The challenges of health disparities in South Africa

Benatar, Solomon R.

doi:10.7196/samj.6622

Cited by 102 publications

(84 citation statements)

References 8 publications

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“…Although 84% of the South African population are treated in state facilities, with no access to private medical facilities, only 6% of the total number of radiosurgery treatments were performed within state sector facilities because of limited resources. 8,9 Groote Schuur Hospital (GSH) has offered limited radiosurgery to state patients since 2008, treating 25 between 2008 and 2012 using a second-hand Radionics cone-based radiosurgery system. This broke down and became obsolete in 2012, and a new replacement system was not financially possible.…”

Section: Resultsmentioning

confidence: 99%

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

Burger¹,

Gregor²,

Balchin³

et al. 2017

S. Afr. j. oncol.

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Purpose: Treatment options for acoustic neuromas (ANs) are limited in low- and middle-income countries. The aim of this study was to investigate whether hypofractionated image-guided radiotherapy (IGRT) is a clinically acceptable treatment option for departments where no other radiosurgery options are available. Methods and materials: Fifteen dynamic conformal arc plans that had been clinically utilised were evaluated against the Radiation Therapy Oncology Group (RTOG) radiosurgery criteria and published indices. Analysis involved evaluating critical structure doses and the volume of normal tissue receiving 12 and 10 Gy single fraction equivalent dose (V12Eq and V10Eq). Results: Overall, there was only one RTOG protocol deviation in the whole patient group, where quality of coverage was compromised in order to achieve brainstem tolerance. Conformity indices were within clinically acceptable limits (CIPaddick ≥ 0.6) despite being inferior to the published Universitair Ziekenhuis Brussel (UZB) Gamma Knife and CyberKnife results (p < 0.0001). Homogeneity was superior to the Gamma Knife (p < 0.0001) and Novalis dynamic conformal arc (p = 0.0002) results. Gradient index results were inferior to all published techniques, but doses to the normal structures were well controlled with the exception of the cochlea. The V10Eq data showed increased sensitivity when compared with V12Eq. Conclusion: Dynamic arc IGRT allows for good coverage of AN lesions, but the dose fall-off is not as steep as that obtained with mainstream radiosurgery systems. Contouring and planning should include detailed critical structures analysis. For normal brain parenchyma analysis, V10Eq is a superior risk indicator when compared to V12Eq for this technique. Dynamic arc IGRT offers a dosimetrically acceptable treatment alternative for patients without serviceable hearing, in departments where there are no mainstream radiosurgery treatment options available.

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Section: Resultsmentioning

confidence: 99%

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

Burger¹,

Gregor²,

Balchin³

et al. 2017

S. Afr. j. oncol.

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“…With the likely exception of state facilities in the Western Cape province, the steady deterioration of services at government hospitals is well documented, [1] and CHBAH, despite being a major academic teaching hospital in SA, is no different. There are neither full-time paediatric gastroenterologists nor full-time paediatric gastroenterology nurses, who are needed to cope with the medical needs of the hundreds of children who attend our clinic.…”

Section: Opinionmentioning

confidence: 99%

Paediatric lver transplantation for children treated at public health facilities in South Africa: Time for change

et al. 2014

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“…An editorial [2] warns of the challenges faced in implementing NHI as a result of the extant disparities in health in SA. These are acknowledged in a second editorial, [3] and in a Forum article that moots the establishment of a Health Promotion and Development Foundation (HDPF).…”

Section: Further Perspectives On National Health Insurancementioning

confidence: 99%

Editor's Choice

Seggie¹

2013

S Afr Med J

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The challenges of health disparities in South Africa

Cited by 102 publications

References 8 publications

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

Paediatric lver transplantation for children treated at public health facilities in South Africa: Time for change

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