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

Background:  Vision impairment (VI) limits the ability of affected individuals to achieve optimal functioning and impacts their quality of life.

Aim:  This study assesses the vision-related quality of life (VRQOL) and its associated factors in individuals with VI.

Setting:  The study was conducted at selected public hospitals in Limpopo province, South Africa.

Methods:  A cross-sectional, quantitative study was conducted between January and August 2023 across 29 public hospitals, utilising a semi-structured questionnaire. Data obtained from the participants' responses were analysed to assess their VRQOL.

Results:  The study sample consisted of 454 participants, 57.0% female. The participants' ages ranged from 18 to 82 years. The mean composite score was 22.50 ±13.01 (range: 4.0-55.7). Factors associated with increased risk of poorer VRQOL included illiteracy (B: -10.32; p  0.001), primary level education (B: -6.81; p = 0.015) and male gender (B: -3.80; p = 0.003). Regarding VI severity and aetiology, blindness (B: -21.35; p  0.001), cataracts (B: -2.98; p = 0.015) and corneal diseases (B: -6.85; p = 0.005) were associated with risk of poor VRQOL. Conversely, employment (B: 12.76; p  0.001) and refractive error (B: 11.84; p  0.001) were associated with improved VRQOL outcomes.

Conclusion:  The VRQOL among individuals with VI attending public hospitals in Limpopo province is relatively low. The main causes of VI were largely preventable or correctable, indicating the need to strengthen comprehensive eye care services. Enhancing these services may significantly improve the quality of life for individuals with VI in the province.Contribution: The study fills the knowledge gap regarding the impact of VI on VRQOL in individuals seeking care at public hospitals in Limpopo province.

Background:  Rehabilitation services are crucial for addressing the growing burden of functioning problems related to chronic conditions in low and middle-income countries. These services, however, remain limited in South Africa and Zimbabwe's primary health care (PHC) settings.

Aim:  To identify recommendations for enhancing the accessibility and quality of rehabilitation services in PHC in South Africa and Zimbabwe from the perspectives of primary care providers (PCPs) and patients.

Setting:  Ten PHC facilities in the Eastern Cape, South Africa and in Manicaland, Zimbabwe.

Methods:  A qualitative descriptive study was conducted. Semi-structured interviews were conducted with 37 PCPs and 40 patients. Thematic analysis of transcribed and translated data was done in ATLAS.ti version 22.2.4.

Results:  Five key recommendations emerged: (1) provide rehabilitation services closer to home through facility-based services, outreach, home visits and telerehabilitation; (2) improve patient awareness of rehabilitation through patient education, community engagement and patients actively seeking information; (3) enhance PCPs' knowledge and basic skills in rehabilitation through training and guideline development; (4) improve communication among PHC stakeholders; and (5) advocate for rehabilitation inclusion in leadership, resource allocation and multi-disciplinary teams.

Conclusion:  Implementing the identified recommendations could significantly improve the accessibility and quality of rehabilitation services in PHC, aligning with global initiatives to scale up rehabilitation in health systems. Future research should focus on evaluating the implementation and impact of these recommendations.Contribution: The study emphasises the inclusion of PCPs' and end-users' voices in providing practical, context-specific strategies for establishing or strengthening rehabilitation services in low-resource PHC settings.

Background:  The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme has good benefits for both patients with chronic conditions and nurses if it is effectively implemented. In most of the Sekhukhune Primary Health Care (PHC) facilities, the implementation of the CCMDD programme has been highly challenging but at the same time very beneficial.

Aim:  The purpose of this study was to describe the experiences of nurses and patients following the implementation of the CCMDD programme in Sekhukhune clinics.

Setting:  Nine of the Sekhukhune district clinics in Limpopo province, South Africa, were used as study sites.

Methods:  The qualitative research approach with a descriptive and explorative research design was used in this study. Data were acquired through 45 one-on-one semi-structured interviews, with Sekhukhune PHC nurses managing the CCMDD programme and patients with chronic conditions who are enrolled in the programme, and then analysed thematically.

