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

Background:  Patients with advanced non-malignant diseases experience pain, dyspnoea and fatigue, requiring a rehabilitation approach within palliative care.

Aim:  To identify components of non-pharmacological interventions for symptom self-management for patients with non-malignant chronic disease.

Method:  This scoping review identifies: (1) systematic reviews of symptom self-management interventions for breathlessness, pain and fatigue in chronic lung, heart, renal and liver disease; (2) primary studies in low- and middle-income countries to identify intervention components, contextual factors, facilitators and barriers to symptom self-management. Six databases were searched, records exported to Rayyan and deduplicated. Following screening for inclusion, extraction was conducted. We conducted a narrative synthesis of intervention components and implementation factors, and content analysis of barriers and facilitators to interventions.

Results:  Thirty-one articles were included (21 systematic reviews and 10 primary studies). The populations studied had chronic lung disease (n = 19), heart disease (n = 12), chronic renal disease on dialysis (n = 2) and none had hepatic disease. The three most common intervention components were information, training and rehearsal for practical self-management activities and lifestyle support. Common patient barriers included motivation, adherence and health literacy, while facilitators encompassed knowledge, support and family involvement. The availability of healthcare workers can impact implementation, but remote access options should be considered.

Conclusion:  Disease and management information for patients and their family members, along with support for home application, form the foundation for effective symptom self-management.Contribution: Symptom self-management for non-malignant chronic diseases is uncommon in low-resource settings. This review outlines the necessary components and implementation considerations.

No abstract available.

Voluntary medical male circumcision (VMMC) is a priority human immunodeficiency virus (HIV) preventive intervention. Challenges in funding national VMMC programmes mandate us to adopt new methods to provide circumcisions in a primary care setting. This study aims to test the practicality of instrument-assisted circumcision in primary care in pre-school-age boys. The study setting was one primary care centre in Western Cape, South Africa. The methodology adopted is prospective case series of minimally invasive voluntary circumcision using the Unicirc instrument in boys less than 6 years of age. We circumcised 221 healthy boys using the Unicirc instrument, using a combination of topical anaesthetic, subcutaneous local anaesthetic and intramuscular ketamine. There were 5 (2.3%) mild complications and 48 (21.7%) had mucosal swelling as a result of lysis of physiological phimosis. All boys were fully healed at 2 weeks and all caregivers were highly satisfied. Using a circumcision instrument in primary care simplifies circumcision in pre-school-age boys and has a low rate of adverse events. This study demonstrates that a new model of circumcision in primary care may enhance national VMMC programmes.

Researchers need to not only produce scientifically valid work but also consider how their new knowledge will impact society. Strategies to propel research into use for greater impact are part of the knowledge translation process. Traditionally, researchers presented their work at conferences and through scientific publications. While this remains an important strategy for engaging researchers and academics, it is insufficient to ensure impact with other stakeholders. Integrated knowledge translation (IKT) is a collaborative model of research co-production that involves a variety of stakeholders throughout the research process to enhance the relevance, timeliness and application of research findings for use in policy and practice. The key steps in IKT are outlined in this article and include stakeholder analysis, an engagement strategy and evaluation. For each stakeholder, the engagement strategy should consider the purpose of engagement, the key message, the most effective medium, the best messenger, the timing of engagement and the resources required.

Background:  Interprofessional practice (IPP) is essential for strengthening rehabilitation services within primary health care (PHC) settings. However, many healthcare professionals currently in the workforce have not been trained in interprofessional education (IPE), which limits effective collaboration.

Aim:  This study aimed to develop and validate interprofessional activity guidelines that align with core interprofessional competencies and support the implementation of a rehabilitation model at the PHC level in South Africa.

Setting:  The study was conducted remotely with geographically diverse experts but remained grounded in the South African PHC context. It focused specifically on the Western Cape Department of Health.

Methods:  A two-round Delphi technique was used to gather expert consensus. In Round One, 15 experts identified 26 interprofessional activity guidelines aligned with the 5 phases of an existing PHC rehabilitation model. In Round Two, 11 experts evaluated the guidelines for consensus and convergence. A consensus threshold of 70% agreement and a convergence threshold of a median score above 3.24 were used.

Results:  Of the 26 guidelines, 25 achieved the required 70% consensus. One guideline, which did not reach the consensus percentage, was retained based on a median score above 3.24, indicating convergence of expert opinion. All guidelines were mapped to the four IPE core competencies.

