South African Family Practice最新文献

Background:  Providing first aid during an epileptic seizure can be lifesaving; however, many individuals lack the necessary knowledge and skills because of persistent misconceptions about epilepsy. This study assessed knowledge and attitudes towards seizure first aid among attendees of the Gateway Clinic in Bloemfontein.

Methods:  A cross-sectional analytical study was conducted using a structured questionnaire to evaluate participants' knowledge and attitudes regarding seizure first aid.

Results:  Of the 466 questionnaires distributed, 391 were included in the study. Most participants were knowledgeable, with a median score of 13.0 (interquartile range [IQR]: 9.0-16.0). Attitudes towards epilepsy were positive, with a median score of 6.0 (IQR: 3.0-9.0). A majority, 64.7% of participants, believed that an object should be placed in the mouth during a seizure, and 33.5% were unsure whether epilepsy was contagious.

Conclusion:  Participants at the Gateway Clinic were knowledgeable and had positive attitudes towards epilepsy and seizure first aid. Nonetheless, misconceptions persist, particularly regarding harmful practices during seizures. Public education and structured training on seizure first aid remain essential to improve safety and awareness.Contribution: This study highlights the need to strengthen community awareness and education on epilepsy and seizure first aid to reduce stigma and enhance appropriate responses during seizure events.

Background:  Regional anaesthesia in emergency centres (ECs) offers clear benefits for patient care and system efficiency. However, its use in South African ECs remains inconsistent, and the knowledge, attitudes and practices of emergency doctors are not well understood. A notable gap exists in formal training.

Methods:  A cross-sectional survey was conducted among EC doctors at four district hospitals in the Metro-East health district of the Western Cape, South Africa. Data were collected via an electronic questionnaire exploring knowledge, attitudes and practices related to regional anaesthesia.

Results:  Eighty-five doctors participated (58% response rate). Among them, 67.1% had prior training in peripheral nerve blocks, predominantly informal and peer-based (98.2%), with only 8.8% receiving formal training. Most (96.5%) expressed interest in further training. Regional anaesthesia was underused: 36.5% used it less than monthly, 23.5% weekly and only 2.4% daily. Despite this, 77.6% rated it as important or very important, and 75.3% scored its usefulness ≥ 7/10. Barriers included limited confidence in managing local anaesthetic toxicity and inconsistent monitoring: 39.1% never monitored, while only 25% did so consistently. The most cited barrier (92.9%) was a lack of knowledge.

Conclusion:  Despite strong interest and favourable attitudes, regional anaesthesia remains underutilised because of limited knowledge, informal training and concerns about safety and monitoring.Contribution: This study reveals a disconnect between positive clinician attitudes and limited practical competence. It underscores the need for structured, formal educational initiatives to support safe and effective regional anaesthesia use in district ECs.

No abstract available.

Background:  Dolutegravir (DTG) became central to South Africa's (SA's) first-line human immunodeficiency virus (HIV) regimen since 2019, offering improved tolerability, fewer drug-drug interactions, and a higher resistance barrier compared to efavirenz (EFV). Concerns remain about the long-term cardiovascular, metabolic, and renal consequences of DTG-based therapy in people living with HIV (PLHIV). This study compared demographic and clinical outcomes across three groups: (1) those on tenofovir, emtricitabine and efavirenz (TEE); (2) those on tenofovir, lamivudine and dolutegravir (TLD); and (3) those switched from TEE to TLD.

Methods:  This retrospective, analytical study was conducted at an urban district hospital in KwaZulu-Natal. A sample of 212 patients was calculated using a chi-squared test for multiple proportions (80% power, 95% confidence interval). Data extracted at baseline, 6 and 12 months, were analysed with SPSS version 28.0.

Results:  There were statistically significant differences between the three groups. The Switch group showed a higher incidence of new hypertension (HT) (9.9%, p = 0.03) and chronic kidney disease (CKD) (12.1%, p = 0.01). TLD group maintained stable outcomes. TEE group had the highest incidence of newly diagnosed dyslipidaemia.

