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

Background: Prematurity and low birth weight (LBW) are the main causes of neonatal mortality in South Africa (SA). Home visits by lay health workers (LHWs) may be effective in addressing this.

Aim: To inform a national guideline on LHW home visits as part of the Global Evidence, Local Adaptation (GELA) project, we conducted a rapid qualitative evidence synthesis exploring the acceptability, feasibility and equitability of this intervention for preterm and LBW babies.

Setting: We included studies conducted in SA.

Methods: We searched PubMed and Embase until 15 September 2023 and identified eligible studies independently and in duplicate. We synthesised evidence using thematic analysis, assessed study quality using an adaptation of the Critical Appraisal Skills Programme tool and assessed confidence in the review findings using GRADE-CERQual.

Results: The 16 eligible studies included diverse settings and populations in SA. Factors facilitating mothers' acceptance included the knowledge and skills gained, the psychosocial support offered and improved healthcare access and relationships with facility staff. Distrust in LHWs and stigma associated with home visits were barriers to acceptance. Lay health workers' acceptance was facilitated by them feeling empowered. The emotional burden of home visits for LHWs, coupled with insufficient training and support, undermined the feasibility of home visits.

Conclusion: A complex range of interacting contextual factors may impact on the implementation of home visit programmes for preterm and LBW infants in SA.

Contribution: This country profile provides insights into how home visits for preterm and LBW infants in SA might be contextually tailored to increase local relevance and in turn effectiveness, with potential relevance for other African countries.

No abstract available.

Background:  There is paucity of data regarding the prevalence of common mental disorders (CMDs) in people living with HIV (PLHIV) in Ekurhuleni Health District (EHD), South Africa. Also, there is an association between CMDs and poor HIV treatment outcomes. Guidelines therefore recommend that healthcare practitioners screen for CMDs in PLHIV.

Aim:  To determine the prevalence and correlates of CMDs in PLHIV in primary health care facilities in Ekurhuleni district.

Setting:  Seven primary health facilities in Ekurhuleni district.

Methods:  A cross-sectional study was conducted in which data were collected from 403 randomly selected participants, using a questionnaire that incorporated the scores of the Patient Health Questionnaire (PHQ)-9, generalised anxiety disorder (GAD)-7 and substance use disorder (SUD) criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The proportion screening positive for CMDs was calculated. 'R' statistical software was used for univariate and multivariate analysis, with a confidence interval (CI) of 95%.

Results:  Most participants (63%) were female and the mean age was 43 ± 11 years. Forty per cent of participants screened positive for CMDs, 16.6%, 15.1% and 24.1% screened positive for depression, GAD and SUD, respectively. Common mental disorders were associated with poor adherence and HIV non-suppression, while increasing age and being female were associated with reduced risk of CMDs. The risk of severe SUDs in males was 11 times compared to females. During assessment, clinicians screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively.

Conclusion:  The prevalence of CMDs remains high. Adherence to recommendations to screen for CMDs in PLHIV is low.Contribution: This study reveals a low CMD screening rate, estimates the prevalence of CMDs in PLHIV in Ekurhuleni district, and its impact.

Background:  As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development.

Aim:  To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD).

Setting:  The study was conducted in Mopani District, Limpopo province, South Africa, in 2017.

Methods:  Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach.

Results:  Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient.

Conclusion:  Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary.Contribution: This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive.

Background:  Nurses in Eswatini are best positioned to assist adolescents living with HIV to disclose their status to others. Nonetheless, it is evident that many nurses are not actively involved in the disclosure process.

Aim:  The aim of this study was to explore the process of nurses in preparing adolescents for self-disclosure and describe the role of policymakers in enabling adolescents to disclose their HIV status to others.

Setting:  The study was conducted in four facilities, one from each of the four regions of the country, after getting ethical clearance from a Public University Higher Degrees Ethics Committee and the Eswatini Health and Human Research Review Board.

Methods:  In-depth interviews were conducted on 28 participants: 24 nurses and 4 policymakers. The three steps of open, axial and selective coding were used to analyse data until theoretical saturation was achieved.

Results:  Adolescents were assisted to disclose by providing them with HIV information to empower them, encouraged to enrol in teen club because it created a conducive environment for peer-to-peer support, and they were given ongoing psychosocial support to prepare them for self-disclosure. Adolescent HIV management workshops were not routinely done because such training relied on funders.

Conclusion:  Nurses are not preparing adolescents satisfactorily to disclose. Prioritising the training of nurses would lead to a remarkable increase in the rate of HIV self-disclosure by Swati adolescents.Contribution: This study is the first of its kind in Eswatini, and the results will contribute to the review of HIV management guidelines and promote adolescent self-disclosure.

Background:  The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings.

Aim:  The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict.

Setting:  Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study.

Methods:  Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed.

Results:  Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support.

Conclusion:  If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients.Contribution: Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Background:  Screening for traditional risk factors of cardiovascular disease is well known in primary healthcare (PHC) settings. However, other risk factors through newer tools (such as bioelectrical impedance analysis [BIA]) could also be predictors of increased cardiovascular risk (CVR). Body composition estimates (body fat percentage, body water percentage, body lean mass) by BIA and its association to CVR have been studied with variable results.