Conclusion:  This study presents validated interprofessional activity guidelines to enhance rehabilitation services at the PHC level. Aligned with core competencies, these guidelines support practical implementation through a phased approach, with readiness assessments and ongoing evaluation recommended. The Delphi-informed process may be adapted for similar resource-limited health systems.Contribution: The results from this study provides validated activity guidelines that translate a South African health policy vision into actionable steps for IPP in the rehabilitation sector at the PHC level. The guidelines strengthen teamwork, communication and patient-centred care across disciplines, offering a replicable model for improving coordination and service delivery in African PHC contexts.

Background:  Despite acceptable contraceptive coverage rates in South Africa, the rise in the number of termination of pregnancies is worrisome and suggests that family planning services are not yet optimal. Emergency contraceptives are underutilised in South Africa.

Aim:  To assess the knowledge and use of emergency contraceptives among women presenting to a termination of pregnancy (TOP) facility.

Setting:  The study was conducted in the JB Marks sub-district, North West province, South Africa.

Methods:  This cross-sectional study was based at the TOP clinic at Potchefstroom Hospital, North West province. One hundred and ninety-six women completed self-administered questionnaires. Completion of the questionnaire was considered consent. Descriptive statistics were performed, and Chi2 and Fischer exact test were used to determine relationships between variables.

Results:  The mean age of participants was 26.5 years (standard deviation [s.d.] = 5.87), with 114 (58.2%) participants being single women in their 20s. Among 162 participants who had never used emergency contraceptives, 64.8% cited a lack of knowledge as the primary barrier to use. Only 34 (17.4%) of participants have previously used emergency contraceptives. The main reason for poor uptake among the women who never used emergency contraceptives could be attributed to poor knowledge.

Conclusion:  This study highlighted that knowledge and usage of emergency contraception are low in women presenting for TOP in the health sub-district. Emergency contraceptives can reduce the number of unintended pregnancies and its associated trauma significantly. Community intervention should be of utmost importance to improve the knowledge and usage of emergency contraception.Contribution: This study emphasised the need to make young adults aware of emergency contraceptives to avoid the trauma of unintended pregnancy for women.

Background:  The African Forum for Health Education and Research human immunodeficiency virus management training (AFREhealth HIV) project was launched in 2019. The project offers a reimagined model for interprofessional training and mentorship to improve clinical care and equip healthcare workers with the technical knowledge and clinical tools to respond to HIV and other health issues.

Aim:  The study aims to evaluate learners' experiences of interprofessional health workforce capacity building across sub-Saharan Africa (SSA) to enhance HIV management.

Setting:  Participants included pre-service medical and nursing students and early career professionals (learners). Learners were associated with 14 AFREhealth partners in 11 SSA countries.

Methods:  Learners attending AFREhealth HIV training workshops were invited to provide feedback using a standardised online form, which included 28 Likert-type questions and 3 open-ended questions. Analysis of the 3 open-ended questions was done by coding responses into a set of common themes and sub-themes.

Results:  Findings showed that of the 3711 learners who participated, only 2570 completed the post-training evaluation. Findings also showed that the learners appreciated the approach adopted in the workshops and believed they gained significant knowledge and skills for themselves. The importance of collaborative, team-based and interprofessional approaches throughout the training was highlighted.

Conclusion:  The training approach adopted by the AFREhealth HIV project has proven to be highly effective. The project has thus continued to target final-year health professional students and working health professionals at affiliated training sites, with module workshops being offered both online and onsite.Contribution: Collaborative and interprofessional approaches to training health professionals for HIV management can improve knowledge, skills and, very importantly, attitudes, with the potential thus to improve the quality of team-based care provided especially in low-resource settings.

Background:  Non-communicable diseases constitute the primary cause of mortality in South Africa, surpassing infectious diseases. Among these, diabetes mellitus is the second leading cause of death. Although local literature on community-orientated primary care (COPC) remains limited, international evidence supports its effectiveness.

Aim:  This study aimed to evaluate the effectiveness of a COPC model for adults with type 2 diabetes compared to the standard facility model of care.

Setting:  The Chiawelo COPC (Chiawelo Community Practice) and Chiawelo Community Health Centre (CHC) in Soweto, South Africa.