Conclusion:  DTG-based therapy remains the preferred regimen in SA, its long-term metabolic and renal impact in patients switching from EFV warrants careful surveillance. The increased rates of HT and CKD in the Switch Group emphasises the need for closer monitoring to mitigate against complications.Contribution: This research contributes to the body of evidence on DTG, highlighting its benefits and the clinical challenges of managing ageing PLHIV with multimorbidity.

New medical knowledge is being rapidly added to the existing body of scientific understanding. However, the degree to which knowledge translation and the integration of research evidence into clinical practice are aligned and implemented remains unclear. This paper aims to promote the implementation of research evidence, thereby influencing professional behaviors, patient outcomes, and health policy. The focus is on the district research outcomes to facilitate changes in practice. An analysis of the dissemination of research findings within the health district is presented. A locally designed, innovative model is introduced, and global evidence-based models are incorporated to provide further insights. We conclude by reaffirming that utilizing evidence-based tools to develop and implement clinical guidelines and policies could transform practice and enhance patient outcomes. Contribution: The article's contribution is in motivating health care workers to engage in research to expand their competencies, and promote the alignment of research findings with implementation.

Background:  Stillbirth is a profoundly personal experience shaped by sociocultural norms, healthcare systems, and policies. Limited research exists on parents' lived experiences in South Africa. This study explored socio-ecological factors influencing parents' experiences of stillbirth in Limpopo, South Africa.

Methods:  This qualitative exploratory study used in-depth interviews with 12 purposively selected parents. Interviews were conducted in Xitsonga, transcribed, translated, and thematically analysed using ATLAS.ti.

Results:  The findings revealed that parents' experiences of stillbirth were shaped by a range of interconnected factors across multiple levels of the socio-ecological framework. At the individual level, participants expressed varying understandings of stillbirth, emotional distress, self-doubt and fear of recurrence. Interpersonal relationships played a dual role, with some participants receiving strong emotional support from partners and family members, while others experiencing blame and stigma. Organisational factors included positive and negative experiences with religious institutions and healthcare services, with reports of compassionate care and critical gaps in communication and response time. Societal influences were reflected in cultural beliefs, such as Xirheti, which shaped perceptions of repeated stillbirths and contributed to stigma. At the policy level, participants not only recognised the importance of antenatal care as promoted by national guidelines but also highlighted systemic barriers such as delayed transport and limited access to timely healthcare services.

Conclusion:  Addressing the impact of stillbirth requires a multi-level approach that integrates personal, social, cultural, healthcare, and policy dimensions to support parents.Contribution: This study offers evidence to inform more family-centred and system-responsive approaches in primary and maternal healthcare.

Background:  Anaemia in pregnancy often reflects inadequate nutrition and is linked to adverse pregnancy outcomes. This study aimed to determine the prevalence of anaemia in pregnancy and the related contributing factors in the Vhembe District.

Methods:  A descriptive cross-sectional study was conducted among women attending antenatal services from April to June 2021. A total of 419 pregnant women were sampled, with data gathered from their maternity case files and a short questionnaire on medication use.

Results:  The prevalence of anaemia in pregnancy in Vhembe District was 32.2%. Of those with anaemia, 58.7% were mild, 38.4% were moderate and 2.9% were severe. Adherence to prescribed oral supplements was 96.5% for iron and 97.3% for folic acid. Reported stock out for iron and folic acid supplements was 27.2% and 30.5% respectively. The mean age of the sample was 26.7 years (SD6.2) while the median gestational age was 30 weeks (IQR 21 to 38). The median gestational age at booking was 16 weeks (IQR 10 to 21) and median parity was one child (IQR 0 to 2). Majority of pregnant women with anaemia had food insecurity.

Conclusion:  The prevalence of anaemia in pregnancy in the Vhembe District represents a moderate public health concern. This study adds to the expanding body of knowledge on maternal health by emphasizing food insecurity as a key contributing factor to anaemia in pregnancy.Contribution: The findings provide locally relevant data that can inform targeted interventions, including integrated food and nutrition support programs within antenatal care services.

