to provide expert testimony when called upon to testify, which many be several months or years later.  However, from discussions with prosecutors and defence attorneys dealing with sexual offence cases there is a perennial complaint of poorly completed J88 forms which leads to poor expert testimony.

This presentation will discuss the pitfalls in the history taking, clinical examination, forensic evidence collection and the follow-up of victims of sexual assault.  It will aim to show that part of the challenge is that the examiner does not understand his/her forensic role fully as opposed to the therapeutic role as these two roles are mutually exclusive.  It will highlight the importance of careful and methodical clinical examination and documentation.  It will also highlight some of the challenges that clinical forensic medical practitioners currently face in this field.  Some pointers for expert witnesses will be discussed.

Adv. Carina Coetzee

TITLE: The role and nature of expert evidence in a criminal trial

Rape and sexual assault are some of the worse forms of Gender-Based violence perpetrated on women and children. It is a serious social problem about which, fortunately, we are at last becoming concerned. Our courts have consistently held that rape is always and foremost an aggressive act. It is a violation that is invasive and dehumanising. The consequences for the rape victim are severe and permanent. And for many rape victims the process of investigation, evidence collection and prosecution are almost as traumatic as the rape itself. Unfortunately, rape is also a topic that abounds with myths and misconceptions that can result in justice being denied to victims. Very often, the victim is a single witness whose evidence the courts approach with caution, and for which corroboration for the victim’s version is sought in other evidence before being accepted as credible and reliable. In a complex society as South Africa the evidence of an impartial and objective expert witness, with specialised knowledge that does not form part of judicial knowledge, is invaluable to help presiding officers reach just verdicts. This presentation will discuss the definition and important role of an expert witness, and the nature of expert evidence, including opinion evidence. The presentation will also deal with methods of presenting expert evidence and cross examination.

Prof. Bob Mash

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This plenary talk will bring people up to date with the key achievements and activities of the South African Academy of Family Physicians (SAAFP) over the last year. Prof Mash will outline our advocacy for the discipline with National and Provincial government, based on our position paper, as well as through the Private Sector Forum. He will outline what is happening with Continuing Professional Development, the South African Family Practice Journal, the Next-5 special interest group, national Education and Training initiatives, and our bid to host WONCA World Conference in 2027. This will include the publication of the 4th edition of the South African Family Practice Manual.

During his plenary talk, he will launch the initiative to accredit family physicians as competent and effective clinical trainers in the workplace. The first group of family physicians will receive their Certificates of Accreditation.

This will be his final duty as the outgoing President of the SAAFP and he will announce the newly elected Council and Directors to the membership.

Prof. Haroon Saloojee

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The presentation will delve into the concept of integrated care as it applies to child health and examine the ability of comprehensive and collaborative care to address children’s physical, mental, and social health and well-being. Achievements and challenges of integration in high and low-income country settings will be explored, alongside the potential for implementing integrated child healthcare in South Africa’s private and public health sectors.

Prof. Shabir Moosa

KM Seedat Lecture: Community-oriented primary health care for National Health Insurance

Head of Clinical Unit: Family Medicine, Johannesburg Health District

Associate Professor, Division of Family Medicine, University of Witwatersrand

Member at Large, WONCA World Executive Committee

SUMMARY 

South Africa is on the cusp of establishing National Health Insurance (NHI), as an approach to improve health services and universal health coverage through strategic purchasing. This strategic purchasing will allow resources to be managed at a more decentralized level and allow private providers to be included in service provision. In primary health care (PHC) it will involve contracting with private general practitioners (GPs) using a capitation payment method. A study on GPs in 2011 showed that GPs that GPs could price competitively given a scenario of contracting for 10 000 people at a visit rate of three per year (vs two in the public sector and four in the private sector). The saw three risks (and ways to mitigate them): unreliable partner in government (needing a strong contract); higher visit rates (need a health promotion approach); and big practice paradigm changes (needing management skills).

