South African Family Practice最新文献

In this opinion piece, the author critically reflects on his own antimicrobial stewardship practices in primary care and the complex factors influencing antibiotic prescription, specifically in children.Contribution: In light of emerging evidence of the role of the microbiome in both health and disease, this piece raises a key question: Are we doing more harm than good?

Background:  There is a high prevalence of diabetes in South Africa and a related increase in poor treatment outcomes among people with diabetes. Poor glycaemic control is often associated with a lack of knowledge of self-management. The study aimed to assess diabetes knowledge levels among patients in the Mhlontlo Municipality in the OR Tambo District of the Eastern Cape province in South Africa.

Methods:  The study used a quantitative descriptive cross-sectional design. A convenience sample was taken of patients ≥ 18 years of age with Type 2 diabetes at a Community Health Centre and a district hospital. Data were analysed using SPSS 29, with descriptive statistics and chi-square tests applied.

Results:  A total of 172 respondents were surveyed. Most respondents (57.6%) were female and most (54.2%) obtained information from healthcare facilities. Respondents demonstrated a moderate level of diabetes knowledge, with an overall median score of 62.5% across all question categories. A total of 41.3% respondents had a high level of knowledge, 29.1% had moderate knowledge levels and 29.6% had low knowledge levels. Using chi-square tests of association, tertiary-level education, younger age (between 18 and 29 years) and being employed were significantly associated with high knowledge levels.

Conclusion:  Health facilities in Mhlontlo should focus on providing health education for people aged more than 50 years to improve diabetes self-management.Contribution: This study contributes to previously unavailable context-specific information on diabetes knowledge levels among patients in Mhlontlo.

No abstract available.

Background:  Pre-exposure prophylaxis (PrEP) is key for preventing human immunodeficiency virus (HIV) transmission, but uptake is limited, especially in rural areas of South Africa. Nurses in primary healthcare (PHC) play a vital role in delivering PrEP, yet little is known about their knowledge, attitudes and practices (KAP) in this area.

Methods:  A cross-sectional analytic study was conducted among 178 nurses from three healthcare facilities in the Mhlontlo sub-district of the OR Tambo District, Eastern Cape. A structured, self-administered questionnaire was used to assess demographic variables, PrEP-related knowledge, attitudes and practices.

Results:  While 78.7% of participants were aware of PrEP, only 43.3% demonstrated comprehensive knowledge, and just 46.6% had ever initiated a client on PrEP. Community health centre (CHC) nurses demonstrated significantly better knowledge and practice than those in district hospitals (p  0.001). Attitudes were generally positive, with 91.4% agreeing that PrEP is an effective HIV prevention method. However, 73.1% believed it could lead to increased transmission of sexually transmitted infections (STIs). The study identified barriers to PrEP implementation, including lack of training (57.9%), protocol shortages (25.3%) and insufficient time (40.4%).

Conclusion:  Primary care nurses demonstrate a high level of awareness and positive attitudes towards PrEP; however, knowledge and practice gaps persist. Primary care providers' capacity building through targeted training, integration and improved human and healthcare resources is vital to enhancing PrEP implementation for national HIV prevention.Contribution: This study highlighted the frontline primary care providers' vital roles in the PrEP for prevention of HIV infection in resource-limited rural healthcare settings.

Background:  Diabetes is a major contributor to the burden of disease in South Africa, but glycaemic control is poor. Group empowerment and training (GREAT) for people with type 2 diabetes is a cost-effective intervention in our setting. The aim was to evaluate the implementation of GREAT for diabetes at a primary care facility in Cape Town.

Methods:  A convergent mixed-method study evaluated implementation outcomes over 6 months. A programme theory model was used to prospectively plan implementation. Semi-structured individual interviews were held with healthcare workers, focus group interviews with patients and sessions were observed to evaluate adoption, feasibility, fidelity and sustainability. Quantitative data evaluated reach, cost and aspects of fidelity. Qualitative data analysis used ATLAS.ti and the framework method. Data were analysed deductively according to the pre-determined implementation outcomes.

Results:  Key stakeholders agreed that GREAT was acceptable and appropriate and encouraged adoption. Initial implementation reached 35 patients in four groups and 65% of those invited attended. Only 29% attended all four sessions. Fidelity of the intervention to the training manual was good. Several contextual factors influenced the feasibility of implementation (e.g. support of management, space for group sessions, integration with appointment system, effect on number of walk-in patients, streamlined referral system). Incremental operational costs were trivial (R30/month), while opportunity costs were higher (R26 252/month). Sustainability will be related to ongoing managerial and staff buy-in and adjustment of the implementation strategies to overcome some of the barriers.

Conclusion:  The study identified 30 determinants of successful implementation outcomes.Contribution: Can guide future implementation in similar contexts as GREAT for diabetes is scaled-up in Cape Town and scaled-out to other provinces in South Africa.

Background:  Families raising children with developmental disabilities face complex, interconnected challenges requiring coordinated support across multiple professional domains. While interdisciplinary collaboration is widely endorsed in policy and practice guidelines, significant knowledge gaps exist regarding how healthcare professionals operationalise these collaborative approaches in real-world settings.

Methods:  A qualitative study was conducted using individual semi-structured interviews with 12 experts representing diverse disciplines. The study was grounded in the Capabilities Approach as both a theoretical lens and a methodological framework. Data were analysed using Braun and Clarke's six-step thematic analysis, with the Capabilities Approach framework informing each analytical phase.

