African Journal of Primary Health Care & Family Medicine最新文献

Background:  Young women living with disabilities in Botswana face significant challenges in accessing reproductive health services, including modern contraceptive methods, yet their unique needs and barriers to uptake remain underexplored.

Aim:  The aim of this study is to assess the knowledge, attitudes and factors associated with the uptake of modern contraceptive methods among young women living with disabilities in Botswana.

Setting:  This study was conducted in eight districts in Botswana, within organisations that offer services to people living with disabilities.

Methods:  This cross-sectional study was conducted among young women (10-30 years) living with disabilities, recruited through non-probability purposive sampling from disability service organisations. Using an interviewer administered tool, data collected was analysed using STATA 15.

Results:  Among the 349 participants, the pattern of disabilities were deaf or hard of hearing (36.68%), physical disability (30.09%) and albinism (1.43%). The majority (71.6%) were aware of contraceptive methods, and 69.6% received information from health personnel. Of those, 60.4% knew oral pills, and 81.6% linked modern contraceptives to preventing sexually transmitted infections. About 38.3% reported using modern contraceptives, mainly male condoms. Stigmatisation fears emerged as a significant barrier (36.0%).

Conclusion:  Knowledge, gaps and unfavourable attitudes towards contraception were evident suggesting a need for interventions to meet needs of young people living with disabilities.Contribution: The study provides critical insights into the knowledge, attitudes and barriers affecting the use of modern contraceptives among young women living with disabilies in Botswana, offering evidence to inform more inclusive healthcare policies and programmes.

Background:  In South Africa, oral diseases are a significant public health concern. The Western Cape has a high prevalence of dental caries, with rates increasing from 82% to 84% in 6-year-olds over a 13-year period. This study explored the experiences of oral hygienists, children and their parents to generate insights that can inform the design of a new approach to oral health promotion (OHP).

Aim:  This exploratory descriptive qualitative study was conducted within an interpretivist paradigm using semi-structured individual interviews with three groups of participants: oral hygienists, children aged 8-12 years and their parents.

Setting:  The study was conducted at the dental public health facilities in the Western Cape Metropole.

Methods:  The transcripts were thematically analysed using ATLAS.ti software and guided by the Ritchie and Spencer framework approach to thematic analysis.

Results:  Seven main themes were identified: oral health promotion approaches and effectiveness, professional development, barriers and challenges, children and parents' oral health knowledge, attitudes and practices, parental influence and family dynamics, cultural and socio-economic considerations and engagement between oral hygienists, parents and children. Resource limitations within the public dental healthcare system had a negative effect on the hygienists' ability to deliver effective OHP services.

Conclusion:  Although oral hygienists employ diverse methods, including practical demonstrations and interactive techniques, current OHP strategies remain inadequate to address the high burden of dental caries. These findings support the development of an alternative approach to OHP in this setting.Contribution: The study contributes to understanding the role of family dynamics in reducing the burden of oral diseases among children in the Western Cape.

Background:  There is a low and erroneous rate of patient safety incident reporting system in the primary health care institutions in the study. These gaps are identified through clinical audits of patient files, performance reviews and complaints received through the provincial call centre.

Aim:  The study aimed to explore and describe factors influencing the reporting of patient safety incidents in primary health care facilities.

Setting:  The study was conducted in the Mqanduli District of the Eastern Cape Province. Five healthcare facilities were included, as these were the facilities where the identified problems were evident.

Methods:  A qualitative, exploratory, descriptive design was used. Purposive sampling was used to select 10 nurses who were interviewed. Data were analysed by thematic analysis, and measures to ensure trustworthiness, and ethical principles were followed.

Results:  The reporting process for patient safety is influenced by a number of factors, such as nurses' reluctance to report for fear of punishment, a lack of training and education and fear of lawsuits. Nurses need support from management in the form of training and provision of resources, creating a positive work environment and safety culture by not punishing those who make errors and rewarding those who report patient safety incidents.

Conclusion:  Nurses receive minimal support from managers, have inadequate knowledge of patient safety incidents (PSI) reporting and guidelines, insufficient resources and high staff workloads, which need to be addressed in order to improve PSI reporting. Nurses require a supportive work environment, with encouragement from colleagues, management and the Department of Health.Contribution: Recommendations are provided for nursing education, research and practice to enhance nurses' understanding and proficiency with PSI reporting, thereby ensuring quality of nursing care and patient safety.

Background:  Although traditional medicine (TM) has historically been marginalised within the allopathic medicine (AM) systems and policy frameworks, it remains a core component of healthcare-seeking behaviour among South Africans. However, communication regarding TM use between patients and physicians is often inhibited by cultural stigma, trust deficits and isolated systems.

Aim:  This study explored physicians' perceptions of communication dynamics influencing TM disclosure, guided by communication privacy management (CPM) theory.

