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

Cost-effectiveness analysis (CEA) is an important tool for guiding decisions on resource allocation in primary health care (PHC), particularly in low- and middle-income countries that face constrained budgets and competing health priorities. Despite its potential, many early-career primary care researchers struggle with the theoretical and methodological aspects of CEA. This article aims to build capacity in CEA application by providing an accessible guide. It explains fundamental concepts, describes methodological steps, examines quality standards and illustrates real-world applications through detailed case studies from rural settings in Kenya and South Africa. The objective is to equip emerging researchers with the knowledge and skills to embed economic thinking into primary care research and contribute meaningfully to improving the efficiency and equity of health service delivery.

Human papillomavirus (HPV) is widely recognised for its role in causing cervical cancer, prompting many countries, including South Africa, to prioritise girls in school-based vaccination programmes. This short report presents an exploratory case for expanding HPV vaccination to adolescent boys as well, drawing on emerging, but still limited evidence of maternal and paternal HPV transmission to neonates. Although current data on neonatal risks are preliminary, the possibility of vertical transmission and associations with respiratory papillomatosis, preterm birth and fertility issues warrant further investigation. Beyond neonatal outcomes, gender-neutral HPV vaccination offers ethical and public health benefits by promoting equitable protection, enhancing herd immunity and addressing transmission dynamics. Recent advances, including the World Health Organization-endorsed single-dose schedules and the availability of affordable vaccines, provide opportunities to revisit cost-effectiveness analyses. We recommend further context-specific research and modelling to quantify the long-term benefits of gender-neutral strategies in South Africa and similar settings.

Background:  Patients diagnosed with cancer require holistic care that covers the physical, psychosocial and spiritual aspects of wellbeing.

Aim:  To describe the spiritual needs, practices, association between spirituality, using Traditional Health Practitioners (THPs), ancestral belief, with socio-demographic and clinical characteristics, and examine the association between spiritual interventions and spiritual characteristics.

Setting:  Palliative Care units at two tertiary hospitals in Johannesburg.

Methods:  An observational retrospective study used routinely collected data of patients older than 18 years, diagnosed with cancer, having complete records on spiritual questions, and enrolled between January 2021 and December 2023. Data were analysed using STATA V18.

Results:  Most participants (n = 2465) were female (70.5%), with a mean age of 53.6 (s.d.: 22.7). Half were unemployed, 40.1% married/partnered, and 54.4% living with HIV. Many participants were religious (94.1%) and spiritual (96.3%), Christian (84.3%), 11.3% consulted a TPHs, and 20.0% had ancestral beliefs. Most (94.7%) relied on their faith for comfort, their faith grew stronger (84.9%,) and 79.7% needed forgiveness. Receiving spiritual interventions was associated with the need for forgiveness, relying on faith for comfort and receiving support from the faith community.

Conclusion:  The study confirms that patients with cancer are spiritual and religious; some have ancestral beliefs, need forgiveness, and rely on their faith and faith communities to cope. The study further highlights the need for culturally relevant tools and interventions to address these needs.Contribution: The article highlights the unique spiritual beliefs and practices among patients with cancer that may influence planning for palliative care and cancer programmes.

Background:  Antiretroviral (ARV) exposure influences the early-life gut microbiota in regions with high human immunodeficiency virus (HIV) burdens. Understanding how ARV drugs affect the infant gut microbiota is important for optimising short-term and long-term health outcomes.

Aim:  This scoping review synthesises current evidence on the gut microbiota of infants born to mothers with HIV (MWH) in sub-Saharan Africa, focusing on the effects of in utero and postnatal ARV exposure. By examining emerging data in this context, we highlight potential implications for infant health and identify key areas for future research.

Method:  Online databases were systematically searched using comprehensive search strategies. In addition, grey literature was explored. Three authors independently screened titles and abstracts for relevance, evaluated full-text articles for eligibility and performed data extraction.