Results:  Five major themes emerged from the capability-guided analysis: facilitating emotional transformation, building system navigation competence, creating inclusive participation opportunities, strengthening family functioning and fostering adaptive identity development. Across all themes, participants consistently emphasised three critical mechanisms for effective interdisciplinary support: coordinated care delivery as capability enhancement, comprehensive emotional support as capability development and whole-family capability strengthening interventions.

Conclusion:  The findings highlight the significance of interdisciplinary approaches informed by the Capabilities Approach in providing comprehensive support for parents of children with developmental disabilities. Rather than traditional deficit-focused models, participants systematically described how they enhance family capabilities by functioning as capability facilitators who orchestrate conversion factors, build emotional capabilities while respecting family agency and create environmental modifications that expand family possibilities.Contribution: This study contributes a novel capability-focused framework for understanding interdisciplinary collaboration in developmental disability support, moving beyond traditional service coordination models to emphasise systematic capability enhancement approaches that build sustainable family strengths across multiple domains simultaneously.

Background:  Diabetic neuropathy has an estimated prevalence of 50% among individuals with longstanding diabetes, with distal symmetric polyneuropathy (DSPN) being the most common manifestation. Poor glycaemic control is a recognised risk factor for DSPN. This study aimed to determine the prevalence of symptomatic DSPN in patients with type 2 diabetes mellitus (T2D) using a validated symptom-screening questionnaire - the diabetic neuropathy symptom (DNS) score. In addition, the association between haemoglobin A1c (HbA1c) and DSPN was investigated.

Methods:  A cross-sectional study was performed at the diabetes clinic at Helen Joseph Tertiary Hospital, Johannesburg, South Africa. A total of 206 consecutive patients with T2D were included. Underlying comorbidities and HbA1c values were obtained from patient records. The DNS score was used to assess for the presence of symptomatic DSPN.

Results:  The prevalence of symptomatic DSPN was 61.2%. Among those who screened positive for DSPN, 58% were not receiving pharmacological treatment for DSPN. Patients with HbA1c values of 7% - 10% and 10% were 2.9 and 3.7 times, respectively, likely to have DSPN (prevalence ratio [PR] = 2.9; 95% confidence interval [CI] 1.5-5.4, p = 0.001; PR = 3.7; 95% CI 2.0-7.0, p  0.001, respectively), compared with those with an HbA1c value 7%.

Conclusion:  A higher than expected prevalence of symptomatic DSPN was observed in this study population, indicating the need for enhanced screening. Furthermore, a significant proportion of symptomatic patients were not receiving treatment. Poor glycaemic control with HbA1c values 7% significantly increases the risk of DSPN.Contribution: The DNS score can easily be implemented at a primary care level to detect symptomatic neuropathy and facilitate prompt treatment.

Background:  Cervical cancer is more prevalent in human immunodeficiency virus (HIV)-positive women and is frequently diagnosed in an advanced stage. This study sought to understand factors contributing to the delayed diagnosis of cervical cancer in HIV-positive women at Mokopane Hospital in the Limpopo Province of South Africa.

Methods:  A qualitative phenomenological study was conducted using individual interviews among purposively sampled HIV-positive women who were diagnosed with cervical cancer. Interviews were recorded, transcribed verbatim, translated and analysed thematically.

Results:  Four major themes emerged from the study, providing possible explanations for the delay in cervical cancer diagnosis. Firstly, women believed that Papanicolaou (PAP) smears are diagnostic and should be performed when symptoms appear, rather than for screening. Secondly, their readiness, fear and embarrassment to do the procedure delayed them from having a PAP smear. Thirdly, consulting traditional healers initially, also caused delays. Fourthly, a lack of equipment, inadequate follow-up, health workers' low index of suspicion and unwillingness to do the procedure further delayed diagnosis.

Conclusion:  Human immunodeficiency virus-positive women have an inadequate understanding of cervical cancer screening and its importance. Patient education and health worker training are urgently needed to improve the screening. To counteract delays in screening, adequate staffing, regular maintenance and availability of equipment are vital for improved care for HIV-positive women.Contribution: This study highlights how a poor understanding of cervical cancer screening, patients' readiness, fear and embarrassment to do the procedure, as well as inadequate equipment and poorly motivated health workers, all contribute to the delayed cervical cancer diagnosis in HIV-positive women.

Background:  People on drug-resistant tuberculosis (DR-TB) treatment face multiple challenges, which include severe disease and treatment side effects, together with psychosocial and socioeconomic challenges. These challenges impact patients' ability to remain in care and complete their treatment.

Methods:  We conducted a scoping review to synthesise evidence on patient-centred care interventions that have been offered to DR-TB patients to facilitate retention in care. Studies published from 2005 until 2023 were retrieved from primary research articles, grey literature and review articles published in peer-reviewed journals.

Results:  Among the 347 articles sought for retrieval, 172 were subsequently excluded from the analysis for various reasons. Ultimately, 14 studies met the inclusion criteria, providing valuable insights into patient-centred interventions for DR-TB patients. These interventions aimed to mitigate the complex challenges faced by DR-TB patients during treatment and were categorised into four groups, consistent with the World Health Organization (WHO) recommendations on social support for people with DR-TB: (1) informational, (2) emotional, (3) companionship and (4) material support. Most studies (n = 11) offered DR-TB patients integrated forms of support. Material support was the most common form of support utilised across the studies (n = 12), followed by informational (n = 9), companionship (n = 7) and emotional support (n = 5).

Conclusion:  Patient-centred care interventions improve retention in care and treatment outcomes among DR-TB patients.Contribution: The study contributes to the discourse on the value of patient-centred care in managing people with DR-TB.