South African Family Practice最新文献

Background: In South Africa, graduate rehabilitation therapists undertake a compulsory community service (CS) year in public healthcare facilities, often entering this role without sufficient competency to work independently. They rely on supervision and support, which may come from senior therapists of different disciplines. This study, conducted in KwaZulu-Natal (KZN) province, explores the experiences of rehabilitation therapists regarding cross-disciplinary supervision and support during their CS year.

Methods: A qualitative, descriptive, and exploratory design was employed. Virtual semi-structured interviews were conducted with seven purposively sampled participants from five KZN districts. Data were audio recorded, transcribed verbatim, and analysed thematically.

Results: The findings revealed four themes and ten sub-themes, highlighting the challenges and benefits of cross-disciplinary supervision, dissatisfaction with existing support structures, and recommendations for improvement. The CS therapists, as junior staff, often lacked the experience and authority to deliver optimal patient care within resource-constrained settings.

Conclusion: While discipline-specific supervision remains the preferred approach, cross-disciplinary supervision contributed positively to professional development, broadening therapists' understanding of other rehabilitation disciplines. However, the limited availability of accessible, discipline-specific supervisors remains a significant concern. Given their frequent isolation and minimal experience, CS therapists require consistent, discipline-specific support to meet service demands.Contribution: This study emphasises need to address the experiences of CS therapists, who face high patient loads and limited support, in public health sector planning. Incorporating their insights can enhance their ability to deliver essential services, ensuring better outcomes for the populations served by the public health system.

Background: Men who have sex with men (MSM) are regarded as a key population that needs specialised healthcare services to address their healthcare needs. This is because of their sexual practices. Men who have sex with men encounter positive and negative experiences when accessing healthcare services in public health care facilities. This study explored and described the experiences of MSM about accessing healthcare services in public healthcare facilities. The study was conducted in Ekurhuleni district, situated in the East of Gauteng province, South Africa.

Methods: A descriptive, explorative, qualitative approach was employed to investigate the experiences of MSM about accessing healthcare services. In-depth interviews were conducted with 17 MSM aged 18 years and above.

Results: Overall, MSM had both negative and positive experiences when accessing healthcare services. However, mainly the negative in the public healthcare facilities, whereas positive were experienced in the private healthcare facilities.

Conclusion: The negative experiences of MSM, the judgemental and discriminatory attitudes of healthcare workers towards them and the scarcity or unavailability of resources and healthcare services to address their specific healthcare needs in healthcare facilities have created interpersonal and structural barriers, which prevent MSM from accessing healthcare services.Contribution: These findings suggest the need for the training of healthcare workers to be truly caring, the allocation of resources and healthcare services to addressing MSM-specific healthcare needs in healthcare facilities and the creation of an accommodating environment for them.

Background: Cultural and religious illnesses such as spirit possessions are health conditions that are not easily understood by healthcare providers in mental healthcare service institutions. Mental health care providers' understanding is guided by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) that seems to not recognise cultural and religious illnesses as a disorder that needs distinct care. The study explored mental healthcare providers' understanding of cultural and religious illnesses that could assist spirit-possessed persons to receive proper management and early referrals to traditional health practitioners and faith healers who are expects in cultural and religious illnesses.

Methods: Hermeneutic phenomenology explored 12 mental healthcare providers' understanding of cultural and religious illnesses. In-depth individual interviews were conducted with 12 mental healthcare providers who were selected through a purposive sampling technique. Data were collected from two mental healthcare institutions in the Gauteng province of South Africa that provide mental healthcare services. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps.

Results: The findings revealed that mental healthcare providers understood cultural and religious illnesses as mental illness that is unclassified, a calling for a person to become a traditional health practitioner, a demonic spirit and/or witchcraft. The term 'unclassified disorder' denotes that there are no specific criteria that could be used to classify an illness.

Conclusion: Understanding of cultural and religious illnesses could assist mental healthcare providers that ill-nesses that do not respond to psychiatric treatment can be referred to traditional health practitioners with expert cultural and religious assessment.Contribution: The study could assist MHCPs to acknowledge and take culture and religion into account when providing care to person with cultural and religious illness. Considering the culture and religion of the spir-it-possessed person could be an attempt to move towards a holistic understanding of health needs that highlight the continuous connections between mind, body, and soul.

Background: While the Choice on Termination of Pregnancy (CTOP) Act No. 92 was legalised in 1996 permitting termination of pregnancy (TOP) to be accessed at various public health facilities in South Africa, unsafe abortions continue to take place outside of legally designated facilities. The aim of this study was to explore the knowledge, attitudes and practices of healthcare professionals regarding TOP services at public primary healthcare (PHC) centres in the central business district (CBD) of the eThekwini Municipality in KwaZulu-Natal Province, South Africa.

Methods: This quantitative, descriptive analysis used a questionnaire to obtain data from the healthcare professionals on four areas: demographic details, knowledge of (8 questions), attitudes to (10 questions) and practices (10 questions) regarding TOP services.