Results:  The scoping review highlights differences in gut microbiota because of HIV exposure and ARV drugs in infants born to sub-Saharan African MWH. Of interest is a disturbance in the gut bacterial balance in infants with HIV, who harboured enriched with more diverse and potentially harmful bacteria relative to HIV-exposed uninfected infants. There was agreement from some countries, that is Nigeria and Zimbabwe, that their gut microbiota genomes comprise Bifidobacterium longum subspecies infantis and Enterococcus.

Conclusion:  Both antiretroviral therapy and HIV influence the gut microbiota in infants born to MWH. Pathogenic overgrowth within the infant gut microbiota for individuals with HIV may impair immune maturation during early-life, with lasting consequences for host health.Contribution: This highlights the need for further research into probiotic interventions for infants in high HIV-burden settings.

Background:  Climate change is impacting health and healthcare in Africa. Primary health care can improve community resilience, but only if the workforce is prepared. Pre-service training does not yet address climate change, so continuing professional development (CPD) is needed.

Aim:  This study aimed to evaluate what primary care providers in sub-Saharan Africa need to know about building climate-resilient facilities and services, and how their learning needs should be addressed.

Setting:  The Primary Care and Family Medicine (PRIMAFAMED) network in sub-Saharan Africa.

Methods:  A descriptive exploratory qualitative study purposefully selected members of the network who had published on their experience of climate change. Snowball sampling was used to identify additional informants. Data were analysed with ATLAS.ti and the framework method.

Results:  Nine respondents from eight countries across Africa identified six major learning needs: (1) awareness of the pathways that link climate change to health and social effects and changes in the management of diseases, (2) management of diseases linked to exposure to extreme heat, (3) development of a community-orientated primary care approach that includes attention to environmental determinants of health, (4) disaster preparedness and management, (5) how to make your facility and services more climate resilient and (6) how to educate patients and communities on climate related health issues. Most respondents supported web-based approaches to CPD in their contexts.

Conclusion:  Key learning needs were identified and will be further quantified and validated in a cross-sectional survey.Contribution: The findings will inform the development of CPD on planetary health for primary care providers in sub-Saharan Africa.

Background:  The continuous increase in the prevalence of refractive error (RE) globally, with uncorrected refractive error (URE) having been established as the leading cause of visual impairment (VI) in children, is a public health concern. Previous RE studies in South Africa also indicated a growing prevalence, substantiating the burden on schoolchildren.

Aim:  To determine the prevalence of URE among high school learners.

Setting:  No-fee-paying high schools in the Free State, South Africa.

Methods:  A school-based cross-sectional study design was conducted on 13- to 19-year-old learners through a multistage stratified random method. The examination included an unaided logarith of the minimum angle of resolution (LogMAR) visual acuity test, binocular motor alignment tests, ocular health assessment and cycloplegic autorefraction.

Results:  A total of 868 learners consented to participate in this study, with a mean age of 16.4 ± 1.7 years. Male participants accounted for 34.5% (n = 299), while female participants accounted for 65.6% (n = 569), with the majority being Grade 10 learners. The prevalence of URE stood at 27.1% (n = 233), with astigmatism being the most prevalent ametropia, accounting for 22.3% (192 cases), followed by myopia at 15.1% (n = 130) and hyperopia at 5.4% (n = 46).

Conclusion:  A high prevalence of URE, especially among older participants, was established, prompting an urgent concerted intervention from all stakeholders to curb the scourge.Contribution: This study accentuates the visual situation of vulnerable learners, that is, older children from disadvantaged backgrounds in the Free State, which until this point had not been established.

Background:  Existing research on female migration and healthcare in sub-Saharan Africa has predominantly focused on internal migration and maternal and child health, often overlooking broader healthcare access issues for (international) migrant women.

Aim:  This study aimed to quantitatively assess healthcare barriers faced by internal and international migrants relative to non-migrant women.

Setting:  The setting of this study was The Gambia.