Chiawelo Community Practice (CCP) was set up in 2014 in Soweto to explore some of the assumptions in this scenario. It was premised on a community-oriented primary healthcare (COPC) approach. COPC is a blend of personal care and public health, developed by the Karks in the 1940s in South Africa, as a pilot for a National Health System suited to the needs and resources in South Africa. CCP was premised on COPC with four elements (as a strategy to improve quality and reduce utilization through targeted health promotion): community healthcare workers (CHWs) managing segments of the population (±1000); best practice in Family Medicine at the clinic, esp. appointment options, good record-keeping, and linkages with CHWs; regular stakeholder engagement especially patient groups to prioritise the last element; targeted health promotion using the information from the above. This had the remarkable effect of improving quality (with more than 90% access and satisfaction rates) and reducing visit rates to less than one, despite being manned mostly by different interns rotating weekly though CCP.

CCP attracted the attention of the South African National Treasury (NT) and a capitation contract for GPs under NHI was developed. It included the concept of “community” practices based on COPC to assist contracted GPs to better embrace the paradigm of capitation contracting, especially to address the need to manage visit rates whilst improving quality. However, discussions with consultants, showed challenges in senior managers thinking. It easily veered towards discrete services with little innovation in respect of managing processes within PHC. The National Department of Health showed no interest in CCP or the NT design over these years. Fortunately, Chiawelo, has become the site for Gauteng’s proof of concept for Contracting Units of PHC and there is an opportunity to design the NHI with COPC at the core.

Information to follow.

Dr Prithy Ramlachan

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In this workshop on sexual history taking, family practitioners will explore the importance of addressing sexual health in primary care for overall well-being. Participants will reflect on personal beliefs and values towards sexuality, intimacy, and sexual health. The workshop will emphasize the need for primary care physicians to be proactive in screening, addressing dysfunctions, and providing treatments. Creating a safe and non-judgmental environment will be discussed to establish trust with patients, enabling open communication about sexual health concerns.

The comprehensive approach to sexual health screening will cover physical, psychological, relational, and sociocultural factors using validated tools. Gender-sensitive considerations and strategies for overcoming challenges in providing inclusive care will also be addressed. Ethical principles surrounding sexual behaviour and expression will be explored. The workshop will cover risk assessment, sexual health first aid, and history taking techniques for special groups. The conclusion highlights the crucial role of primary care providers in improving sexual health outcomes by integrating sexual health into routine care and addressing access barriers.

Dr Sheena Mathew

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Dr. K. K. Tsebe-Mchunu

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MENTAL HEALTH IS EVERYONE’S BUSINESS

Background: Mental health care is still significantly rendered in Specialized centres in South Africa, with most non-specialised clinicians not able to fully care for Mental health care users at the primary health care setting. The current model of care is expensive, not well accessible to patients and it is not sustainable for South Africa, its health budget and population health needs.

Methods: Review of the National Mental Health Policy Framework and Strategic Plan 2023 – 2030, as well as published articles on the current state of mental health care provision and proposed solutions to the integration of mental health into primary health care. Review the cost of the current model by looking at various published articles.

Discussion: Discuss the current state of mental health provision in South Africa. Discuss the proposed solutions on the National Mental Health Policy Framework and Strategic Plan 2023 – 2030.

Conclusion: The benefits of a fully integrated health care model, to the patient, the service providers and the health care funders. Highlight the benefits of a patient centered care model.

Dr S Ruder

Dr. Nasrin Mahyoodeen

Hyperglycaemia first detected in pregnancy – screening and diagnosis

Hyperglycaemia first detected in pregnancy (HFDP) is one of the most common metabolic disturbances of pregnancy and is associated with maternal and fetal morbidity and mortality. It encompasses a spectrum of dysglycaemia viz. women who had pregestational diabetes who are only detected in pregnancy as well as those who develop gestational diabetes. The optimal screening and diagnostic strategy has been the subject of controversy. This seminar provides and overview of HFDP focuses on the screening and diagnostic criteria for HFDP. It also briefly covers the challenges encountered in low-resource settings.

