Health SA Gesondheid最新文献

Background: Despite the increased funding and advancements in providing public health services, the health system continues to be challenged by the high prevalence of diseases.

Aim: The objective of this study is to review health sector financing in South Africa by highlighting causes for spending pressures in the health system. The study setting comprised the National Department of Health in Pretoria.

Method: The study employs a qualitative approach by reviewing the literature on healthcare financing and expenditure in South Africa through the analysis of multiple electronic database searches to provide insight into trends and behaviour of health care budgets, expenditure, and health financing indicators.

Results: Health financing indicators reveal that South Africa's real health budgets have increased over the past years. However, the increase has barely kept pace with population growth rates. Also, the analysis of the consumer price index (CPI) and medical inflation shows that the costs for medicines and other consumables have, over time, remained significantly above the normal consumer inflation.

Conclusion: The rising trend in population growth and life expectancy rates suggests that health care funding will need to rise considerably in the next decade as individuals live longer and are anticipated to be given unrestricted access to public health services.

Contribution: This study deepens the comprehension that, while reforms in the health sector and mobilisation of additional resources are essential for tackling disparities and access to health care, it is also crucial to examine and improve the efficiencies in the utilisation of these resources.

Background: Providing palliative care (PC) is an ethical obligation, and health systems must ensure access for all patients with life-limiting and life-threatening conditions. South Africa's National Policy Framework and Strategy for Palliative Care mandates integration into public services.

Aim: To assess integration of PC services, previously neglected, before and 2 years after policy implementation.

Setting: South Africa's Cape Metro District.

Methods: A cross-sectional descriptive study compared baseline (March 2019-June 2019) and follow-up (March 2021-June 2021) via desktop and document review. Fifteen documents and quantitative changes in deidentified morphine use, as a tracer for outpatient PC pain control, and International Classification of Diseases (ICD)-10 coding, as a proxy for PC service availability, were reviewed. Other key measures included financing (number of beds, funding per bed), planning and service delivery (care pathways, referral process).

Results: Palliative care was partially integrated into primary care. Indicators of policy adoption included an increased number of PC beds in intermediate care facilities, significant growth in healthcare professionals trained in PC and increased morphine usage in some sub-districts. However, integration remained uneven across the district.

Conclusion: Integrating PC into an already overburdened health system is challenging. Further integration of PC is needed, together with training tailored for diverse professionals. Effective practices in some subdistricts of the region, such as optimised morphine prescribing and streamlined referral pathways, could serve as models for subdistricts where integration is less advanced.

Contribution: The study documents positive changes following policy implementation and underscores the importance of strong project management and resource mobilisation for successful integration of complex services like PC.

Background: Adolescents living with HIV continue to experience poorer treatment outcomes than adults, with consistently lower rates of adherence and viral load (VL) suppression. This population faces unique developmental, social and emotional challenges that heighten their vulnerability.

Aim: This study aimed to explore the psychosocial determinants influencing VL suppression among adolescents living with HIV (ALHIV) in Mpumalanga province, South Africa, by applying the Social Action Theory (SAT).

Setting: The study was conducted at Mpumalanga province in South Africa.

Method: An explorative, descriptive qualitative design was used, and data were collected from September to November 2023. Data were collected through in-depth interviews using a semi-structured interview guide in a local language. Nineteen participants were interviewed. Thematic analysis was employed, and the theory of social action; context influences, process of social and self-change and states of action were followed to orient the findings.

Results: Six major themes, structured according to the SAT constructs, emerged, namely: Stigma and emotional distress hindering adherence and socio-environmental barriers to treatment consistency; Family and peer support promoting motivation for adherence and developing self-awareness and coping mechanisms; and lastly, Acceptance and responsibility towards treatment and formation of health-protective routines.

Conclusion: Adolescents who understand HIV diagnosis and understand the benefit of antiretroviral treatment are actively engaged in targeted behaviour and are influenced by beliefs about their abilities and potential outcomes rather than passively driven by external forces.

Contribution: There is a need for psychosocial support and monitoring from family members to help adolescents achieve the suppression of VL and to ensure adherence with antiretroviral therapy.

Background: Polypharmacy is a significant and persistent issue that hinders patient treatment plans and outcomes. It is associated with a wide range of harmful outcomes, including adverse drug interactions, increased morbidity and even mortality rates. The dire effects of polypharmacy have been associated with increased medication errors, hospitalisations, early readmissions and healthcare costs. Despite the extensive documentation and public awareness of these risks, little has been done to address the problem effectively. Deprescribing serves as a valuable strategy to mitigate and prevent the negative consequences associated with polypharmacy.

Aim: The study sought to explore and describe prescriber's understanding and experiences regarding deprescribing of polypharmacy.

