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

Introduction:  Extracranial carotid artery aneurysms and pseudoaneurysms are rare, comprising less than 4% of all peripheral artery aneurysms. Rural primary health care facilities often face significant challenges because of limited access to formal imaging. Point-of-care ultrasound (PoCUS) has the potential to bridge this gap, accelerating timely diagnosis and management in remote settings.

Patient presentation:  A 19-year-old male presented to a rural primary health care clinic in the Western Cape of South Africa with a 3-week history of left-sided neck swelling and recent odynophagia. Physical examination revealed a firm, pulsatile mass with an audible bruit.

Management and outcome:  Formal imaging was unavailable for several months, delaying surgical advice. However, the clinic's newly procured mobile ultrasound allowed for PoCUS, which identified a pulsatile vascular lesion consistent with a carotid pseudoaneurysm. Computed tomography angiography confirmed the diagnosis, and the patient was referred for tertiary care where the lesion was repaired. He had vasculitis on histology and exhibited inconclusive features of a connective tissue disorder, but a definitive cause was not found. Despite multiple attempts, he could not be contacted for follow-up.

Conclusion:  This case highlights how PoCUS can accelerate definitive management in resource-limited settings.Contribution: Point-of-care ultrasound is potentially an effective, cost-efficient diagnostic tool in rural healthcare settings but requires significant investment in equipment and training. Further research is needed to evaluate its feasibility in South African rural health systems.

Background:  Antibiotic utilisation is a growing public health issue due to antimicrobial resistance. Community pharmacies are a key access point for antibiotics; thus, an evaluation of dispensing records will provide insights into their use.

Aim:  To describe the utilisation of antibiotics in a private community pharmacy.

Setting:  This study was undertaken in a private pharmacy located in the North West province of South Africa.

Methods:  A retrospective, cross-sectional study reviewed electronic dispensing records of oral antibiotics from January 2022 to August 2024, categorising them according to the World Health Organizations (WHO) Access, Watch and Reserve categories, generic status, diagnosis and payment methods.

Results:  A total of 10 468 antibiotic dispensing records were analysed. Adults (18-64 years) accounted for the majority of prescriptions (80.7%; n = 8446). Overall, Access antibiotics were mostly dispensed (56.5%; n = 5910); however, azithromycin, a Watch antibiotic, was the most dispensed antibiotic (n = 1849). Notably, 82% (n= 8584) of prescriptions were linked to non-specific International Classification of Diseases, 10th Revision codes. Generic medicines constituted 92.6% (n = 9694) of prescriptions. Although most patients (72.8%) used medical aid, cash-paying patients were more likely to be dispensed a generic antibiotic.

Conclusion:  Antibiotic prescribing largely aligned with WHO guidelines; however, the high rate of Access antibiotics dispensed highlights the need for targeted interventions to improve prescribing practices and guideline adherence.Contribution: This case study indicates that dispensing records contribute to improved understanding of local antibiotic usage patterns that can help combat antimicrobial resistance within a community.

Background:  Cardiovascular diseases (CVDs), including hypertension (HTN), have emerged among people living with HIV (PLHIV) as the most important prevalent contributors of non-AIDS-related mortality. Moreover, HTN itself is a modifiable risk factor for other CVDs. Data are limited regarding the prevalence of HTN and associated factors among PLHIV in Lesotho.

Aim:  To determine the prevalence of HTN and associated factors among PLHIV attending Senkatana ART Clinic.

Setting:  The study was carried out at Senkatana ART Clinic in urban Maseru, Lesotho.

Methods:  A cross-sectional study was conducted from February to July 2022. Data were analysed using SAS statistical software (v9.4) and Microsoft Excel. To determine HTN prevalence, blood pressure (BP) was measured, and a questionnaire was administered to participants who were randomly selected using the lottery method from the clinic's daily attendance list. Multiple logistic regression was used to assess factors associated with HTN in PLHIV while controlling for potentially confounding factors.

Results:  The prevalence of HTN was 57% (exact 95% CI: 51.2%, 62.7%). Of those with HTN, 33.3% were newly diagnosed during this study (exact 95% CI: 26.3%, 40.9%), while 69% of those previously diagnosed with HTN had uncontrolled HTN at enrollment (exact 95% CI: 60.0%, 77.6%). Age older than 50 years (p  0.0001) and a body mass index (BMI) of 25.0 kg/m2 or higher (p  0.0002) were independently associated with HTN.

Conclusion:  Hypertension was highly prevalent and poorly controlled. Factors associated with HTN in PLHIV were older age and higher BMI. The study's findings support models of comprehensive healthcare delivery.

