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

Background:  The human immunodeficiency virus remains a global public health concern mainly affecting adolescent girls and women. Pre-exposure prophylaxis (PrEP) uptake among this group remains low in the Richmond rural community despite known benefits.

Aim:  This article explores the experiences of adolescent girls and young women aged 18-24 of oral PrEP uptake in Richmond Local Municipality, KwaZulu-Natal, South Africa.

Setting:  The study was carried out in the peri-urban area with two traditional councils located in the uMgungundlovu district of KwaZulu-Natal, South Africa.

Methods:  Using qualitative methodology, 12 in-depth interviews were conducted among participants who had used PrEP between 1 month and 12 months. These interviews were thematically analysed using Colaizzi's method.

Results:  Thematic analysis identified four themes capturing the experiences of adolescent girls and young women regarding PrEP uptake: (1) perceived factors influencing usage decisions, (2) barriers to uptake, (3) facilitators of continued use, (4) community education and awareness about PrEP. Barriers like stigma, healthcare access challenges and fear of side effects further hindered initiation, adherence and retention. Facilitators for continuation included family, community support and convenient access to re-supply. The study highlights the importance of school-based parental meetings and discussions to normalise PrEP use among participants in the peri-urban area.

Conclusion:  The identified practical approaches enable convenient resupply and could increase the uptake. Peer support is critical in improving side effect management.Contribution: The study highlights the need to improve social support by using the school's parental meetings to educate the community about the benefits of pre-exposure prophylaxis to improve adherence and retention.

Not applicable.

Background:  Postnatal care (PNC) knowledge and positive perceptions are crucial for women's utilisation of PNC services.

Aim:  The study aimed to assess the level of PNC knowledge, perceptions of PNC, and determinants of both among women.

Setting:  Public healthcare facilities in the Oshana region, Namibia.

Methods:  The study followed a quantitative cross-sectional survey design. A self-administered questionnaire was administered to 814 participants selected via systematic random sampling. PNC knowledge and perceptions were used separately as dependent variables. Participants' characteristics were used as independent variables. Chi-square tests and binomial and multinomial logistic regression were used to analyse associations between PNC knowledge or perceptions and participants' characteristics.

Results:  Among the participants, 55.6% (n = 434) demonstrated good PNC knowledge, while 27.3% (n = 213) had positive PNC perceptions. Participants who had no formal education, were unemployed, and did not utilise PNC services had a lower likelihood of having good PNC knowledge; adjusted odds ratio (AOR) = 0.33, 95% confidence interval (CI), 0.21-0.53, crude odds ratio (COR) = 0.68, 95% CI, 0.49-0.92; and AOR = 0.72, 95% CI, 0.52-0.98. Similarly, women who did not attend antenatal care had a lower likelihood of having positive PNC perceptions; COR = 0.56, 95% CI, 0.33-0.96.

Conclusion:  There is a need for multipronged interventions to improve PNC knowledge and perceptions among women in the Oshana region.Contribution: This study identified context-specific factors that influence women's PNC knowledge and perceptions.

Background:  Cervical cancer ranks fourth among cancers recorded globally and is the second most common cause of cancer-related morbidity and mortality in women. Although cervical cancer is fatal, the early discovery of precancerous cells by extensive and recurrent screening could lead to a significant decline in incidence. However, the acceptance of cervical cancer screening is low, even among healthcare workers.

Aim:  To explore the perceptions of primary care nurses about cervical cancer screening.

Setting:  The study was carried out in four primary health care centres (PHCCs) in the Leribe district.

Methods:  This is an exploratory qualitative study. The researcher purposively selected and interviewed 10 nurses at the selected PHCCs. The data were analysed thematically.

Results:  Nurses' perceptions of cervical cancer screening influenced whether they routinely detect the disease. Certain perceptions, such as being susceptible to cancer, fear of cancer consequences, feeling relieved by negative results, high self-efficacy, training and witnessing deaths, all encouraged routine screening. Those that discouraged routine screening included fear of positive testing, lack of results, perceived lack of confidence and privacy in screeners and low self-efficacy.

