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

Background:  Conventional evaluation approaches are often designed for predictable, linear systems and fail to capture the non-linear dynamics of complex community health interventions. Health projects in mining-affected communities are typically fragmented, with limited coordination or responsiveness to socio-ecological realities. This study applied complexity theory, community-oriented primary care (COPC) principles, and used a transdisciplinary approach to assess a health and wellness project in such a setting.

Aim:  To describe and reflect on the methodology of a complexity-informed assessment of the coherence and contextual alignment of a health and wellness project in mining-affected communities.

Setting:  Health and wellness projects funded by the Sishen Iron Ore Company Community Development Trust (SIOC-CDT) and implemented across five municipalities in the Northern Cape and Limpopo provinces, South Africa.

Methods:  A complexity-informed, mixed-methods design was used. Data were gathered through document review, field observation, and 12 key informant interviews with implementing agents, health officials and traditional healers. Community-oriented primary care principles and complexity theory guided iterative analysis and were supported by digital tools.

Results:  The study identified fragmented implementation, limited household engagement and weak data systems. Despite widespread activity, the lack of integration and adaptive strategy limited systemic effectiveness. However, transdisciplinary engagement, adaptive iteration and co-production of knowledge and reflection facilitated institutional learning and practical proposals for change that are integrated and context sensitive, responding to complexities.

Conclusion:  Sustainable health system change in complex settings requires integrated, reflexive and locally grounded approaches that move beyond project-based interventions.Contribution: This study demonstrated how complexity theory, transdisciplinarity, and community-oriented primary care principles offer a viable methodological framework for adaptive evaluation and systemic learning in community health and development, contributing to the journal's focus on primary care and community health systems in dynamic contexts.

Observational studies offer a non-experimental and minimally disruptive approach for generating real-world evidence, making them particularly valuable for informing clinical practice, research and health system strengthening - especially in primary care. This article, part of the African Journal of Primary Health Care Family Medicine (PHCFM) methods series, introduces key observational study designs including cross-sectional, cohort and (nested) case-control studies and discusses their application in doctoral-level research. Drawing on historical and contemporary examples, we examine methodological considerations, ethical issues and modern analytical strategies essential for the careful planning and execution of observational research. By integrating conceptual frameworks and causal inference methods, this primer aims to equip researchers at different career stages with a foundational understanding of how to choose and implement observational designs that are both methodologically robust and relevant to primary care contexts.

Mixed methods research is becoming more common in African primary care studies, yet systematic reviews show most mixed methods studies demonstrate low methodological rigour in integrating qualitative and quantitative components. This integration failure undermines addressing complex health challenges facing African primary care systems, where medical pluralism, resource constraints, and diverse disease burdens demand sophisticated methodological synthesis. This article describes a framework for achieving meaningful mixed methods integration in African primary care research contexts, addressing key challenges and providing practical strategies for transformative synthesis. Drawing on recent methodological advances, including the Mixed Methods Integration Quality Framework, systematic reviews of African mixed methods studies, and exemplar cases from primary care research, the framework integrates theoretical foundations with practical applications in resource-constrained settings. The framework encompasses: temporal considerations for integration decisions; identification of interface points; practical strategies including joint displays and data transformation; team-based approaches to synthesis; and solutions to common integration pitfalls. It addresses epistemological tensions, institutional barriers, and resource constraints in African research contexts. The framework enables researchers to move from separate methodological streams to genuine confluence, generating transformative insights transcending individual methodological contributions. By addressing context-specific challenges while maintaining methodological rigour, it supports producing nuanced understanding necessary for strengthening African health systems. This framework addresses integration challenges in African primary care research, offering practical tools for doctoral researchers and established investigators navigating complex health phenomena in resource-constrained settings.

Currently less than 2% of Kenyans with severe symptoms receive palliative care (PC). Moreover, PC services are concentrated in urban settings and most rural healthcare providers have limited PC expertise. Project ECHO® Palliative Care for Western Kenya was developed as part of a hub-and-spoke model for improving primary PC in rural Kenya. The programme is based at Moi University and Moi Teaching and Referral Hospital, a public, tertiary care facility with a catchment of 25 million Kenyans, the majority of whom live in rural settings. Self-reported assessments by primary care providers found the Project ECHO® Palliative Care for Western Kenya programme improved PC knowledge and clinical skills, increased professional confidence and decreased professional isolation. The training sessions led to an increase in collaborative care management between primary care providers and PC specialists outside of the educational sessions. While a positive finding, it does present challenges to an already small cadre of PC specialists in Western Kenya. A monthly education programme is a useful tool for expanding primary PC services, but optimal clinical care will require increasing the number of speciality PC providers. Effective PC will be most effective when primary and speciality PC are developed in a coordinated fashion.

Background:  Breast cancer is a public health issue in Botswana. Associations of patient-level factors with late breast cancer diagnosis are not well understood. This may explain why there are many cases of late diagnosis.