Dr. Lisa Galvin

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The awareness of the importance of early diagnosis and holistic management of neurodevelopmental disorders such as Autistic Spectrum Disorder and Attention Deficit Hyperactivity is increasing. Changes in diagnostic criteria along with changes in social media use have influenced our approach to these disorders. There is overlap of symptomatology however it is also now recognised that these disorders may occur comorbidly. Child psychiatric care resources in low-middle income countries such as South Africa are scarce and symptoms may be missed if one does not have an awareness of how children often present with symptoms of these neurodevelopmental disorders.  Children will often initially present with symptoms when being seen in the general medical setting, either for a concern related to the symptoms of the disorder (such as poor academic performance) or for an unrelated health concern. Early identification of these disorders in the general medical setting and having an appropriate pathway for early intervention is vital to improve long-term outcomes. There is also a need for resources that are widely accessible. Little is known about how current social media use has influenced the prevalence of these disorders and how they present. Social media may be a double-edged sword, improving access to care and novel approaches to treatment however one needs to also consider negative effects of social media use in people who have been diagnosed with Autistic Spectrum Disorder, Attention Deficit Hyperactivity Disorder or both of these disorders.

Dr Frances Kaplan

Information to follow.

Andrew Heilbrunn & Philippe Gradidge

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The purpose of this seminar is to explore the benefits of physical activity and exercise for addressing and preventing chronic diseases. In the first part of this seminar the facilitators will review the scientific evidence on how exercise can help to improve symptoms, reduce the risk of complications, and improve overall quality of life in patients. Then, the facilitators will describe two case studies of persons with multiple chronic conditions that have been managed with exercise.

Dr Gaynor Grace

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This seminar explores the potential as well as the challenges of collaborative projects between traditional health practitioners (THPs) and the biomedical system.

Key seminar highlights:

• An overview of South Africa’s diverse indigenous healing traditions.
• Evaluation of collaborative projects between THPs and the biomedical system.
• Exploring the principles of cultural sensitivity and ethical considerations in healthcare collaborations.
• Practical insights for establishing effective partnerships.

Whether you’re interested in collaborative projects or simply curious about traditional medicine in South Africa, this seminar offers an opportunity to deepen your understanding of an intriguing topic.

Klaus von Pressentin*, Arun Nair, Indiran Govender, Ramprakash Kaswa, Shane Murphy 

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Research capacity building workshop. Topic: “How to publish your first paper”

*Corresponding author: klaus.vonpressentin@uct.ac.za

120 minutes workshop presentation, with editorial team members, on Research Capacity Building

Primary healthcare professionals need to create and adapt new knowledge and use existing evidence to improve the health of their patients and communities. This requires an increasing number of trained and experienced primary healthcare scholars, to ensure good research practices, as well as validate data collected by primary care providers. Research grounded in clinical care and generated within the local context ensures evidence-based practice and informed education to primary healthcare scholars. Clinician-scientists are rooted in health services and apply research techniques to inform and strengthen clinical practice. In addition to improving health care outcomes, clinician-scientists in primary care support self-directed and team learning to facilitate the development of an expanding set of competencies such as critical thinking and change agency.

There are limited opportunities for early career researchers to meet and share their perspectives, as well as learn from each other and more experienced researchers. The South African Family Practice editorial team aims to support colleagues from South Africa in their development from early-career researchers to established clinician-scientists. This workshop builds on the insights gained from our 2022 National Congress workshop participant feedback, with a focus on publishing academic work.

Target audience:Health sciences students and professionals working in the field of family medicine and primary care across different settings (private, hospital, district and primary healthcare) are most welcome. This workshop is particularly aimed at students and professionals with limited experience in research who are typically planning their first or second research project, either as part of a degree or applied research as a practising clinician.

Aims: To guide emerging and early-career clinician-researchers on how to prepare and successfully publish their research in a peer-reviewed scientific journal.

Objectives: 

1. To enable the participants to prepare their manuscripts for submission and editorial review.
2. To understand the peer-review process and guide novice researchers on how best to respond to reviewer comments.
3. To explore formal and informal development opportunities to grow scholarly writing skills.
4. To facilitate how to identify research partners or mentors and create a research network.
5. To facilitate networking with fellow researchers and the editorial team at SAFP journal.

Format: An interactive session, where participants engage with each other, share experiences, ideas and pose questions.