Settings: The study was conducted at district hospitals in Gauteng province.

Methods: A qualitative, descriptive, exploratory and contextual research approach and design was applied in the research. Non-probability purposive sampling techniques were used to select prescribers. Eight steps of data analysis were followed to analyse the data.

Results: Three themes and nine sub-themes emerged from the study: (1) Negative effects of the impact of polypharmacy (the negative impact on the patients, the impact on prescribers and the impact on the organisation), (2) factors that hinder the deprescribing of polypharmacy (prescriber-related factors, patient-related factors, complexity of the prescribing environment and deficiencies in organisations) and (3) measures that can enhance deprescribing of polypharmacy (holistic systems for the deprescribing of polypharmacy and promotion of awareness and education).

Conclusion: This study concluded that prescribers currently believe deprescribing is a complicated process, and few of them actually engage with it. Deprescribing is a safe and effective way to manage inappropriate polypharmacy. This study recommended that improved interdisciplinary and multidisciplinary approaches among health practitioners be introduced to encourage deprescribing, which will avert polypharmacy in the district hospitals.

Contribution: The research findings provide insight, create awareness and encourage safe, rational and judicious prescribing practices among authorised prescribers in district hospitals in Gauteng province.

Background: Cardiotocography (CTG) is a globally used intrapartum monitoring tool to assess the foetal heart rate and the related responses to the physiology of the uterine action. The intrapartum foetal monitoring is the primary responsibility of the midwives caring for the woman in labour. Midwives' knowledge and understanding of CTG traces and interpretation ensure timely responses to pathological findings, thus ensuring positive foetal and neonatal outcomes.

Aim: The study aimed to assess the midwives' knowledge of cardiotocograph interpretation and documentation in a selected hospital in Gauteng.

Setting: The data were collected in a selected secondary hospital, a referral hospital for the midwife-led obstetric units and district hospitals in the Gauteng province.

Methods: The study employed a quantitative retrospective research design, utilising a checklist to analyse patients' past medical records - this retrospective analysis aimed to evaluate midwives' knowledge in interpreting CTG.

Results: A review of 336 CTG case records analysed five criteria: baseline heart rate, variability, decelerations, accelerations, and overall trace assessment. Significant discrepancies in record-keeping were found between midwives and researchers. Researchers maintained complete records and interpretations for all criteria, whereas midwives exhibited considerable gaps, ranging from 31% to 100% across the CTG criteria.

Conclusion: Analysis indicates a substantial gap in CTG documentation by midwives compared to researchers.

Contribution: Midwives exhibiting significant data omissions that may affect intrapartum care quality and clinical decisions.

Background: Radiographers are regarded as essential healthcare workers. Therefore, knowledge and training regarding infection control are vital to minimise the potential risk of infections to patients.

Aim: The aim of the study was to investigate the self-perceived knowledge of infection control among qualified radiographers and diagnostic radiography students.

Setting: The study was conducted in three public sector radiology departments during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A quantitative questionnaire was completed by 106 participants comprising radiographers and students of diagnostic radiography. Data were analysed using SAS version 9.4. The Wilcoxon two-sample and Kruskal-Wallis tests were performed to calculate the difference between the median values and to determine the significant differences between the experience, training cycle of infection knowledge, and knowledge of the participants.

Results: Only 30.2% (n = 32) of the participants knew that hands are the most basic mode of transmitting infections, while 98.1% (n = 104) knew that long fingernails harbour microbes. The participants' knowledge of infection control was low to adequate. They rated themselves as having adequate to excellent knowledge about infection control. However, their median score was 60% which demonstrates an adequate level of knowledge. No significant relationship was noted between training and knowledge nor between the years of experience and knowledge.

Conclusion: Considering the findings, radiographers' and student radiographers' knowledge of infection control requires improvement. An infection control audit accompanied by in-service training on infection control might encourage radiographers to comply with infection control guidelines and enhance their knowledge.

Contribution: While infection control has been widely studied, fewer studies focus specifically on diagnostic radiography students and radiographers, despite their direct patient contact and exposure to infection risks. The study provides much-needed data for this under-researched group.

Background: Learner substance abuse is a global public health concern contributing to preventable injuries, poor academic performance, and increased dropout rates. Addressing it in schools is crucial for improving both educational and health outcomes.

Aim: This study explores high school educators' perceptions and experiences of learner substance abuse.

Setting: The study was conducted in six high schools in Galeshewe Township, Northern Cape province.

Methods: A qualitative, exploratory and descriptive approach was employed. Sixteen Life Orientation (LO) educators were purposively sampled for in-depth interviews. Data were collected using a semi-structured guide until saturation. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability. Thematic analysis followed Braun and Clarke's six-step process, with transcription via Microsoft Word and Excel.