Results:  Positive experiences included overcrowding and workload reduction, saving of time and money for transport, improves medication adherence, reduction in incidents of file loss, reduction in patient waiting times, preservation of clinic drug supplies and easy and convenience. However, negative experiences such as shortage of staff, the lack of communication and information on the CCMDD programme hindered the effectiveness of the CCMDD programme.

Conclusion:  Both nurses and patients of Sekhukhune PHC facilities had positive and negative experiences with regard to the implementation of the CCMDD programme; hence, strategies to improve the programme are needed to be developed.Contribution: The study contributes by providing recommendations for nurse training in the CCMDD programme, in order to improve service delivery processes of the implementation of the CCMDD programme in Sekhukhune PHC facilities.

Background:  The psychological approach can provide valuable insights into vaccination behaviour, especially in high-risk contexts. It offers new perspectives for effective interventions to improve vaccination behaviour.

Aim:  To investigate key factors influencing stress related to vaccination in emergency situations among healthcare professionals.

Setting:  Eastern region of Morocco.

Methods:  We conducted a descriptive and analytical cross-sectional study involving 221 healthcare professionals in the Eastern region of Morocco. A snowball sampling method was used to select the participants who were administered a questionnaire. Logistic regression analysis was performed with p  0.05 being the level of statistical significance.

Results:  The participants had a median age of 25.5 years (30-34.5) and were predominantly females (68.3%). Vaccination coverage stood at 84.6%, with a positive perception of 77.8%. The analysis of the Perceived Stress Scale (PSS) revealed that 51.6% (n = 114) of healthcare professionals experienced stress towards vaccination. Females were almost two times more susceptible to experiencing vaccination stress (p = 0.03). Furthermore, the analysis showed that vaccination profile (p = 0.02), accepting the vaccine for any reason other than its accessibility (p = 0.03) and having a previous coronavirus disease 2019 infection (p = 0.03), were significantly associated with stress. In contrast, healthcare professionals based at the university hospital had a significantly lower stress level (p = 0.01).

Conclusion:  Moroccan healthcare professionals exhibited high vaccine acceptance and positive perceptions, particularly among vaccinated individuals despite notable stress around immunisation.Contribution: These insights can guide governments and policymakers in developing strategies to enhance healthcare workers' awareness and understanding of vaccination.

Background:  Hepatitis B virus (HBV), a significant cause of liver disease globally, is recognised as a 2030 elimination target by the World Health Organization (WHO). Healthcare workers (HCWs) require appropriate HBV knowledge to identify, manage and prevent HBV.

Aim:  We investigated the knowledge, attitude and practices (KAP) pertaining to HBV among HCWs to establish insights into awareness and inform the delivery of training.

Setting:  The study was conducted among HCWs of 18 primary healthcare facilities in Bloemfontein, Free State province, South Africa.

Methods:  Data were collected via anonymous, self-applied, 28-question-questionnaires in English. Data were captured on a Microsoft Excel spreadsheet and analysed by a biostatistician, using Statistical Analyses Software (SAS 9.4).

Results:  The response rate was 88% (88/100), and median participant age was 44 years. Participants were mostly female (83%), professional nurses (65%) with more than 8 years of experience (60%). Median scores were 83% for epidemiology and transmission, 50% for clinical picture, 44% for laboratory diagnosis, 40% for management and 40% for prevention. No difference was noted based on number of years of experience.

Conclusion:  Considerable gaps in KAP to HBV were noted among primary HCWs in Bloemfontein. Larger studies are needed to ascertain the KAP towards HBV among South African HCWs, to identify areas for enhanced training.Contribution: Hepatitis B virus, an important cause of liver disease in Africa, is poorly identified and managed. Our study highlights the need to strengthen HCW education to ensure individuals are appropriately diagnosed, managed and educated on preventative measures, to reduce the burden of disease.