Setting:  The study setting was four district hospitals with outpatient departments in Gauteng province.

Methods:  This qualitative descriptive study collected data from 14 physicians through semi-structured interviews. The findings were inductively analysed using open and axial coding, with CPM theory serving as a sensitising framework.

Results:  Four interrelated themes aligned with CPM theory's core concepts: (1) disclosure practices, (2) facilitation of collaboration, (3) managing disclosed information and (4) challenges in non-disclosure. Physicians reported that patients regulate TM disclosure according to trust, perceived judgement and cultural norms. Respectful, non-judgemental communication fostered openness, whereas dismissive attitudes reinforced secrecy.

Conclusion:  Communication privacy management theory provided a valuable lens for understanding physicians' perceptions of privacy management within South Africa's dual healthcare context. Disclosure of TM is a relational and culturally mediated process shaped by social trust and institutional dynamics.Contribution: The study contributes theoretically by extending CPM theory to a multicultural and interprofessional setting; methodologically by illustrating its use as a sensitising framework for analysing healthcare communication; and practically by identifying strategies such as cultural humility training, structured disclosure frameworks and collaboration between TM and AM practitioners that can strengthen transparency and patient-centred care.

Background:  Climate change has an adverse impact on health in Eastern Africa. Climate-sensitive diseases pose a threat to the health, growth and development of children.

Aim:  To determine the influence of climate change on children attending primary care in Isiolo County, Northern Kenya.

Setting:  The study was undertaken in Isiolo County Referral Hospital in Isiolo County, Northern Kenya.

Methods:  Convergent mixed methods research design. Quantitative data on climate variability and disease patterns were collected over the last 5 years and analysed using the Statistical Package for Social Sciences. Qualitative data from 12 interviews of parents with children under 5 years and six interviews of healthcare workers were analysed with Atlas-ti using the framework method.

Results:  The county experienced climate fluctuation between 2019 and 2023, characterised by reduced rainfall, high temperatures, food insecurity, reduced access to water and flash floods. Families were vulnerable to the effects of these climate shocks because of limited finances. Primary care services were of low quality and lacked resilience. Healthcare workers reported limited medical resources, healthcare worker shortages and overcrowding in hospitals. Health effects reported by parents included malaria, pneumonia, diarrhoeal diseases and mental health illnesses. Social effects reported were displacement, child neglect and disruption to education.

Conclusion:  Climate change has had a substantial impact on children's health and social circumstances. Families that are dependent on public sector health services are vulnerable and lack the resilience needed to cope with climate stressors. The health facilities also lack the resilience needed to respond adequately to the challenges of climate change.Contribution: This study will strengthen climate and health data and improve policies to address regional community needs. It also demonstrates that improving healthcare financing will impact healthcare system resilience.

Background:  In the low- and middle-income countries (LMICs), cervical cancer is the primary cause of cancer-related female deaths. Lesotho has a cervical cancer incidence that is 2.7 times higher than the global average. This disease can be prevented by vaccination, which is not available in all countries, and through screening, which has been shown to have low uptake even among health professionals.

Aim:  To explore primary health care (PHC) nurses' lived experiences of cervical cancer screening in Lesotho. Thus, to better understand how these experiences can impact nurses' subsequent screening or their goal of offering screening services to their patients.

Setting:  The study was conducted at four PHC centres in the selected district.

Methods:  This is a qualitative study in which a phenomenological design was used. Ten nurses were purposively selected and participated in the in-depth interviews. The data were analysed thematically.

Results:  The findings revealed participants' positive and negative experiences with cervical cancer screening. Positive experiences, including good nursing services, freedom of choice and pain prevention, influenced the nurses' intentions to continue to test in the future and to strongly recommend screening to other women. The negative experiences included a lack of privacy, the absence of counselling and receiving results late. These negative experiences had a detrimental effect on nurses' intentions to undergo screening in the future. However, they had no impact on their goal of offering screening to other women.

Conclusion:  The findings provided essential insights into why cervical cancer screening uptake is low among nurses.Contribution: This evidence is critical for augmenting the knowledge of how cervical cancer screening programmes could be improved to enhance nurses' screening uptake and invariably facilitate higher screening rates within the general population.

Background:  Child wasting remains a challenge despite global targets to eliminate malnutrition by 2030. While the global nutrition community has traditionally focused on treatment, a range of nutrition-specific interventions to prevent child wasting are available.

Aim:  To conduct a rapid qualitative evidence synthesis exploring factors influencing the acceptability, feasibility and equity of preventative interventions to inform a World Health Organization (WHO) guideline on child wasting. This manuscript reports on nutritional supplementation interventions, a subsection of the broader scope of the guideline.

Method:  We searched MEDLINE (PubMed) (database inception to 13 June 2022) for eligible studies. We coded and synthesised findings using a 'best fit' framework synthesis approach and assessed methodological quality of included studies. We presented fit-for-purpose evidence to complete qualitative evidence-to-decision criteria for the WHO recommendation.

