Health SA Gesondheid最新文献

Background: Pre-exposure prophylaxis (PrEP) lowers new human immunodeficiency virus (HIV) infections among individuals at risk; however, its uptake in South Africa is hindered by resource limitations within public health facilities. This occurs despite the established PrEP guidelines to promote its use.

Aim: This study aimed to explore the availability of resources that support nurses in implementing the PrEP guidelines in Johannesburg's primary health settings.

Setting: Four primary healthcare settings in sub-districts A and E of the City of Johannesburg, South Africa, were used to conduct the study.

Methods: A qualitative exploratory design with an interpretive approach was used to gather insights into the availability of resources for implementation of PrEP guidelines. Donabedian's framework was used to assess implementing PrEP guidelines looking at the structure, process and outcomes linked to resource availability. Data were gathered from 19 nurses in four primary healthcare facilities via semi-structured interviews and analysed using the thematic analysis method.

Results: Three overarching themes emerged as barriers to effective PrEP implementation: (1) structural inadequacies; (2) healthcare system processes and support; and (3) unclear performance tracking. Both barriers and facilitators were identified to have an impact on the implementation of PrEP while highlighting the need for the strengthening of the healthcare system in HIV prevention success.

Conclusion: The study highlights critical resource limitations hindering PrEP implementation. It underlines the urgent need for improved physical infrastructure, additional human resources and robust data management systems.

Contribution: The study emphasises the need for policymakers to strengthen infrastructure and human resources to minimise service delays and inefficiencies, ultimately reducing healthcare costs by enhancing PrEP uptake and retention.

Background: Quality theoretical assessments in nursing education are essential for achieving Sustainable Development Goal 4 (ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all). However, misalignment with National Qualification Framework (NQF) standards, an overreliance on recall-based questions and inadequate educator training undermine the fairness of assessments and students' ability to demonstrate clinical competence.

Aim: This study explores theoretical assessment design in nursing education, evaluating its alignment with NQF standards, competency-based assessments and Sustainable Development Goal 4.

Setting: Conducted at a South African nursing school offering undergraduate nursing programmes.

Methods: A multimethod approach integrated educator interviews, document reviews of moderation reports, a scoping review and a student survey to investigate assessment practices.

Results: While educators valued Bloom's Taxonomy, over-reliance on recall-based questions limited critical thinking, clinical decision-making and competency development. Misalignment with NQF standards caused inconsistencies in cognitive demand, while gaps in moderation processes impacted assessment validity and fairness. Educators faced challenges because of limited training and support, and students struggled with ambiguous and linguistically complex assessments that hindered their ability to demonstrate competency.

Conclusion: Strengthening assessment design, moderation and educator training is essential to improving competency-based assessment practices in nursing education. Policy reforms promoting fair, transparent, and competency-driven assessments will enhance graduate preparedness, ensure alignment with NQF standards and support SDG 4's goal of quality education.

Contribution: This study provides empirical evidence supporting assessment policy improvements, promoting structured, competency-based assessments that enhance fairness, deepen learning and align with nursing education standards.

Background: Ensuring assessment quality in nursing education is crucial for preparing graduates for healthcare demands, particularly in South Africa, where healthcare systems face challenges. Moderation serves as a quality assurance tool, yet its effectiveness remains underexplored.

Aim: To review moderation reports on final theoretical assessments of nursing modules in the R425 Bachelor of Nursing programme.

Setting: A higher education institution (HEI) in the Western Cape, South Africa.

Methods: A qualitative exploratory descriptive study analysed 70 moderation reports (2015-2019) using a structured data extraction tool and content analysis.

Results: One main theme emerged, quality assurance in assessment design, with five categories: standard of questions and alignment with Bloom's Taxonomy and NQF levels; linguistic presentation and clarity of questions; clarity of instructions to students; duration and mark allocation; and attainment of module outcomes.

Conclusion: The study revealed persistent gaps in assessment quality, including misalignment with cognitive levels, unclear instructions, inconsistent mark allocation, and limited outcome alignment. These findings reinforce the need for robust moderation processes to support fair, valid, and reliable assessments. Recommendations include strengthening assessor training, implementing structured moderation frameworks, and improving documentation.

Contribution: This study highlights the critical role of quality assurance in final theoretical assessments by identifying recurring issues in assessment design and moderation. It offers practical insights to enhance assessment integrity and ensure alignment with educational standards.