Background:  The South African response to the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was swift and assertive, although it came with economic and social costs. An understanding of the pandemic experiences of different population groups is integral to enhancing disease control.

Aim:  The aim of this study was to identify behavioural responses and public perceptions relating to the coronavirus disease 2019 (COVID-19) pandemic.

Setting:  The study was conducted in South Africa.

Methods:  In June 2022, a national online survey (N = 3018) was conducted among adults ( 18 years). Logistic regression was used to examine the factors associated with adherence to government measures and vaccination. Structural equation modelling (SEM) was applied to examine the direct and indirect relationship of socioeconomic status (SES) with protective behaviours.

Results:  Data showed no direct association between SES and vaccination uptake, but SES was indirectly and positively associated with vaccination uptake. Socioeconomic status was also indirectly and positively associated with adherence to government measures through pathways mediated by access to the Internet, access to local news, government trust and positive government experiences.

Conclusion:  This study highlights the complexity of government measures and vaccination adoption and the socioeconomic barriers affecting these.Contribution: Results from this study should be used to inform future pandemic preparedness plans. In particular, policymakers should consider the importance of providing scientific information through channels accessible to each socioeconomic group to promote positive behavioural changes, as well as the need to adapt pandemic responses to different socioeconomic groups.

South Africa has one of the most established family medicine disciplines in the region, with well over 1000 people on the register. Nevertheless, by international standards, the number of family physicians per 10 000 population is low and there is still a need to advocate for the contribution of family physicians to the health system. The speciality of family medicine was promulgated in 2007 after many years of advocacy. Advocacy has continued with a focus on human resources for health policy and deployment of family physicians in district health services. In the private sector, there is also advocacy for the scope of practice and proper remuneration of family physicians. This short report reflects on the lessons learnt in terms of seven key principles for advocacy with government: understand the issue, identify the right audience, build relationships, use evidence and data, craft a clear message, engage the public, and use the media.

The district hospital is a vital part of the healthcare system in sub-Saharan Africa. It is the key to enabling Primary Health Care to be done well, which in turn can allow for Universal Health Coverage to be achieved. There are numerous challenges at district hospitals making successful ones somewhat rare. One example of a successful district hospital is put forth in this article. In order to increase the number of successful district hospitals a means of sharing solutions to common problems needs to be created, which would ideally be an online repository of said solutions, available to any interested district hospital.

Background:  Oral pre-exposure prophylaxis (PrEP) uses antiretroviral medication to reduce HIV risk in HIV-negative individuals. Despite its effectiveness, global uptake faces policy and accessibility challenges. In Eswatini, PrEP introduction in 2017 showed promise despite stigma and COVID-19 disruptions.

Aim:  This study compared PrEP uptake and retention during and after COVID-19.

Setting and methods:  An analytical cross-sectional study was conducted among clients accessing HIV testing services in selected Eswatini facilities. Data from the HIV testing register, PrEP register, and Client Management Information System (CMIS) were analysed. Uptake, retention, and client outcomes were measured during COVID-19 (March 2020-March 2021) and post-COVID-19 (April 2021-April 2022).

Results:  Of 5286 clients, 45% (n = 2380) initiated PrEP during COVID-19, while 55% (n = 2906) initiated post-pandemic. Facility 3 had the highest initiations during COVID-19 (844), while Facility 5 had the lowest (7). Retention was lower among clients aged 15-29 years. Females initially showed higher retention odds (odds ratio [OR]: 1.50), but this was insignificant after adjusting for confounders. Clients initiated post-COVID-19 had higher retention odds (OR: 2.96).

Conclusion:  COVID-19 impacted PrEP uptake in Eswatini, emphasising the need for flexible healthcare delivery. Targeted campaigns and tailored interventions are crucial for sustaining HIV prevention efforts and addressing demographic shifts.Contribution: This study highlights the importance of responsive healthcare systems and tailored approaches to maintaining HIV prevention during public health crises.