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

Background:  Family physicians (FPs) play a crucial role in clinical governance within South Africa's District Health System, necessitating strong leadership skills.

Aim:  To understand how the postgraduate Leadership and Governance module at the University of Cape Town (UCT) helped prepare qualified FPs working in the Western Cape province public sector for their leadership role.

Setting:  The UCT offers a 4-month Leadership and Governance module as part of its 4-year Master of Medicine in Family Medicine programme, aiming to prepare registrars for leadership roles.

Methods:  An exploratory qualitative study design was used. A total of 10 UCT alumni working in senior public sector roles were purposively sampled for online semi-structured interviews. Interviews were recorded, transcribed and analysed using the framework method. Data were coded deductively into themes, with new themes created for cohesive uncategorised data.

Results:  Findings revealed that FPs shared similar early experiences as clinical leaders and faced a transitional phase after completing their registrarship. While key leadership qualities aligned with existing literature, participants emphasised the importance of context-specific training and the value of community practice resources.

Conclusion:  The module itself was not considered particularly helpful in preparing FPs for real-world leadership and governance challenges.Contribution: The study highlights gaps between theoretical training and practical leadership demands, indicating that the module must better address the realities faced by newly qualified FPs. This research contributes to understanding the limitations of current leadership training and underscores the need for more practical, contextually relevant education for FPs in leadership roles.

Background: Mental health disorders are increasing globally. In South Africa, primary healthcare (PHC) services are tasked with mental healthcare, with limited resources. A task-sharing approach between PHC role-players has also been met with barriers, including negative attitudes towards mental health care, organisational constraints and insufficiently trained staff. Aim: To assess the perceptions and experiences of PHC practitioners in managing common mental health disorders. Setting: Primary healthcare facilities in the Garden Route District, South Africa.

Methods: An observational, descriptive study using a cross-sectional survey obtained a representative sample of 130 participants. Redcap© platforms captured data, which were analysed to give frequencies and means using simple descriptive statistics. Results: Most participants (68.46%) reported average or below average competence in managing mental health conditions. Out-Patient Departments (OPDs) (68.42%) and PHC clinics (56.25%) found reaching a referral practitioner to be challenging. Waiting times of referred patients were longer at hospital OPDs and clinics than at Community Day Centres. Conclusion: Resources allocated to PHC mental health services remained inadequate, while available support structures were underutilised. The presence of a dedicated mental health practitioner at a facility had a direct influence on the experience of the staff in managing these disorders. Policy makers and managers should motivate for training in mental health and empower the PHC system to offer acceptable mental health services, in accordance with national and international guidelines. Contribution: This research contributed insights into the current mental health ecosystem in primary care, and the need for increased awareness, training and utilising available resources, which could be useful in similar contexts in sub-Saharan Africa.

Background:  Malaria is a leading cause of morbidity, mortality and socio-economic burden in Ethiopia. Although the country set a goal to eradicate malaria by 2030, a resurgence has been reported recently.

Aim:  This study was conducted to assess the signs of malaria, its symptoms and knowledge regarding prevention and its associated factors among rural Ethiopians.

Setting:  Three malaria-endemic rural districts in the Bale Zone, Ethiopia, constituted the setting for the study. The study respondents were household members aged 18 and older, predominantly the heads of households.

Methods:  A community-based cross-sectional study design was employed. Data were collected from a randomly selected 634 individuals using a pre-tested structured questionnaire. Descriptive and inferential statistics were computed using SPSS version 28.

Results:  Less than half of the respondents (44.2%) demonstrated a good overall understanding of the signs, symptoms and prevention of malaria, while some participants wrongly attributed malaria transmission to staying long in the sun, lack of rest and drinking alcohol. The most commonly recognised malaria symptoms include fever, headache and uncoordinated speech. Preventive measures that were widely known included eliminating mosquito breeding sites, sleeping under insecticide-treated nets and indoor residual spraying. Factors such as education, religion, marital status, family size and the presence of children and pregnant women in the household were associated with a better understanding of malaria.