Results: Among the 91 participants (whose ages ranged from 32 to 48 years), 91.2% were female, 93.4% belonged to the Christian faith, 42.9% were professional nurses and 74.8% had more than 5 years' work experience. The mean of the overall knowledge, attitude and practice score was 51.7%, 67.4% and 62.8%, respectively, which indicated poor knowledge, moderate attitude and unacceptable practice.

Conclusion: While some healthcare professionals' knowledge regarding TOP services was poor, their personal beliefs may have contributed to their attitudes and practices regarding whether to assist their patients to access such services, despite it being legal.Contribution: This study provides insight into the health worker barriers that impede TOP service provision and access in the CBD of eThekwini.

No abstract available.

Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of conjunctival tumours and, while rare globally, is the most common ocular malignancy in sub-Saharan Africa. Its rising incidence, primarily driven by the human immunodeficiency virus (HIV) epidemic, presents significant challenges in clinical diagnosis, as these lesions often share characteristics with other conjunctival lesions. In South Africa, where risk factors such as HIV, human papillomavirus infection and excessive sun exposure are prevalent, primary care clinicians play a crucial role in identifying and referring cases for early intervention. Ocular surface squamous neoplasia is often the first indication of HIV in patients who are otherwise unaware of their status when they present to healthcare workers, making it essential for healthcare workers to screen for HIV and initiate antiretroviral therapy. Early recognition of at-risk patients and prompt referral of suspicious lesions are imperative to improve patient outcomes and prevent vision loss.

Background: Over years, concerning Carbapenem-resistant Enterobacterales (CRE) have advanced globally, posing a major threat to global health. Prior studies highlight previous antibiotic use and prolonged hospital stays as paramount risk factors for CRE infections. However, there are limited reports available with a focus on identifying risk factors for CRE infections by comparing CRE cases with controls. The aim is to evaluate factors associated with CRE infections among individuals admitted to hospitals in Mthatha.

Methods: A retrospective case-control study among patients who attended Nelson Mandela Academic Hospital (NMAH) and Mthatha Regional Hospital (MRH), Eastern Cape, South Africa. Demographic, medical history and current hospitalisation factors were captured on clinical research forms. GraphPad Prism version 8 software was used for statistical analysis.

Results: Out of the 226 participants with CRE infection, CRE cases were more likely than controls to be adults (51.9%, odds ratio [OR]: 1.34, 95% confidence interval [CI]: 0.72-2.55) and of male sex (54.9%, OR: 1.48, 95% CI: 0,87-2,45). Significant risk factors for CRE infections included underlying illnesses (OR: 2.55, 95% CI: 1.41-4.60, p = 0.002), urine catheterisation (OR: 5.40, 95% CI: 1.45-18.33, p = 0.01), intravascular devices (OR: 2.48, 95% CI: 1.06-6.03, p = 0.05) and prolonged hospital stay (OR: 1.87, 95% CI: 1.01-3.39, p = 0.048). CRE cases compared to controls were almost twice as likely to demise or have an extended hospital stay of more than one month. Klebsiella pneumoniae (62.6%) and Enterobacter cloacae (60.6%) were prevalent Enterobacterales associated with CRE.

Conclusion: Significant risk factors for CRE infections are underlying illnesses, urine catheterisation, intravascular devices and prolonged hospitalisation.Contribution: The complicated nature of CRE infections highlights the importance of targeted interventions to mitigate their spread and impact on public health.

Background: In resource-limited emergency settings, blood testing is crucial for diagnostics but can lead to financial strain and diagnostic challenges if used indiscriminately. This quality improvement project (QIP) aimed to identify commonly requested blood tests in an emergency department (ED), assess their appropriateness, and establish evidence-based guidelines for judicious use. This project was conducted during the family medicine rotation of interns at a tertiary hospital in a semi-urban area.

Methods: The Plan-Do-Study-Act (PDSA) method was employed. Pre- and post-intervention data were collected. An educational intervention, featuring informative visual aids was implemented to help guide the medical practitioners in the unit on appropriate blood test ordering.

Results: The intervention led to a significant 48.7% reduction in total daily blood tests ordered, with a notable decrease in full-panel requests and an increase in individual test ordering.

Conclusion: Educational interventions, aimed at guiding blood test requests, can significantly reduce unnecessary testing. Long-term data collection is necessary to confirm sustained changes in practice.Contribution: Our findings indicate that clear, evidence-based guidelines for the judicious use of blood tests can positively impact test ordering, particularly in resource-limited settings, and suggest opportunities for further long-term studies.

This article provides information on the reasons for inserting an arterial line, how to insert this line, the equipment required to insert an arterial line, and the possible complications that may arise from this procedure. It is hoped this information will guide primary care practitioners working in the South African environment and increase their confidence for inserting arterial lines.