South African Family Practice最新文献

This article focusses on teaching medical students qualitative research in a practical setting of a study about sexual health. Insufficient training, research deviating from the proposal and context-related factors contributed to compromising trustworthiness of the study. The article provides a background to the study and reflects on factors that contributed to the breach of research integrity after the research supervisor questioned the credibility of findings. A semi-structured interview schedule was used, and data analysis exposed flaws. The team used Jasper's reflective cycle to change a crisis into a learning opportunity. The action plan triggered round two of data collection, followed by another reflective cycle.Contribution: The supervision role and student knowledge and attitude contributed to the undergraduate research project. Until a research report is submitted or data published, researchers can learn from the process to produce reliable results and rigorous ethical research.

Background:  Adherence to chronic medication is crucial for managing chronic diseases and preventing complications. However, maintaining consistent adherence remains challenging, particularly in low- and middle-income countries where forgetfulness is a common barrier. The widespread use of mobile phones, even in resource-limited settings, offers a practical opportunity to leverage inbuilt reminder features to support medication adherence. This study evaluates the effectiveness of inbuilt cell phone reminders in enhancing chronic medication compliance among patients in the eThekwini health district of KwaZulu-Natal, South Africa.

Methods:  In this prospective, cross-sectional study, 400 patients on chronic medications were systematically selected from five healthcare centres. Participants were divided into two groups: those using mobile phone reminders (Group 1) and those who did not (Group 2). Medication adherence was assessed using a standardised questionnaire, and statistical analyses, including Chi-square tests and logistic regression, were conducted to identify differences in adherence rates.

Results:  Group 1 exhibited significantly higher adherence rates (87%) compared to Group 2 (67%, p  0.001). The use of cell phone reminders was associated with a 2.5-fold increase in the odds of adherence (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.7-3.6, p  0.001).

Conclusion:  Inbuilt cell phone reminders are a cost-effective intervention that significantly enhances medication adherence, especially in resource-limited settings. Integrating mobile technologies into public health strategies could improve chronic disease management.Contribution: This study highlights the potential of mobile phone reminders as a practical tool for improving medication adherence, with significant implications for public health strategies in low-resource settings.

Background:  Quality rehabilitation services are limited in rural South African areas, such as KwaZulu-Natal (KZN). Public-private partnerships (PPPs) are increasingly valued as an effective model for public health delivery in developing countries; yet, their application in South Africa's rehabilitation sector, especially with the upcoming National Health Insurance (NHI) for universal health coverage, remains unclear. This study examined perspectives on using PPPs for rehabilitation services within the District Health System in KZN in preparation for the NHI.

Methods:  A qualitative study in eThekwini, Amajuba and King Cetshwayo districts of KZN included 57 participants, selected through purposive sampling. Participants were rehabilitation practitioners, managers and social development representatives. Data were collected via focus groups and interviews and analysed using thematic analysis.

Results:  Participants noted that the NHI's strategy of incorporating the private sector is designed to alleviate government pressure and provide financial incentives. Challenges mentioned include service availability, patient care and tariff disputes. Discrepancies between public and private sectors and the private sector's financial sensitivities pose significant challenges to NHI implementation. A knowledge gap exists regarding the role of PPPs in the NHI context for rehabilitation services. Practitioners emphasised the necessity of adequate government funding for private sector partnerships to strengthen public health infrastructure.

Conclusion:  Stakeholders express varied views on PPPs for rehabilitation, highlighting the need for clear guidelines and funding support as South Africa nears NHI implementation.Contribution: This study provides insights into stakeholders' views on PPPs for rehabilitation, identifying key benefits and challenges to inform effective NHI-aligned implementation strategies.

Background:  Maternal and perinatal deaths remain significant despite various strategies that have been implemented. Antenatal care (ANC) for pregnant women is crucial in reducing maternal and child mortality. Delayed ANC is associated with several maternal and foetal complications, which can be prevented through timely intervention. Previous studies have identified various factors contributing to the late initiation of ANC, and although recommendations have been made and implemented, there has been no impact. Objectives were to determine and rank the factors contributing to the delayed initiation of ANC among pregnant women attending a community health centre in the Tembisa township and to explore potential strategies for the early initiation of ANC.