Background: People in South Africa have been diagnosed with malaria, including those coming from other countries. Malaria is still life-threatening, and people are still being diagnosed even after preventive measures have been developed.

Aim: The study's purpose was to determine the post-discharge experiences of people diagnosed with malaria at Mhinga village of Vhembe district, Limpopo province.

Setting: The setting was at the participants' homes at Mhinga village, Collins Chabane Municipality, Vhembe district, Limpopo.

Methods: An exploratory, descriptive and contextual qualitative method was employed to attain a comprehensive understanding of the phenomenon. Audio recordings of semi-structured interviews focused on the post-discharge experiences of malaria patients in Mhinga village, Vhembe district, Limpopo, with participants selected through purposive sampling. Qualitative theme analysis was performed utilising codes, while adhering to trustworthiness and ethical considerations.

Results: Two themes emerged: post-discharge experiences from Mhinga clinic and post-discharge experiences from the hospital. The findings described and expressed the post-discharge experiences of people diagnosed with malaria at Mhinga village, Vhembe district, which included complicated symptoms experienced after discharge from the Mhinga clinic and the transfer to Malamulele hospital.

Conclusion: The study has concluded that the participants had experienced complicated symptoms of malaria even after obtaining treatment from the clinic and hospital.

Contribution: This study highlights the potential reduction of admissions to the Limpopo Province Department of Health by increasing awareness of malaria prevention methods. It suggests strategies to combat malaria, such as enhancing surveillance systems, implementing vector control measures, conducting public awareness campaigns, equipping healthcare facilities, reducing mosquito breeding sites and collaborating with neighbouring regions for cross-border efforts.

Background: Epidermolysis bullosa (EB) is a rare, incurable inherited mucocutaneous blistering disorder that can lead to multisystemic complications. In Africa, there are no established consensus statements or clinical guidelines for the care of patients with EB.

Aim: To develop comprehensive transdisciplinary consensus statements for the care of patients with EB. This article (Part 2) presents 24 consensus statements focused on the biopsychosocial aspects of EB care. Part 1 addressed diagnostic and clinical management and resulted in 16 consensus statements.

Setting: This was a multicentre, multiprovincial study involving healthcare practitioners from Eastern Cape, Free State, Gauteng, KwaZulu-Natal and Western Cape.

Methods: In collaboration with patients and families, the transdisciplinary team of experts developed consensus-based statements through a modified Delphi process. This iterative process involved three consensus rounds with an 80% agreement threshold for each action point to ensure validity and reliability.

Results: In total, 24 consensus statements were endorsed. These included holistic patient and family care; cultural considerations; educational inclusion; paediatric and emergency care; psychosocial care; nutritional; gynaecological and ophthalmic support; occupational therapy; physiotherapy and orthopaedic; dental and podiatric management.

Conclusion: Comprehensive transdisciplinary care is essential for addressing the holistic needs of patients with EB and their families, particularly in resource-limited and culturally diverse settings.

Contribution: This is the first set of consensus statements for the care of EB in South Africa and the broader African continent, offering a culturally sensitive, patient-centred framework for multidisciplinary care.

Background: Epidermolysis bullosa (EB) is a rare, painful and blistering genodermatosis with no cure. Treatment aims to prevent new lesions and manage complications. Previously, there were no management guidelines or consensus recommendations for patients with EB in Africa.

Aim: The aim of this study is to produce a comprehensive, transdisciplinary and practical care guide that is contextually appropriate to the cultural setting and resource limitations in South Africa.

Setting: Multicentre, multiprovincial study involving healthcare practitioners from five South African provinces - KwaZulu-Natal, Gauteng (Johannesburg, Pretoria), Western Cape (Cape Town, Stellenbosch), Free State (Bloemfontein) and the Eastern Cape (Umtata).

Methods: Consensus recommendations for the care of patients with EB were developed by a transdisciplinary team of specialists in consultation with EB patients. The modified Delphi technique was used to reach a robust consensus with a threshold of 80% for each action point to ensure the validity and reliability of the recommendations.

Results: In all, 16 consensus statements were developed, and the main themes included the clinical clues to the diagnosis, complications as per the subtype of EB, diagnostics in a resource-limited environment, management of EB, pruritus and pain, palliative care and genetic counselling.

Conclusion: A transdisciplinary approach is essential for the holistic care of patients and their families with EB in the context of their resource limitations and cultural diversity providing much-needed guidance for clinicians in South Africa and similar settings.