Methods:  A cross-sectional observational study was conducted. File records of adults with type 2 diabetes from both models of care were examined for patients' glycaemic control and clinicians' adherence to evidence-based diabetes standards of care.

Results:  Chiawelo COPC (CCP) outperformed the CHC over the investigation period. Mean patient HbA1c at Chiawelo COPC (CCP) was lower than the CHC (7.9%, 8.9%; p  0.001). Body mass index (BMI) (75%, 36%; p  0.001), urine tests (74%, 42%; p  0.001) and renal function assessments (95%, 80%; p  0.05) showed superior results at the COPC practice. Differences were observed in examinations of feet (61%, 1%; p  0.001) and eyes (38%, 1%; p  0.001). Adherence discussions were more frequent at COPC (63%, 48%; p  0.05).

Conclusion:  The COPC model is more effective than the standard facility-based model in managing type 2 diabetes in the Chiawelo community, Soweto.Contribution: This study contributes to understanding the effectiveness of a COPC model for diabetes care in a South African community.

Background:  The success rates for treating drug-resistant tuberculosis (DR-TB) in programmatic settings have been unsatisfactory. By identifying the factors that predict treatment outcomes, we can implement effective corrective measures that will significantly enhance patient management and improve results for those with DR-TB.

Aim:  This study aimed to investigate predictive factors influencing treatment outcomes among DR-TB patients, focusing on the combined effects of body mass index (BMI), human immunodeficiency virus (HIV) status, comorbidities, socioeconomic factors, substance use and DR-TB type.

Setting:  The study was conducted in rural Eastern Cape, South Africa.

Methods:  This retrospective cohort study was designed to utilise logistic regression models on data from 200 patient medical records. We examined variables including BMI, HIV co-infection, comorbidities (e.g. diabetes, hypertension), income, substance use and DR-TB classifications (multidrug-resistant, rifampicin-resistant, pre-extensively drug-resistant, extensively drug-resistant).

Results:  Key findings indicate a weak association between lower BMI and reduced treatment success (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.81-1.05). HIV-positive status was marginally associated with lower treatment success (OR: 0.89, 95% CI: 0.75-1.12), while income level and substance use emerged as stronger predictors (e.g. substance use OR: 0.72, 95% CI: 0.60-0.88). Among DR-TB types, extensively drug-resistant tuberculosis patients exhibited the poorest outcomes (OR: 0.55, 95% CI: 0.40-0.75). The multivariate model achieved an accuracy of 63.1%, suggesting limited predictive power of BMI and HIV alone and highlighting the significant influence of comorbidities, socioeconomic status and behavioural factors.

Conclusion:  These findings underscore the importance of a multidimensional approach in improving DR-TB treatment outcomes through tailored clinical and social interventions.Contribution: The study noted limited connections between DR-TB and various comorbidities. It highlights the necessity of managing coexisting conditions in DR-TB patients because of their significant impact on treatment outcomes. Customised interventions are essential for those with severe or complex comorbidities.

Background:  Previous research explored the risk factors associated with intimate partner violence (IPV) in the sub-Saharan region, there is a notable paucity of studies addressing cases in which an individual reported experiencing multiple IPV incidents.

Aim:  This study aimed to examine the prevalence and sociodemographic factors of dual IPV among women in Zambia and Zimbabwe.

Setting:  Zimbabwe and Zambia in 2015 and 2018, respectively.

Methods:  Data for this study were obtained from demographic and health surveys. The study included 11 779 (weighted) women aged 15 to 54 years who were selected for questions on domestic violence. Multinomial regression was used to estimate the relative risk of experiencing physical abuse, emotional abuse or both types of violence compared to experiencing none.

Results:  While 12% and 9.7% of the respondents reported experiencing only physical and emotional IPV, respectively, almost a quarter (21.7%) were subject to both forms of IPV in the same period. The probability of experiencing both forms of IPV was highest among those whose partners showed controlling behaviour, consumed alcohol, had lower levels of education and had been employed in the past year. The risk of experiencing IPV increased with lower educational attainment among participants, longer relationship duration, number of co-wives, and was higher among those employed.

Conclusion:  The study recommends counselling interventions, improved access to education and coordinated responses involving key stakeholders. Addressing IPV requires context-specific strategies, the establishment of safe houses and enhanced data systems to monitor its prevalence and trends.Contribution: The study emphasises on the mental healthcare for women who experience IPV.