Methods:  A cross-sectional survey was conducted using a validated questionnaire on pregnant women attending their first ANC after 20 weeks of gestation.

Results:  Multiple variables affecting the early initiation of ANC were identified, namely healthcare workers' behaviour, negative attitude, operational management factors and participants' socio-economic standing. Staff counselling, support and training in holistic maternal healthcare, as well as accurate, uniform and consistent health educational information that recognises and addresses cultural beliefs, could encourage early initiation of ANC.

Conclusion:  Staff empowerment and support for maternal health care through wellness services are crucial. Clinic operational management should adopt best practices to address prolonged time spent accessing services. Relevant health educational information for change should be provided.Contribution: The study's findings offer insights into the factors that delay the timely initiation of ANC and strategies to mitigate these delays.

Accurate arterial blood gas (ABG) interpretation is essential for primary care providers (PCPs), especially in emergency and inpatient settings where timely, informed decisions can significantly impact patient outcomes. This review guides PCPs from basic to advanced interpretation through a systematic five-step approach for ABG analysis, focussing on oxygenation, pH status, and metabolic and respiratory disorders. Emphasising the recognition of complex acid-base disorders that may coexist even when pH appears normal, it incorporates tools such as delta and osmolar gap calculations to address multiple concurrent metabolic disturbances and clarify the interpretation of mixed acid-base conditions. The article also briefly considers the use of arterial and venous blood samples in clinical practice.

Background:  Falls among older adults are a major public health issue. In South Africa, where the elderly population is expected to quadruple within the next three decades, fall prevention is critical.

Methods:  This study evaluated South African audiologists' perceived knowledge, views and reported practices regarding fall risk screening (FRS) in older adults. A quantitative online survey was conducted using an adapted questionnaire designed to assess various aspects of FRS practice. Data were analysed using descriptive and inferential statistics.

Results:  The survey received responses from 106 audiologists. Most respondents reported using familiar tools, such as case history and vestibular assessments, to conduct FRS, with fewer utilising functional balance measures. Only 11% of audiologists reported prior knowledge of FRS, while 69% - 74% perceived their knowledge as insufficient to screen or counsel older adults. While 58% recognised FRS as part of the audiologist's scope, only 21% felt comfortable conducting it. Key barriers included insufficient training (80%) and time constraints (48%). Despite this, 98% expressed interest in learning about FRS and 90% believed FRS could enhance the profession.

Conclusion:  The findings underscore the need for improved clinical guidelines, educational initiatives and practice standards to better equip audiologists in fall prevention efforts and a collaborative approach to fall risk management for older adults.Contribution: This study emphasises the importance of incorporating FRS into undergraduate audiology curricula and continuous professional development programmes and encourages the use of a biopsychosocial approach and collaboration among multidisciplinary teams in fall risk management for older adults.

Background:  In March 2024, the National Institute for Communicable Diseases (NICD) warned against a respiratory syncytial virus (RSV) outbreak during the pre-flu season, 2024. Globally, RSV is responsible for most respiratory infections in young children. Since April 2024, we have noticed a more severe presentation of children with bronchiolitis at the National District Hospital, Bloemfontein. We aimed to investigate the causative organism/s and the appropriateness of the treatment guidelines in our setting.

Methods:  A retrospective file review was carried out as part of the normal audit process. All children admitted with bronchiolitis during the 4-week study period were included in the case series. Ethical approval was obtained from relevant authorities.

Results:  Ten children ≤ 12 months presented with bronchiolitis symptoms. The Modified Tal Score was measured, with values between 8 and 12, indicating moderate and severe bronchiolitis in all cases. The demographics regarding gender, nutrition and vaccination status did not differ from previous years. Influenza A was identified in 60% of the cases, with RSV in only 20% of the cases. All the children responded well to symptomatic treatment and recovered.

Conclusion:  Most bronchiolitis cases were caused not by the predicted RSV outbreak but by Influenza A.Contribution: Despite presenting with severe symptoms, all the children responded to symptomatic treatment as set out in our guidelines.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations for the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series aims to help family medicine registrars prepare for this examination.