Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency

Autor: Salem A Beshyah, Ian L. Ross, Thabiso Mofokeng, Kwazi C. Z. Ndlovu
Rok vydání: 2020
Předmět:
Male
Bacterial Diseases
Heredity
Etiology
Economics
Genetic Linkage
Health Care Providers
Social Sciences
Health Care Sector
Surveys
Pathology and Laboratory Medicine
Biochemistry
Health Services Accessibility
Geographical locations
Cortisol
Primary Adrenal Insufficiency
South Africa
Medical Conditions
Endocrinology
Risk Factors
Health care
Prevalence
Medicine and Health Sciences
Medical Personnel
Lipid Hormones
Child
Adrenoleukodystrophy
Multidisciplinary
Adrenal crisis
Disease Management
Middle Aged
Professions
Infectious Diseases
Neurology
Research Design
X-Linked Traits
Sex Linkage
Child
Preschool
Vomiting
Medicine
Infectious etiology
Female
Private Sector
medicine.symptom
Research Article
Adult
medicine.medical_specialty
Tuberculosis
Adolescent
Nausea
Endocrine Disorders
Science
Research and Analysis Methods
Communicable Diseases
Young Adult
Health Economics
Internal medicine
Physicians
medicine
Genetics
Humans
Clinical Genetics
Steroid Hormones
Public Sector
Survey Research
business.industry
Infant
Newborn
Infant
Biology and Life Sciences
medicine.disease
Tropical Diseases
Demyelinating Disorders
Hormones
Health Care
Cross-Sectional Studies
People and Places
Africa
Population Groupings
Health Facilities
business
Adrenal Insufficiency
Zdroj: PLoS ONE
PLoS ONE, Vol 15, Iss 11, p e0241845 (2020)
ISSN: 1932-6203
Popis: Objective We wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients’ clinical profiles, private being better resourced than public healthcare. Methods An online survey of physicians’ experience relating to PAI. Results The physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%); pppp = 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%); pp = 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%); p = 0.001], shock [36 (67.9%) vs 31(36.9%); pp = 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%); p = 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%); pp = 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency. Conclusion A survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians’ expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.
Databáze: OpenAIRE
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