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Objective: This study aimed to evaluate the effectiveness of the Making the Difference programme (MTDP), an education- and activity-based intervention for Grade 4 learners at primary schools in the Western Cape. Design: This was a cross-sectional, post-intervention survey of an existing programme, using control schools as a comparator. Setting and subjects: The study involved Western Cape primary schools in the 2009 school year. Schools were randomly sampled from two regions. Four intervention (active in the MTDP) and five control (non-participating) schools (n = 325 learners) were selected. Outcome measures: The following outcome measures were assessed using an administered questionnaire to learners: learners' knowledge of, attitudes towards, and behaviour in relation to nutrition and physical activity. Results: A small but significant improvement (eating vegetables and taking lunch boxes to school) was demonstrated with regard to self-reported behaviour in relation to nutrition in the intervention group. However, this behaviour was not explained by differences in barriers to healthy eating, self-efficacy or knowledge, which were not different between the groups, or by perceived social support, which was actually significantly increased in the control group. Groups displayed no differences in physical activity or sedentary behaviour. However, the results showed a significant difference between the groups in terms of a reduction in perceived barriers to physical activity and increased physical activity self-efficacy in the active group. Conclusion: While the MTDP only had a modest effect on the self-reported nutrition and physical activity behaviour of the learners, results regarding lower perceived barriers to physical activity and increased physical activity self-efficacy were promising. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently, none of the community health centres (CHCs) in Cape Town test for microalbuminuria, and there are concerns about its costs and feasibility. Objectives: The aim of this study was to assess the practicality, costs and consequences of introducing a screening test for microalbuminuria into primary care. Design: Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening, costs and consequences was evaluated. Setting and subjects: Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcome measures: Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria. Results: Of the patients with diabetes, 14.6% already had macroalbuminuria. Of the eligible patients, 69.9% completed the screening process which led to a diagnosis of microalbuminuria in another 11.7%. Of those who were positively diagnosed, the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20%, while 49.2% had ACE inhibitors initiated, or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed. Conclusion: The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal, compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient). [ABSTRACT FROM AUTHOR]

This article reviews how the model of family medicine has developed over the last 15 years in the Western Cape. It is based on a series of in-depth interviews with key role players. This period coincides with the immediate post-apartheid era, in which both the health system and health science education experienced rapid transformation. The new focus on primary health care, the district health system and community-based education provided an opportunity for the disciplines of family medicine and in primary care to develop. The model that emerged required the family physician to work at both the district hospital and in primary care, and to have a number of different roles: care provider , consultant, capacity builder , supervisor , manager and community leader . Family medicine was accepted as a new speciality in 2007. The first specialist family physicians will qualify in 2011, and start to consolidate the model that has been developed. Although the model shows promise, a number of challenges still remain, in relation to the health system, the relationship between universities and the province, the discipline of family medicine, research, and training programmes. It is hoped that these reflections will be of value to other provinces in South Africa, and other countries in the region, that are also thinking of including family physicians in their health systems. [ABSTRACT FROM AUTHOR]