Dr Christian L. Lokotola

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Climate change has been declared as the biggest threat to human health in the 21st century. Exposure to climate change-induced extreme weather events is associated with immediate loss of life and injuries as well as destroying healthcare facilities. The significant health and social effects are seen in primary health care, but not all family doctors are aware of the issues and how to tackle them. These effects include malnutrition, infectious diseases, non-communicable diseases, displacement and migration, injuries as well as mental health problems. Several reports have underlined the difficulty of PHC facilities and services operating after extreme weather events.

There are three key aspects to consider: the health and social effects of climate change, the challenge of climate change to healthcare facilities and services, and the contribution of health services to the problem of climate change. This workshop would like to explore practical steps that family doctors can take to address these issues. The workshop will consist of,

1. A short presentation of the Climate Resilience Matrix that brings together both mitigation and adaptation actions for climate change readiness of PHC facilities and services.
2. Group work on two questions:
   1. What can we do to adapt PHC facilities and services to the challenge of climate change? We will refer to WHO framework for climate resilient health systems and the key factors for climate-resilient health services.
   2. What can we do to mitigate the contribution of health services to climate change? We will refer to The Global Green and Healthy Hospitals agenda items: leadership, chemicals, waste, energy, water, transport, food, pharmaceuticals, buildings, and procurement.

Adv. Carina Coetzee

Evidence collection and presentation of clinical forensic evidence in sexual assault cases.

Despite all sexual violence inflicting severe trauma, injuries are not always visible.  It is therefore essential to understand and explain

• Grooming and the impact on penetrative injuries
• Victim’s age and the healing of hymenal injuries
• Victim’s age and elasticity of hymen
• Size of hymenal opening and penetration
• Bruising and time period for presentation
• Sensitivity of hymen
• Hymenal injuries without injuries to labia
• Giving birth and impact on vaginal injuries
• Sexually transmitted infections
• Size of hymenal opening
• Lack of injuries
• Location of injuries
• Likely type and degree of force required to inflict the injury
• Consistent with one incident of penetration or chronic penetration

Even where injuries are absent, evidence containing the DNA of the perpetrator can still be found in inter alia saliva, hair, spermatozoa on clothes / underwear, blood, etc.

Dr Sagie Naidoo

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Forensic Evidence collection in sexual offences is an important part of the medico-legal examination in a rape case.  It is important that the Clinical Forensic Medical Practitioner has an understanding of the intricacies involved and how best to maintain the chain of custody of the specimens until it gets to the Forensic Science Laboratory. The following will be discussed during this session:

1. The principles underlying Forensic Evidence Collection
2. DNA Profiling briefly
3. Potential sources of DNA
4. Locard’s Principle and Forensic Evidence Collection: ‘Every Contact leaves a trace’
5. Different types of Evidentiary material: Known vs Unknown; Reference Samples vs Crime Samples;
6. The “The Chain of Evidence” / The Custodial Chain and its importance
7. The Prevention of Contamination
8. The Timing of Forensic Evidence Collection and the 72 Hour time limit
9. Reasons for the Absence of spermatozoa/DNA
10. Types of Evidence Collection Kits: Demonstration of the contents of the various Kits

• D1: Adult Sexual Assault Evidence Collection Kit: This kit is intended to collect the perpetrator’s DNA from the ano-genital area of a patient over the age of 12 years. It also facilitates the collection of the pantie, tampon and sanitary pad.
• D2: DNA from Body Evidence Collection Kit: This kit has everything to collect DNA samples from the body (extra-genital): swabs to collect semen, saliva, blood; wooden spatula for the scraping of blood and other debris and pointed wooden swabs for scrapings from under the nails.
• D3: Reference Hair Collection Kit: Human hair, both scalp and pubic hair are good sources of DNA as long as it has the hair follicle can be used for good reference DNA samples.
• D5: Clothing Collection Kit: The clothing collection kit is used for the collection of all or some of the clothing for the identification of DNA material from the perpetrator.
• D6: Human Tissue Collection Kit: Used usually by forensic pathologists for the collection of human tissue for identification purposes. It is also used by forensic clinicians for the sampling of the foetus for determining paternity in a rape case.
• D7: Paediatric Sexual Assault Evidence Collection Kit: This kit is used in girl child under the age of 12 years to collect perpetrator’s DNA from the ano-genital area. It also has a thin aluminium shaft swab for the collection of DNA from the internal genital area.
• DB Kit: DNA Reference Collection Kit: Specifically designed to collect buccal cells and to transfer them onto a FTA (Flinders Technology Associates) Filter Paper card for transfer to the laboratory for analysis, resulting in a DNA identification
• PMD1: Deceased Sexual Assault Evidence Collection Kit: Intended to collect perpetrator’s DNA from the ano-genital area of a deceased individual. It also facilitates the collection of the pantie, sanitary pad and a tampon.
• PMD2: Deceased Reference Blood Sample Collection Kit: To collect a reference blood sample from a deceased
• The Blood Alcohol Kit: to collect a blood sample to determine alcohol intoxication