Conclusions:  Malaria-related knowledge is low in the current study area. Some socio-demographic factors were known to have influenced malaria-related knowledge. Contribution: The study provides data on malaria-related knowledge among rural communities. The findings can be used to develop a knowledge-transfer strategy to improve communities' knowledge and accelerate malaria elimination.

Background:  Cervical cancer remains a pressing public health concern in Namibia, with significant barriers to prevention, particularly in rural areas.

Aim:  This study explored health system's challenges and their impact on cervical cancer prevention efforts.

Setting:  This study was conducted in the Ohangwena and Kavango West regions of Namibia.

Methods:  A qualitative exploratory design was employed, focusing on healthcare workers directly involved in cervical cancer prevention. In-depth interviews were utilised to collect data from 11 participants from four district hospitals. Thematic analysis, guided by the World Health Organisation's six health system framework pillars, was used.

Results:  Key service gaps were identified across critical areas of cervical cancer prevention, including a lack of awareness, a lack of human papillomavirus vaccines and referral screening equipment that limited local outreach services. Other significant findings included the shortage of trained personnel and the manual data systems, which resulted in deficiencies in decision-making. Financial constraints, including reliance on non-governmental organisation funding and weak community engagement, exacerbated by cultural stigma, presented leadership challenges.

Conclusion:  Investing in human resources for health, decentralising budget trends and enhancing data systems are critical for cervical cancer prevention in rural Namibia. Equally important is the active involvement of the community in these efforts. Contribution: This study highlights key health system constraints in the Ohangwena and Kavango West regions.

Background:  Many women persist in using traditional medicine despite the evidence that traditional medicines have the potential to harm both the unborn baby and the mother. Data on the extent of use of traditional medicine by women in Lesotho during pregnancy are largely unavailable.

Aim:  This study aimed to determine the prevalence of traditional medicine use during pregnancy among Basotho women and identify the associated factors.

Setting:  The study took place in Ha-Shalabeng, Ha-Molengoane and Ha-Setoko, Lesotho.

Methods:  A cross-sectional design was adopted, data were collected through a structured questionnaire, coded into Excel, and analysed using SPSS. Frequency distribution tables and graphs were used to describe the data on women. The χ2 test examined the association between categorical dependent and independent variables.

Results:  The prevalence of traditional medicine use during pregnancy was 40%. The factors significantly influencing traditional medicine use, included age (p  0.01), educational level (p  0.01), location (p  0.01), transport availability (p  0.04), belief in the efficacy of traditional medicine (p  0.01), reasons for the type of care (p  0.01) and recommendations from parents (p  0.03).

Conclusion:  The utilisation of traditional medicine during pregnancy was found to be high. Therefore, it is crucial to have a policy in Lesotho that regulates the usage and safety of traditional medicine. Contribution: The data would be crucial in informing future research and shaping the development and implementation of traditional medicine policy, thus addressing the existing policy gap regarding traditional medicine in Lesotho.

Background:  Specimen losses across the pathology value chain (PVC) result in missed diagnostic opportunities. It is difficult to fully assess these due to the current paper-based systems, with tracking of specimens only possible on the laboratory information system (LIS).

Aim:  This study aimed to assess specimen losses using the paper-based register.

Setting:  Randomly selected Primary health care (PHC) facilities, City of Johannesburg, South Africa.

Methods:  The retrospective descriptive study design was used to scan 1,000 barcodes from facilities in sub-districts A to G. Data was limited to barcodes from the request form and excluded surveillance testing. Matching data from the laboratory repository was extracted. PVC losses were assessed by determining the percentage of scanned barcodes that had a registered, tested, reviewed and/or rejected date. The analysis was stratified according to sub-district, health facility type and test code.