Results:  We included 25 articles and identified 27 themes relating to acceptability, feasibility and equity for nutritional supplementation interventions. Nutritional supplementation in children was mostly acceptable, but acceptability was mixed for other recipients. Several barriers to and facilitators of nutritional supplementation across intended recipient groups were identified, with education or information frequently emerging as facilitator. Health beliefs, as well as practical challenges, are notable barriers. Evidence on equity is sparse, but sharing practices and gender roles emerged as exacerbating factors.

Conclusion:  Nutritional supplementation interventions are probably acceptable, and there are facilitators of implementation; however, some barriers would also need to be considered. Information regarding equity was relatively sparse.Contribution: Our findings were used in drafting the WHO guideline recommendations on child wasting.

Background:  As cancer treatment options advance, it is increasingly essential for patients and caregivers to possess adequate cancer-specific health literacy to engage in shared decision-making. While there is growing global interest in developing cultural and disease-specific health literacy tools, Africa remains underrepresented.

Aim:  To develop the Swahili Cancer Health Literacy Test (SCHLT) for Swahili-speaking populations in Africa.

Setting:  Two settings were involved in developing the SCHLT: Tanzania and South Africa.

Methods:  A multimethod design was employed, guided by the MEASURE approach through seven steps: (1) establishing a rationale, (2) creating an empirical framework, (3) developing a theoretical blueprint, (4) constructing an item pool, (5) translating items into Swahili, (6) contextualising the pool and (7) assessing readability. The development process drew on the Integrated Model of Health Literacy (IMHL), the Cancer Control Continuum and the Sesotho Health Literacy Test (SHLT) frameworks.

Results:  Nine existing health literacy (HL) tests informed the development of an initial item pool (n = 369). Two Delphi rounds achieved consensus on 52 items for the final version. Readability was evaluated using Flesch-Kincaid Grade Level and cognitive interviews with sixth-grade pupils and the target population.

Conclusion:  The SCHLT presents a novel, culturally appropriate tool for assessing cancer HL in Swahili-speaking populations. The theoretically grounded development process ensures rigour and provides a model for creating other disease-specific HL tools.Contribution: This study addresses a significant gap by contributing to the development of cancer HL assessments relevant to African contexts.

Background:  Drug-resistant tuberculosis (DR-TB) continues to be a major public health threat, especially in high-burden settings like South Africa. Rapid and accurate diagnosis of resistance to rifampicin (RIF) and isoniazid (INH) is essential to ensure that patients receive the right treatment as early as possible. Current diagnostic tools, though effective, have limitations. This study addresses the urgent need for faster, reliable alternatives to improve DR-TB detection.

Aim:  The aim of this study is to assess the performance of the FluoroType MTBDR assay in detecting resistance to RIF and INH in a real-world diagnostic setting.

Setting:  The study was carried out at the National Health Laboratory Services (NHLS) Polokwane Laboratory, a routine laboratory in Limpopo province, South Africa.

Methods:  We tested 152 Mycobacterium tuberculosis (MTB) isolates collected from the 2023 laboratory repository using the FluoroType MTBDR version 2 assay. These results were compared with those from two established methods: GenoType MTBDRplus and Xpert MTB/RIF Ultra. Whole genome sequencing (WGS) was used to resolve any discrepancies, serving as the reference standard. Diagnostic accuracy was evaluated using sensitivity, specificity and predictive values.

Results:  Of the 152 isolates, 65% were drug-resistant. FluoroType MTBDR showed excellent performance - 100% specificity and 96% sensitivity for RIF resistance and 91% sensitivity and 99% specificity for INH resistance - competing with the GenoType MTBDRplus.

Conclusion:  FluoroType MTBDR offers a reliable, rapid alternative for detecting DR-TB, with the potential to improve timely diagnosis and treatment.Contribution: This study highlights the FluoroType MTBDR assay as a valuable diagnostic tool for routine use, contributing to improved TB control strategies, especially in resource-limited, high-burden settings, consistent with the journal's scope.

Many clinicians perceive intravenous (IV) antibiotics as inherently more effective than their oral counterparts. However, randomised controlled trials (RCTs) have demonstrated that oral antibiotics are clinically equivalent to IV antibiotics for many severe bacterial infections. This includes pneumonia, skin and soft tissue infections, pyelonephritis, intra-abdominal infections, osteoarticular infections, bacteraemia and infective endocarditis. When clinically appropriate, oral treatment is more patient-friendly, cost-effective and environmentally friendly. But we still use the IV route much more than necessary. To address a historical practice that is often unwarranted, this Therapeutics Letter reviews evidence from RCTs and compares the advantages and disadvantages of oral and IV antibiotics. We suggest criteria to determine when oral therapy is appropriate.