Background:  Physical activity (PA) plays an important role in rehabilitation by promoting emotional well-being, functional independence, and both physical and cognitive recovery. Although its application in rehabilitation varies, both occupational therapists and speech and language therapists incorporate PA to address individualised patient needs.

Objective:  We explored the use of PA by occupational therapists and speech and language therapists in the integration of PA in treatment.

Methods:  Ten therapists participated in virtual semi-structured interviews to explore their use of PA in patient treatment. A directed content analysis guided by the International Classification of Functioning, Disability and Health (ICF) framework was employed. NVivo software facilitated the coding of data into pre-established ICF categories: body structures and functions, activities and participation, and environmental factors.

Results:  Therapists used PA to achieve endurance, strength and cognitive recovery (body structures and functions); promote engagement in meaningful tasks (activities and participation); and identify environmental barriers and facilitators, such as resource constraints and interdisciplinary collaboration (environmental factors).

Conclusion:  PA is regarded as a valuable therapeutic tool across ICF domains, with its optimal use in public sector facilities being hindered by institutional challenges, including staff shortages and limited resources.Contribution: This study contributes to the understanding of how occupational therapists and speech and language therapists integrate PA into rehabilitation, capturing practical clinical strategies aligned with the ICF framework.

Background:  Blood donation rates in sub-Saharan Africa are historically low. The coronavirus disease 2019 (COVID-19) pandemic amplified this challenge, leading to significant declines in blood donations.

Objective:  This study aimed to assess the impact of COVID-19 on blood donation and utilisation in the Mangaung Metropolitan Municipality (MMM), South Africa, between April 2018 and March 2022.

Methods:  A retrospective analytical study was conducted using data from the South African National Blood Service (SANBS) Business Intelligence System. Blood donations and product utilisation were analysed across different time periods, aligning with COVID-19-related restrictions.

Results:  A substantial decrease in blood donations was observed during the pandemic. Blood collection decreased over all age groups but was particularly notable among younger donors (aged 15-39). Conversely, blood product utilisation increased across both public and private health care sectors during the pandemic.

Conclusion:  The COVID-19 pandemic had a profound impact on blood donation and utilisation in the MMM. To address future blood shortages, strategies are needed to encourage blood donation, optimise blood product utilisation and ensure equitable access to blood services.Contribution: The study contributes to understanding the impact of COVID-19 on blood donation and utilisation patterns in sub-Saharan Africa, specifically in the MMM in South Africa.

Background:  This study investigated the perceptions and experiences of Gauteng Department of Health (GDoH) senior managers about factors that contributed to the high incidence of coronavirus disease 2019 (COVID-19) in Gauteng, the hardest hit province in South Africa.

Methods:  An exploratory qualitative study was conducted using online in-depth interviews with senior managers in Gauteng. Audio recordings were transcribed verbatim, coded and thematically analysed in NVivo 10. Data saturation was reached at 13 participants (n = 13). Findings were reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results:  Two main themes emerged from the analysis. Theme I: Perceptions of the burden of COVID-19 in Gauteng. Theme II: Key health and behavioural factors, including poor protocol adherence, exacerbated the spread of COVID-19. Economic challenges such as limited employment prospects and informal settlements, sociocultural enablers like vaccine hesitancy, social media misinformation, limited vaccine and treatment options, and environmental factors such as the OR Tambo International Airport contributed to high population density and heightened the infections and transmission of COVID-19. Governance issues, including corruption in personal protective equipment procurement and embezzlement of COVID-19 funds, undermined the GDoH response.

Conclusion:  Understanding perceptions of factors that influence disease transmission is crucial for effectively managing infectious diseases like COVID-19 and future outbreaks. Addressing infrastructure gaps in underserved communities and strengthening government regulations could help to reduce congestion in Gauteng, ultimately reducing the spread of contagious diseases.Contribution: The study presents a model for investigating and addressing the human factors that drive the transmission of infectious diseases.