Aim:  This study assesses the body composition estimates and their association with CVR in the South African PHC setting.

Methods:  A retrospective record analysis was conducted on a cohort of de-identified patients utilising the ABBY® Health Check Machine at a PHC facility in South Africa between May 2020 and August 2022. The ABBY Machine estimates body fat percentage (BF%) and body water percentage (BW%) estimates from BIA. Cardiovascular risk based on the Framingham-risk-score was stratified into high, medium and low CVR. An analysis of variance was used to determine mean differences of BF% and BW% among these groups.

Results:  A total of 4008 records (n = 4008) were used in the final analysis. The majority of patients were female (70.1%) with a mean age of 33.6 years. Higher mean BF% (35.75% vs. 31.10% vs. 27.73%; p  0.0001) and lower mean BW% (49.46% vs. 53.15% vs. 56.18%; p = 0000) were found to be significantly associated with high CVR.

Lessons learnt:  This study demonstrated the use of newer technologies that could assist in the identification of CVR in low resource PHC settings.

Background:  People living with human immunodeficiency virus (HIV) and comorbid diabetes mellitus (DM) face significant challenges owing to the complex interplay between these chronic conditions and the need for comprehensive and integrated care. Service availability and readiness for primary care are essential for the health of individuals and populations.

Aim:  This study aimed to explore barriers and facilitators to the provision of care to the patients with HIV and T2DM comorbidity.

Setting:  The study was conducted at Primary health centres in Harare, Zimbabwe.

Methods:  A mixed-methods design was applied.

Results:  An audit of primary care facilities identified that there was adequate infrastructure and equipment for HIV and T2DM diagnosis and treatment. However, there are gaps in the availability of essential medicines and supplies, such as test strips for blood glucose monitoring. The assessment also showed that the centres had a chronic shortage of healthcare providers, including doctors, nurses and counsellors, and there was a need for additional training and support for healthcare providers in the management of HIV and T2DM.

Conclusion:  The study concludes that the delivery of health services to patients with HIV and T2DM at primary care centres in Harare, Zimbabwe, faces significant challenges. Suggestions included improved resource allocation and multisectoral collaboration to improve the delivery of healthcare services.Contribution: The research contributes insight into disparities between urban and rural primary care facilities in providing services, emphasizing the need for targeted interventions to bridge gaps and enhance care quality.

Background:  The World Health Organization, stated that the coronavirus disease 2019 (COVID-19) pandemic not only affected the socioeconomic well-being of millions but also had adverse effects on public health, particularly in the management of chronic diseases at the primary healthcare (PHC) level. What remained unknown was the experiences of professional nurses(PNs) working in PHC regarding this issue.

Aim:  The study aimed to explore and describe the lived experiences of PHC nurses in managing chronic diseases during the COVID-19 pandemic.

Setting:  The study was conducted in the North West province, South Africa.

Methods:  A qualitative descriptive phenomenological design was employed to collect and analyse data. Face-to-face interviews were conducted and audio recorded with 16 PNs from five high-volume PHC facilities selected purposively.

Results:  The study's findings reveal four themes: suboptimal care for patients with chronic disease, a lack of resources, mental health challenges experienced by PHC nurses, and stigma and discrimination from both family and community members.

Conclusion:  The neglect of PHC and its frontline healthcare staff has impeded the mental health of PHC workers and the management of chronic diseases thus any progress made in reducing the burden of chronic diseases is likely to have regressed during the COVID-19 pandemic.Contribution: Policymakers should prioritise strengthening PHC by implementing integrated disease management policies, ensuring ethical clinical standards, providing supportive supervision, fair resource allocation and capacity building for PHC staff. In addition, addressing stigma and discrimination, and raising awareness among families and communities is crucial for future pandemics to effectively manage both chronic and infectious diseases.

Background:  In South Africa, most palliative care takes place in health districts as part of home-based care provided by nongovernment organisations (NGOs). The National Policy Framework and Strategy on Palliative Care (NPFSPC) aims to ensure adequate numbers of palliative care trained healthcare workers. Guidelines and tools such as the Supportive and Palliative Care Indicators Tool (SPICT) assist in identifying and caring for patients needing palliative care.

Aim:  To evaluate the knowledge, attitudes and practices of public sector doctors to provide palliative care in the Garden Route and Central Karoo Districts.

Setting:  The study was conducted at public sector district-level hospitals.

Methods:  A descriptive observational cross-sectional survey was conducted. The study population included all public sector district-level doctors. Participation was voluntary, and 73 responses (60%) were obtained. Data were collected with an online questionnaire using the adapted 'Knowledge Attitudes Practice' model. Quantitative data were imported into the Statistical Package for Social Sciences for analysis.

Results:  Participants had poor knowledge, attitudes and practices regarding palliative care. There was a statistically significant difference between the knowledge of junior doctors and senior doctors, with 78% of junior doctors having inadequate palliative care knowledge. Only 25% of respondents had received formal postgraduate palliative care training. Seventy (96%) participants reported that home was the best care setting for terminally ill patients.

Conclusion:  Doctors in the Garden Route and Central Karoo need further training to meet the NPFSPC standards.Contribution: This study adds to the palliative care field, highlighting the need for ongoing training of doctors.