Conclusion:  These findings show that nurses' decisions to undergo a regular screening are either encouraged or discouraged by their perceptions about cervical cancer screening. They also imply that the general public may be impacted by these perceptions as well.Contribution: These findings add significantly to the body of knowledge about how policies can be improved to improve nursing screening programmes, which can improve screening rates among the general population.

Background:  Social media has become a platform where unheard voices within different communities are shared with government.

Aim:  The study explored and described expressed reactions of social media users regarding the implementation of the National Health Insurance (NHI) in South Africa.

Setting:  This study was conducted online on existing social media platforms that share current news. These social media platforms included X (formerly known as Twitter), Facebook, Instagram and TikTok.

Methods:  This was a qualitative study that applied an explorative-descriptive approach. Using convenience sampling, raw data from screenshots of the first 10 social media users' reactions from each news media company were collected. The authors collected information verbatim from the screenshots and created two main transcripts with 10 reactions from each of the selected news media accounts. Thematic analysis was used to analyse data.

Results:  Eight main themes emerged from the reactions of the users. These include concerns about the public financial and taxation burden, corruption and mismanagement by the government, concerns about the quality of healthcare services, fear of medical staff exodus, issues of equity and access to healthcare, government's political motives and electioneering, user's preference for improving current public healthcare system and doubts about NHI implementation feasibility.

Conclusion:  The findings emphasise the need for government officials to include the community before introducing, signing and implementing different bills.Contribution: Through highlighting the public's sentiments on challenges, readiness and feasibility of implementing the NHI, policymakers will be encouraged to ensure adequate health communication and community participation.

Background:  The annual World Health Organization reports confirm over 295 000 maternal deaths globally with most of these occurring during delivery. Interestingly, some studies have established a significant relationship between environmental factors and hospital-based intrapartum care.

Aim:  This study investigated the associated environmental factors among women presenting for peripartum care at the Ketté District Hospital.

Setting:  The study was conducted at the Ketté District Hospital.

Methods:  This quantitative cross-sectional study was conducted at the Ketté District Hospital on women presenting for peripartum care. A convenient sampling was used while a self-administered questionnaire was the data collecting tool to measure environmental factors affecting the delivery practices. Using IBM-SPSS version 29.0, logistic regression served for data analysis with statistical significance considered at p  0.05.

Results:  The study involved 471 women presenting for peripartum care, of whom 325 (69.0%) were aged 18-25 years. Most women, 429 (91.1%), indicated having used earthed road links to the hospital. The majority agreed having suffered complications during delivery. Means of transportation (p = 0.010), number of past pregnancies (p = 0.044), place of delivery (p = 0.001) and delivery outcome (p = 0.001) were significantly associated with delivery complications.

Conclusion:  The study found that delivery complications were significantly associated with means of transportation to antenatal visit, place of delivery, delivery outcome and number of pregnancies.Contribution: This study contributed to a better understanding of the effects of environmental factors on the utilisation of healthcare services during the intrapartum period in rural communities of Cameroon.

Background:  The Framework and Strategy for Disability and Rehabilitation (FSDR) in South Africa aims to improve rehabilitation services for individuals with disabilities. However, research related to its implementation process is limited.

Aim:  To explore the experiences of the implementation process of FSDR among stakeholders in Gauteng, South Africa.

Setting:  The study was conducted in 5 districts in the Gauteng Province of South Africa namely, City of Johannesburg, Ekurhuleni, West Rand, Sedibeng, and Tshwane.

Methods:  A descriptive qualitative study design was used, combining semi-structured interviews and focus groups with diverse stakeholders, including clinicians, rehabilitation managers and community health workers. Data were analysed thematically using MAXQDA software, with key themes mapped deductively to the stages of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to identify key implementation steps taken.

Results:  Challenges to implementation including resource shortages, limited career progression, weak management communication and procedural inefficiencies were reported. Participants emphasised the need for policy adaptations reflecting field experiences and advocated for increased accountability and resources. The EPIS framework highlighted the critical role of phase-specific interventions and continuous monitoring for effective policy implementation.

Conclusion:  The study concludes that systemic barriers must be addressed to enhance the sustainability and impact of the FSDR policy on rehabilitation services.Contribution: Recommendations include fostering accountability, improving resource allocation and realigning policies with frontline needs to ensure long-term improvements in disability and rehabilitation services.