Background:  There is a growing prevalence of type 2 diabetes (T2D) in South Africa and a high proportion of people have poor glycaemic control.

Aim:  Having developed 'Diabetes Together', a couples-based intervention to support diabetes self-management, we explored places of worship as potential options for recruiting couples in the community.

Setting:  Places of worship in low-income settings in Cape Town, South Africa.

Methods:  Community entry involved approaching leadership of each place of worship to discuss the programme and our target of recruiting 15-20 eligible couples, where one partner was living with T2D. The research team and study were introduced to each congregation. Enrolment took place at the first of three intervention sessions. Attendance, participant feedback and facilitator observations were recorded. Recruitment and retention outcomes were summarised using descriptive statistics. Participant and facilitator feedback was deductively coded based on the evaluation questions and overarching themes identified.

Results:  The intervention was conducted in two churches and one mosque after engaging with leaders of six places of worship. A total of 37 people living with T2D were screened; 34 were eligible and had a self-reported T2D diagnosis, 32 partners were screened. Twenty-nine couples were eligible, and 24 couples enrolled. Retention was good across all three places, minimum 75% by session three. Participant and facilitator feedback revealed that participants gained new knowledge, reported having a positive attitude towards diabetes management and valued group interaction and open communication.

Conclusion:  Recruitment of couples from places of worship in low-income settings in Cape Town was feasible under certain conditions. The intervention was acceptable and retention of couples for repeated sessions was high.Contribution: As there is limited evidence on using community settings like places of worship for diabetes management programmes, we present practical considerations for successful recruitment from these settings in South Africa.

Background:  Efficient referral systems are essential for improving healthcare and patient outcomes, especially in resource-limited settings where access to public specialist care is limited by too few specialists, growing populations and constrained resources impacting non-emergency and emergency referrals. District hospitals (DHs) must ensure that patients receive the appropriate level of care. High-quality referral systems are necessary for the cost-effective flow of patients between district and regional hospitals (RHs).

Aim:  This study aimed to evaluate emergency and non-emergency patient referral processes between DHs and the RH in two districts in South Africa.

Setting:  Ten DHs and the RH in the Garden Route and Central Karoo districts in South Africa.

Methods:  A mixed-methods design incorporated quantitative survey data and qualitative thematic analysis to provide a comprehensive understanding of referral processes. The study population included all doctors working at 10 DHs and the RH, with 120 voluntary participants.

Results:  Key findings revealed disparities in referral satisfaction between emergency (66%) and non-emergency (59%) referrals. Communication breakdowns and systemic barriers hindered timely access to specialist care, mismatched expectations and understanding, coupled with inconsistent referral guidelines. Inadequate capacity building increased inappropriate referrals.

Conclusion:  Communication breakdowns and differing expectations between DHs and the RH regarding available resources and services negatively impacted referrals. Improved communication, targeted outreach, capacity-building initiatives, stronger collaborative relationships and standardisation of processes could enhance patient referral efficiency.Contribution: This work adds new knowledge to patient referrals between rural district and regional hospitals in resource-limited contexts, highlighting the complexity of the referral process.

Background:  Gender intersects with multiple forms of socio-cultural, economic and health system factors to influence the overall care-seeking experiences of caregivers.

Aim:  This study aimed to understand the multiple gendered intersecting factors that shape women caregivers care-seeking experiences for children with probable pneumonia.

Setting:  The study was conducted in Karemo, Siaya County in western Kenya.

Methods:  In-depth interviews (IDI), participant observation and informal interviews were utilised. The IDI was conducted among purposively selected 12 caregivers out of which 11 were enrolled in participant observation. Data were managed and analysed using Dedoose and hermeneutic phenomenology, respectively.

Results:  Women juggle household chores, caregiving and income-generating activities, which sometimes led them to decline child's hospitalisation because of competing household responsibilities. At the hospital, women experienced long waiting times, poor communication, unfavourable conditions, unfriendly staff and lack of drugs. Some women reported challenges in accessing money from their husbands for their child's healthcare. They were often required to make difficult choices, such as prioritising work because of financial constraints, prioritising other children because of lack of external support, or opting for over-the-counter medication because of convenience, drug shortages or long waiting times at the hospital.

Conclusion:  Lived experiences are shaped by women's daily realities and constraints. To improve women's caregiving experiences, a holistic approach that considers the multiple dimensions of caregivers' lives and gendered dynamics is recommended.Contribution: This study's findings emphasise the necessity of a holistic approach when developing intervention geared towards improving healthcare-seeking behaviour by considering the subtler factors beyond structural, social and economic influences.

Background:  Malawi faces a heavy cancer burden because of high incidence and late-stage diagnoses, largely driven by low public awareness of cancer risk factors and early warning signs.