Results: Four themes emerged: factors driving learner substance abuse, educational disruptions, educator training and support, and intervention strategies. Educators reported substance abuse as common both in school and off-premises especially among older boys. They also observed an increasing trend among younger learners and girls. It was linked to disruptive behaviour affecting teaching and learning. Educators felt unprepared to manage these issues and criticised the LO curriculum's limitations.

Conclusion: Educators emphasised the need for specialised training programmes to equip them with skills to manage learners involved in substance abuse. They also called for greater support from leadership in the Department of Education.

Contribution: The study's findings highlight the challenges of learner substance abuse in the Northern Cape and provide context-specific interventions that can be used to inform policy that addresses substance abuse in schools.

Background: Climate change is an increasingly global issue with significant adverse impacts on public health. Its effects can lead to an increase in ocular health problems and diseases.

Aim: To determine the knowledge and perception among final-year students registered in the School of Health and Rehabilitation Sciences at the University of the Free State Bloemfontein, on the impact of climate change on eye health.

Setting: The study was conducted at the University of the Free State, Bloemfontein campus.

Methods: A descriptive study was carried out using a self-administered questionnaire. Responses were collected during June 2024 and July 2024, and the results were analysed using descriptive statistics using SAS version 15.2.

Results: A total of 107 final-year health science students participated in the study, with a response rate of 85.60%. The study found a high level of awareness about climate change, with 99.07% (n = 106) acknowledging its occurrence. However, 64.49% (n = 69) of the participants felt they were not well informed about climate change issues, while 35.51% (n = 38) felt adequately informed. In addition, 93.46% of participants believed that protecting their eyes outdoors can reduce the risk of climate change-related eye health issues.

Conclusion: The study highlights the varying levels of knowledge among future healthcare professionals, emphasising the need for enhanced educational initiatives to bridge gaps in understanding.

Contribution: This study adds to the broader public health conversation by highlighting the connection between specific environmental changes and eye health. It calls for detailed approaches to reduce the negative impacts of climate change on eye health.

Background: The global call for nursing education transformation is gaining momentum. South Africa's R171 nursing programme, revised since 1984, aims to produce generalist nurse practitioners with required competencies. This research aims to explore nurse educators' experiences in implementing the R171 nursing programme.

Aim: To explore the experiences of nurse educators implementing R171 work-integrated learning (WIL).

Setting: The interviews took place at a nursing college in a private room with no interruptions. Unstructured interviews were used.

Methods: The study utilised a qualitative descriptive phenomenological design to investigate the experiences of nurse educators implementing the R171 nursing programme. The participants were selected through non-probability purposive sampling from the Gauteng College of Nursing (GCON) campuses. The sample size was determined by data saturation. Data were collected through unstructured interviews.

Results: The study identifies five themes: WIL allocation in the R171 nursing programme, challenges faced by nurse educators, consequences of these challenges, identified strengths and recommendations made by these educators for implementing the R171 WIL programme.

Conclusion: The study revealed challenges in student nurse placements, including access to clinical practice areas, discipline time, assessments, staff shortage and resource limitations.

Contribution: The study recommends revising the R171 programme, phasing it out over a year, increasing WIL hours, starting the primary healthcare (PHC) module in the second year, improving infrastructure and re-establishing the Clinical Education and Training Unit (CETU).

Background: Intimate examinations are vital in midwifery, but without proper care and communication, they can cause distress, especially for first-time pregnant women. A holistic approach that addresses physical, emotional, social, psychological and spiritual needs is essential for ensuring comprehensive and compassionate care.

Aim: To review existing literature on holistic perinatal care during intimate examinations.

Method: An integrative review was conducted across relevant databases, which included Google Scholar, PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Elton Bryson Stephens Company (EBSCO) host to identify original research articles published in English between 2014 and 2024. In total, 67 articles which met the inclusion criteria were reviewed: 32 were international, 30 were from sub-Saharan Africa and 5 were from South Africa.

Results: This study highlights two key aspects of holistic perinatal care during intimate examinations: biological and psychosocial. These aspects include health education, informed consent, decision-making involvement, emotional support, communication, counselling, social support, cultural competence and infection prevention to enhance women-centred care.

Conclusion: Most studies focus on pregnancy-related interventions rather than holistic perinatal care during intimate examinations, and there are no maternity guidelines for such examinations in Africa. This review highlights the need for further research and outlines the biological, psychosocial and ethical considerations for improving perinatal care.

Contribution: This study highlights the importance of holistic perinatal care during intimate examinations, emphasising biological, psychological and social aspects to enhance women's experiences. It identifies gaps in maternity guidelines, particularly in Africa, and calls for further research to ensure comprehensive, women-centred care.