Dr. Chantelle van der Bijl, Family Physician, UFS
Prof. Klaus von Pressentin, Associate Professor and Head: Division of Family Medicine, UCT
Dr. Arun Nair, Family Physician and Acting head of Unit RMSH Family Medicine, UFS 

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The scarcity of advertised positions for family physicians in South Africa demands more than just clinical expertise to secure a desirable job. To address this issue, this workshop aims to equip registrars and newly qualified family physicians with the skills and confidence needed to excel in job interviews. The workshop focuses on interview preparation, communication techniques, and answering challenging questions.

The interactive and engaging workshop employs presentations and group discussions. Qualified family physicians will facilitate the workshop, sharing their insights and providing practical guidance.

The expected outcomes of the workshop include enhanced interview preparation and improved communication skills. Skills include strong verbal and non-verbal communication, articulation, active listening, and confident body language. Participants will also learn strategies for answering challenging questions commonly faced by family physicians during interviews.

The workshop is designed for registrars and newly qualified family physicians who are transitioning to new roles or exploring career opportunities. It caters to individuals looking to enhance their job interview skills, regardless of their experience level.

Dr Jurgens Staat

Emergencies often present to primary healthcare facilities. It is therefore essential that the practitioner in the primary healthcare setting knows how to approach and stabilise these patients while awaiting transfer to their referral hospital. Rural Life Support (RuLS) provides a structured approach to any emergency in primary healthcare. The workshop at the SAAFP Conference will be an interactive session where participants will practically assess and manage medical and trauma cases facilitated by RuLS instructors.

Prof. Olufemi Omole, Dr Laurel Baldwin-Ragaven, Prof. Klaus von Pressentin, Dr Madeleine Muller, Prof. Mergan Naidoo

Workshop to explore family medicine sub-specialisations in South Africa: maximising PHC special interest integration.

Background: Family medicine and primary care represent a generalist clinical discipline which aims to advance the practice, teaching, and research of high-quality primary care according to the needs of individuals, families and communities served. Our discipline’s pluripotent nature and encompassing philosophy make it possible to bridge holistic person-centred care and universal healthcare access for all through comprehensive primary healthcare. It opens the possibility of imagining a multiverse of primary care practice models, including considering special interest areas within the broader scope of primary care. Some question the ethos of family medicine as a speciality, while others believe the discipline needs to be narrower and would like to focus their clinical interest on a sub-speciality.

Aim: This workshop explores the possibilities and interest in family medicine subspecialist/ special interest areas (such as infectious diseases, palliative medicine, etc.).

Format/methods: Following a brief introduction and sketching of the global and national developments on disciplinary sub-specialisation and the development of special interest areas, the workshop will allow the exploration of possible options for Family Medicine in South Africa. We propose a guided discussion to tease differences, identify criteria to develop and assess sub-specialities and unpack possible considerations to guide the College, SAAFP and university departments.

Planned workshop outcomes: This workshop will capture feedback from participants on the way forward, which may inform a possible research project and future Delphi process and provide guidance for the operational strategy for the CFP.

Target audience: All conference attendees are welcome. This is an open workshop for all colleagues interested in growing the primary care discipline for Southern Africa.

Prof. Hanneke Brits

Information to follow.

Presentation

Information to follow.