Aim:  We assessed patient-level factors associated with late breast cancer diagnosis among women in Botswana.

Setting:  The study was conducted at four designated cancer public health facilities in Botswana.

Methods:  A cross-sectional hospital-based survey questionnaire was administered to 211 adult women (15 September 2023 - 15 December 2023). Descriptive statistics, Chi-square/Fisher's exact test and logistic regression were performed using StataNow 18 SE to analyse the association of patient factors with late diagnosis for breast cancer.

Results:  Forty-six per cent (n = 90) of women studied presented with advanced cancer at the first stage of diagnosis. Occupation (χ2 = 9.0342; p = 0.029) and age at first full-term pregnancy (χ2 = 6.3287; p = 0.042) were associated with late diagnosis at bivariate analysis. With univariate analysis, being single (odds ratio [OR]: 0.184, 95% confidence interval [CI]: 0.036-0.932) and formally employed (OR 3.395, 95% CI: 1.467-7.860) were associated with late diagnosis. Multivariate analysis identified second-degree family history as a major predictor of late cancer diagnosis among women (adjusted odds ratio [AOR]: 0.340, 95% CI: 0.129-0.893).

Conclusion:  Almost half (45.91%, n = 90) of the study participants presented with advanced stages of breast cancer at the time of initial diagnosis. While we did not study all women in Botswana, the geographical spread of our sample reflects a countrywide problem. We recommend scaling-up cancer awareness campaigns for improved benefits of early breast cancer screening and diagnosis.Contribution: We identified patient level factors associated with late breast cancer diagnosis among women studied in Botswana. Thus, our study informs an awareness campaign for reducing cases of breast cancer late diagnosis.

No abstract available.

During independence in 1990, Namibia inherited a healthcare system that was deeply rooted in racial segregation and heavily centred on curative rather than preventive care. The delivery model was structured in two tiers: public healthcare under the Ministry of Health and Social Services (MoHSS) and private healthcare. Since the global recognition of primary health care (PHC) at the Alma-Ata conference in 1978, PHC has served as the foundation and the cornerstone of the global strategy for achieving 'Health for All'. The MoHSS adopted this model at independence and has since relied on it to guide major health sector reforms. One of the government's key objectives has been to correct historical imbalances by reallocating resources towards underserved regions. This has involved shifting the focus from hospital-based curative care to more preventive and community-based services delivered through local clinics, mobile health teams and community health volunteers.

This article examines the transformative journey of pursuing a Doctor of Philosophy (PhD) in family medicine and primary care through the lived experiences of four African scholar-practitioners. Using the Hero's Journey framework, the authors reflect on the emotional, intellectual and structural aspects of doctoral education, highlighting the unique challenges faced by clinician-researchers in resource-limited settings. Each vignette illustrates the transition from dreaming to doing by navigating identity shifts, funding obstacles, methodological complexities, as well as the need to balance clinical service with academic development. The article offers practical insights for prospective doctoral degree candidates, including the importance of defining one's purpose, building supportive networks, and adopting adaptable strategies. It also calls for institutional reforms to enhance supervisory capacity and funding mechanisms. By merging personal narratives with reflective analysis, the authors aim to inspire and equip future doctoral candidates in family medicine and primary care, encouraging them to view their journey not just as an academic endeavour but as a pathway to leadership, thereby strengthening the discipline's knowledge foundation and enhancing primary care. This contribution serves as a guide for moving from aspiration to action, offering practical wisdom for navigating the complexities of doctoral education in African primary care contexts.

Background:  Men often face social barriers linked to norms and systemic issues when engaging with public healthcare services. South Africa's first Public Men's Clinic (PMC) was established in 2020, and now, 20 more clinics operate across the country within traditional government clinics. Staffed mainly by male healthcare providers, they are tailored to address men's health needs, but no published scholarly studies have yet reported on their environment or effectiveness in South Africa.

Aim:  The authors aimed to investigate men's experiences of healthcare professionals and the clinical environment at a South African PMC.

Setting:  The study setting was a peri-urban PMC in a community health centre (CHC) in Sedibeng District, Evaton.

Methods:  This qualitative descriptive phenomenological study collected data from 43 men through four in-person focus group discussions (FGDs). The findings were thematically analysed.

Results:  Participants reported two themes from the FGD: (1) negative healthcare experiences at previous traditional clinics they had attended and (2) positive healthcare experiences at the PMC. Despite general challenges faced in the past at public healthcare facilities, they overwhelmingly reported improvement at the PMC.

Conclusion:  Its conducive environment and helpful personnel made participants more comfortable and willing than before to engage with healthcare services.Contribution: This study, the first scholarly study of men's experiences of a South African PMC, offers a promising point of departure for broader, more wide-ranging investigations and a benchmark for service providers wishing to set up and run PMCs in their own facilities.