Background:  Gender discrimination (GD), particularly that against women, remains a challenge in the workplace and paramedicine is no exception. Discrimination against women persists despite, in many cases, their being more qualified than their male counterparts.

Aim:  The aim of this study was to explore GD in paramedicine using the perceptions and experiences of South African female emergency care practitioners (ECPs).

Setting:  The study setting was within the Johannesburg area in South Africa, and targeted female ECPs.

Methods:  This study used a qualitative description design to gather data using online or face-to-face interviews from seven participants. Interviews were transcribed verbatim, read vertically and horizontally, coded using ATLAS.ti version 22 software and analysed for categories and themes.

Results:  There were six dominant themes that emerged from the data: (1) GD remains prevalent in emergency medical services (EMS); (2) female ECPs were undermined in the workplace; (3) there were race factors related to GD; (4) gender stereotypes were based on physical capabilities; (5) the negative effects of GD in the workplace; and (6) maternal wall bias.

Conclusion:  Gender discrimination against women in EMS persists with females being stereotyped, undermined and subject to maternal wall bias. Effects of GD on participants included psychological stress, feelings of inadequacy, isolation, sadness and self-doubt. Contribution: There is a paucity of research on GD in African EMS. The findings of this study provide valuable insights into GD in the EMS workplace and contribute to the growing body of knowledge related to GD worldwide.

Background:  Self-managing type 1 diabetes (T1D) can be challenging, especially for adolescents in a critical developmental stage. Some adolescents struggle to successfully self-manage T1D and struggle to keep it well-controlled into adulthood. Despite this concern, there is a notable lack of evidence-based research on protective factors and/or resources to support adolescents living with T1D in South Africa.

Aim:  This study aimed to explore and describe the protective factors of resilience among South African adolescents living with well-controlled T1D.

Setting:  The study was conducted at the Centre for Diabetes and Endocrinology (CDE) in Parktown, Gauteng, South Africa, a specialised facility offering comprehensive, multidisciplinary care for adolescents with T1D.

Methods:  A qualitative descriptive research design was used, and seven semi-structured interviews were conducted, transcribed and thematically analysed.

Results:  Four themes emerged from the data: Just do it: Commit to the diabetes care plan; It takes a village to raise a child living with diabetes; The silver lining of developing positive characteristics and It's a process of continuously learning about T1D.

Conclusion:  Internal abilities (planning, taking responsibility, perseverance and determinism) and external resources (parents, family members, school, mentors) foster positive outcomes and adjustment for adolescents with well-controlled T1D. The potential for adolescents with T1D to use available internal abilities and external resources in managing their diabetes could be beneficial to the successful management of T1D.Contribution: The study addressed a gap in understanding protective factors involved in the successful self-management of adolescents living with well-controlled T1D in South Africa.

Background:  The National Department of Health introduced Differentiated Service Delivery (DSD) models to improve retention in care and decongest healthcare facilities. Anova Health Institute supported the implementation of DSD guidelines in five districts of South Africa.

Aim:  The study aimed to describe how the models contained in DSD policies are operationalised.

Setting:  Five districts of South Africa - two metropolitan, two mixed and one rural.

Methods:  We used a mixed-methods approach, incorporating a 2-day participatory workshop in 2023 and a retrospective review of routine programmatic data. A mapping exercise was used to understand all models of chronic medication provision in the five study districts and to describe differences in operationalisation. We also report on the number of options per facility and healthcare provider perspectives of benefits and limitations.

Results:  External and facility pick-up points were the most commonly implemented models. Three key themes were: the trade-off between convenience and additional support, the trade-off between controlling client care and outsourcing tasks and the distribution of work between cadres of staff. Sedibeng District provided the most options per facility, with 57% of facilities having three possible options. Cape Town provided the fewest, with 50% of facilities offering only one option.

Conclusion:  Health and environmental contexts guide the choice of DSD modalities offered. It is possible to offer clients options in South African settings.Contribution: This study highlights the context-specific nature of DSD model implementation and the importance of client choice. Further research into availability and options from a client perspective would be useful.