Contribution: This is the first consensus recommendation of care for patients with EB in Africa.

Background: Obesity is a major contributor to non-communicable diseases (NCDs) and is rising in socioeconomically disadvantaged communities with limited health literacy and access to nutritious food. Namibia, like many African countries, faces increasing obesity rates because of dietary and lifestyle transitions. Community-based screening is essential for early identification and prevention.

Aim: This study aimed to determine the prevalence of obesity among community members in Otjomuise, Namibia.

Setting: The study was conducted at a community health care clinic in Otjomuise, Namibia.

Methods: A cross-sectional, descriptive study was conducted with 335 adults. Body mass index (BMI) was calculated and classified according to Centers for Disease Control and Prevention (CDC) categories: underweight, healthy weight, overweight, or obese.

Results: Of the 335 participants, 67.2% (n = 225) were female and 32.8% (n = 110) male. Overall, 9.3% (n = 31) were underweight, 48.7% (n = 163) had a healthy weight, 26.6% (n = 89) were overweight, and 16.7% (n = 56) were obese. Mean BMI was 22.92 ± 4.64 kg/m² for males and 26.76 ± 6.28 kg/m² for females.

Conclusion: Less than half of the participants had a healthy BMI, with notable overweight and obesity prevalence, particularly among women. These findings align with regional and global trends and underscore the need for targeted public health strategies.

Contribution: This study provides updated obesity data for Namibia and supports community-based screening as a tool for surveillance and intervention. It highlights the importance of multisectoral approaches promoting diet, physical activity, and health education to reduce NCD risk.

Background: The National Health Insurance (NHI) Act 20 of 2023 aims for universal health coverage. However, rehabilitation professions, especially physiotherapy, had limited involvement during key phases of NHI policy development, including the Green and White Papers, pilot projects, and the NHI Bill. President Cyril Ramaphosa enacted the NHI Bill in May 2024.

Aim: To assess South African physiotherapists' perceptions and attitudes towards NHI, focusing on their perception of its objectives and implications for their profession.

Setting: An online survey was conducted among 146 South African physiotherapists.

Methods: A quantitative, non-experimental online survey was used.

Results: The data analysis revealed significant demographic influences on perceptions regarding NHI. Gender, age and professional experience played a role in shaping responses. Male physiotherapists were more likely than their female counterparts to perceive NHI as a means of addressing past healthcare disparities and increasing universal coverage. Professional experience and qualifications also played a crucial role, with distinct perspectives based on respondents' qualifications. Age influenced opinions on the impact of NHI on physiotherapists in private practice, with younger physiotherapists perceiving more negative impacts compared to older colleagues.

Conclusion: Physiotherapists acknowledge NHI's potential to address healthcare disparities, but express concerns about its implementation and impact. They advocate for more inclusive policymaking, better communication, and improved strategies to ensure NHI meets diverse healthcare needs nationwide.

Contribution: Developing demographic-sensitive strategies and addressing resource allocation and infrastructure challenges are crucial to implementing NHI effectively.

Background: Surgical site infection (SSI) is a prevalent healthcare-associated infection worldwide, defined as any incisional infection occurring within 30 days post-operation or within 1 year in the presence of an implant. Healthcare-associated infections represent a significant threat to patient health and continue to pose a major global challenge.

Aim: This study aims to determine the prevalence of SSI and identify associated factors among patients in surgical wards who have undergone surgical procedures in Windhoek, Namibia.

Setting: This study was conducted in two state hospitals in Windhoek, Namibia.

Methods: This study employed a quantitative, hospital-based cross-sectional design, utilising a retrospective chart review of patients who underwent surgical procedures between March 2019 and February 2021.

Results: The overall prevalence of SSI was 10.1% (95% confidence interval: 8.4% - 11.8%). Hospitals 1 and 2 had a prevalence of 11.5% and 8.7%, respectively. Factors associated with SSIs were found to be age groups 31-60 years, male patients, postoperative hospital stays ≥ 5 days, emergency surgery, abdominal and lower extremity surgeries, operation referred from other hospitals, previous history of surgery, 1 h-2 h duration of surgery and deceased patients. Diabetes mellitus, HIV/AIDS, cancer, malignancy and multiple comorbidities were also noted to increase the risk of SSIs.

Conclusion: The prevalence of SSI in this study remains high, and therefore, context-based interventions should focus on the factors identified to guide the effective management of patients.

Contribution: This study provides evidence to improve surgical site infections in Namibia.