Aim:  This study aimed to explore the cancer knowledge of cancer risk factors and early warning signs, and sources of information among the public.

Setting:  This study was conducted in four districts within the Southern Region of Malawi.

Methods:  The study used a cross-sectional approach to elicit knowledge of cancer and sources of cancer information among a sample of 305 participants. Data were collected using a previously standardised Cancer Awareness Measure (CAM). Statistical data analyses were conducted using IBM® SPSS® statistics version 22.

Results:  Awareness of cancer risk factors and early warning signs was found to be low, indicating a significant lack of public knowledge about cancer. The radio emerged as the most common medium of cancer information through which Malawians receive cancer information, followed by clinics and hospitals. Interestingly, many individuals perceived clinics - not the radio - as the primary source where they gained a clearer understanding of cancer information.

Conclusion:  The study concludes that public knowledge of cancer in Southern Malawi is low and although radio is the main information source, clinics are more effective because of expert guidance.Contribution: This study identifies critical gaps in cancer awareness and understanding in Malawi, highlighting the need for improved and targeted communication strategies, particularly among vulnerable populations.

Thyroid hormones regulate essential metabolic processes and development. The hypothalamic-pituitary-thyroid axis regulates hormone production, with thyroid-stimulating hormone (TSH) levels being a key indicator of thyroid function in primary hypothyroidism. This therapeutics letter emphasises a TSH-centred approach to the diagnosis and management of primary hypothyroidism (dysfunction at the level of the thyroid gland) in adults. It discourages routine thyroid function screening in asymptomatic individuals due to a lack of demonstrated benefit and potential harm from overdiagnosis and overtreatment. It outlines appropriate diagnostic strategies, including when to use TSH, free T4 (thyroxine), and free T3 (triiodothyronine) tests, and outlines indications for antibody testing. Special considerations are provided for subclinical hypothyroidism and hypothyroidism during pregnancy.

Background:  The HIV Testing Services (HTS) are a vital component of human immunodeficiency virus (HIV) prevention initiatives, and the essential first step to healthcare. Men in South Africa have been shown to test for HIV at a lower rate than women, with a resulting higher mortality rate.

Aim:  This narrative review aimed to describe the approaches used to improve the uptake of HTS by men both at the facility and community level in sub-Saharan Africa (SSA).

Method:  Online databases were used to search for relevant studies published from 2019 to 2024 in English. A total of 475 records were identified, with 426 being included after duplicates were removed. After reviewing the abstracts, only 13 studies were included in the review.

Results:  This findings revealed three themes and seven sub-themes related to improving HTS uptake: improved access to testing (HIV self-testing, community-based testing and workplace testing), motivation and support (stakeholder involvement and creating a demand for testing) and health facility services (facility-based testing and services provided by male healthcare workers).

Conclusion:  The limited number of studies highlights the need for more research into developing and testing interventions to encourage men to utilise HTS. A multipronged approach that includes various role-players can be beneficial. This needs to be supported by continuous demand creation utilising platforms such as social media, radio and local newspapers.Contribution: The study collates the interventions intended to encourage men to undertake HTS in SSA.

Background:  The need for integrated healthcare has been increasingly recognised because of mounting challenges associated with the proliferation of injuries and noncommunicable diseases. A developing example of integration is between Emergency Medical Services (EMS) and palliative care. Despite recommendations for integration in South Africa (SA), these services remain segregated.

Aim:  This study aimed to develop and prioritise approaches facilitating EMS and palliative care system integration within SA.

Setting:  An online meeting was held with SA EMS and palliative care experts.

Methods:  A nominal group technique was employed to answer the question, 'What do you think should be done to most effectively integrate EMS and palliative care services in SA?' Answers were categorised, awarded scores by participants, and ranked according to impact and feasibility.

Results:  The following categories were generated: Awareness, Education, Community Engagement, Communication and Information Sharing, Stakeholder Collaborations, Alternative Pathways and Approaches, Research, Funding, Policy Development and Governance. The top five individual approaches were: (1) enable EMS to administer already prescribed medications, (2) Emergency Medical Services undergraduate training in palliative care, (3) improve EMS recognition of signs of dying at the end-of-life, (4) palliative care awareness for the EMS community, and (5) palliative care awareness for in-hospital healthcare providers, particularly those in emergency medicine.

Conclusion:  The categories developed in this study should be used to guide EMS and palliative care integration in SA. Future research should aim at establishing the safety and efficacy of these interventions.Contribution: This study provides a structured approach to integrating EMS and palliative care in SA, enhancing holistic care for patients with palliative needs.