Results:  The dataset analysed included 33 867 barcodes with 121 697 test codes, equating to 3.59 tests per barcode. Matching registered, tested and reviewed dates were detected for 33 107 (97.76%) barcodes. In total, a rejection for one or more test codes was detected for 1,961 barcodes (5.79%). At the sub-district level, between 95.95% (D) and 98.90% (E) of barcodes were reviewed. The rejection rate ranged from 3.27% (F) to 10.93% (D). For community health centres and clinics, 97.37% and 97.97% of the barcodes had a matching reviewed date.

Conclusion:  PVC losses reported were 4.05%, excluding rejections (5.79%), with slightly higher levels noted at the sub-district level. Contribution: The continuous audit of PVC losses is recommended.

Background:  Tuberculosis (TB) remains a major public health issue in South Africa, a high-burden TB country. The coronavirus disease 2019 (COVID-19) pandemic has exacerbated challenges in accessing essential TB services. This scoping review explores how access to TB care was impacted during the pandemic.

Aim:  This research aimed to review original studies on access to TB care in South Africa during the COVID-19 pandemic using a scoping review methodology.

Method:  A scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Five databases were systematically searched for original peer-reviewed research published between 2020 and 2022. Data were extracted and synthesised using the Penchansky and Thomas framework of healthcare access.

Results:  Three studies met the inclusion criteria. The review identified significant disruptions in TB service delivery during the pandemic, including reduced diagnostic capacity, healthcare facility closures and economic barriers. Patients reported delayed diagnoses and increased stigma, while healthcare workers faced resource shortages and operational challenges.

Conclusion:  The COVID-19 pandemic has exacerbated pre-existing barriers to TB care in South Africa, highlighting critical gaps in healthcare delivery. This review provides insights into the challenges faced and emphasises the need for resilient health systems to sustain TB care during future health crises. Contribution: This article highlights the impact of the COVID-19 pandemic on TB care access in South Africa, identifying key barriers across healthcare access dimensions and offering recommendations to improve TB care delivery during public health emergencies.

Family physicians (FPs), as educators, capacity builders and clinical governance leaders of primary care (PC) teams, work to make them more effective and responsive to the needs of their patients. Various strategies are required to raise the profile of Family Medicine (FM) to ensure stronger representation in health sector planning and policy development for advocacy on behalf of the communities they serve. An illustration is given of the need for FP leaders to become equal partners in the National Surgical, Obstetric and Anaesthesia Planning process to ensure safer surgery at district hospitals and to address unmet surgical needs. Integrating FM teaching throughout undergraduate medical programmes familiarises graduates with FM as a possible career choice. Collaboration with professional FP associations such as in Botswana, Kenya and Zambia has helped to define and promote the discipline of FM, increasing public and professional awareness of the specialty's value. Promoting development of an FP scope of practice as a collaborative exercise between academic FPs and national associations assists in differentiating the roles of FPs versus non-specialist generalists. The new generation of young FPs has played a significant role in marketing FM globally, using social media platforms to support each other and to share information and best practices for managing themselves and their patients. Positioning multidisciplinary PC teams at the centre of health systems, with strong leadership from FPs, integrated people-centred care and evidence-based practices, could catalyse the intensity of change needed for more equitable, cost-effective and sustainable healthcare in Africa.

This article outlines the essential features of clinical trials for doctoral or early career researchers. The World Health Organization has recently emphasised the need for higher quality clinical trials, more trials from low- and middle-income countries, as well as primary care, more engagement with patients and communities and adoption of innovative trial designs. In sub-Saharan Africa, primary care researchers need to move beyond quasi-experimental and before-and-after designs to conduct randomised clinical trials. The article describes the key methodological requirements of a randomised controlled trial: the hypothesis, design, setting, recruitment, randomisation, sample size, intervention, assessment, results, interpretation and extrapolation. We also discuss the aspects of ethical and well-organised trials that respect study participants, engage with collaborative processes, have appropriate governance and transparent dissemination of results. Finally, we outline innovative designs such as step-wedge, clinical trial networks and adaptive platform designs.