Methods:  Using the 2019-2020 Gambia Demographic and Health Survey and overlap weighting, we compare healthcare access - based on reported usage and key barriers - between non-migrants and internal or international migrants. We distinguish between recent and settled migrants according to the duration of residence at the destination.

Results:  Financial barriers are reported by 26.46% - 28.09% of women, geographic barriers by 21.47% - 26.02% and safety barriers by 11.85% - 15.37%. Internal female migrants encounter significantly more geographic (odds ratio [OR] = 1.32, 95% confidence interval [CI] [1.19, 1.45]), permission (OR = 1.43, 95% CI [1.16, 1.76]), safety (OR = 1.16, 95% CI [1.03, 1.30]) and financial (OR = 1.21, 95% CI [1.10, 1.33]) barriers than non-migrants - differences that persist for settled migrants. Conversely, international migrants do not experience more barriers than non-migrants. In addition, migrants who have moved in the past 3 years used health services more than non-migrants, both for internal migrants (OR = 1.14, 95% CI [1.00, 1.31]) and for international migrants (OR = 1.42, 95% CI [1.02, 1.98]), but these differences disappear for settled migrants.

Conclusion:  Policy interventions should address disparities between internal migrants and non-migrants and improve healthcare access for all women.Contribution: This study highlights internal migration as a key factor shaping healthcare access.

Background:  South Africa is faced with a mental health burden attributed to a large treatment gap for common mental disorders (CMDs), and a shortage of mental health professionals. Although comorbidity of CMDs with chronic diseases is common, chronic and non-communicable diseases may receive more attention than CMDs highlighting the need for contextually appropriate, culturally relevant counselling to increase access to mental healthcare for CMDs at primary health care (PHC).

Aim:  To explore the experiences of patients with comorbid chronic medical conditions and depression attending PHC, to inform the adaptation of an existing evidence-based lay counselling intervention developed in South Africa for human immunodeficiency virus (HIV)-positive patients.

Setting:  Dr Kenneth Kaunda district, North West province, South Africa.

Methods:  Semi-structured qualitative interviews were conducted with 16 Sestwana speaking adult chronic care patients with hypertension and HIV who screened positive for depressive symptoms using the Patient Health Questionnaire (PHQ-9), to explore their lived experiences of depression.

Results:  Poor understanding of depression and poor mental health literacy were highlighted. Depressive symptoms were commonly associated with social determinants including poverty, interpersonal conflict, stigma, illness and grief and bereavement. Most participants were unaware of available depression treatments.

Conclusion:  Psychoeducation to improve mental health literacy, cognitive behavioural interventions and problem-solving techniques using task sharing are recommended.Contribution: There is limited evidence of explanatory models for depression among this population in South Africa. To our knowledge, this is the only study that focused on a predominantly Setswana-speaking chronic care adult population with comorbid depression.

Background:  Childhood visual impairment is an important public health concern considering the social, emotional and economic consequences. Lack of access to eye care services contributes to this growing problem. Therefore, integrating primary eye care into existing primary healthcare would facilitate improved access to equitable, effective and affordable eye care services, particularly for children.

Aim:  The study assessed the provision of primary paediatric eye care services in health facilities in the Ashanti region of Ghana.

Setting:  The study was conducted at the primary health facilities in the Ashanti region of Ghana.

Methods:  Stratified random sampling was used to select 145 health facilities in this descriptive study. The eye care professionals in these facilities completed a questionnaire concerning primary eye care services for children. Data were analysed using descriptive and inferential statistics.

Results:  Eye care services were available in 131 (90%) of the health facilities resourced with essential eye equipment. Refraction services were provided by 129 (98.5%) despite limited coverage by the national health insurance scheme. More than 80% of participants lacked continuing education and 59% had poor awareness of management guideline. Barriers identified included lack of specialised equipment and inadequate resources.

Conclusion:  The study highlights disparities in the provision of child eye care services among the health facilities in the Ashanti region of Ghana.Contribution: This study provides useful information to inform policy on targeted interventions for child eye care services to ensure accessible, equitable and comprehensive services.

No abstract available.