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

Background:  The prevalence of hypertension (HTN) is increasing among people living with human immunodeficiency virus (HIV). Self-management is vital for improving health outcomes and preventing disease progression. While education for HTN self-management has been implemented in South Africa, little is known about its acceptability.

Aim:  The study aims to explore the acceptability of patient education for self-management of HTN among people living with HIV (PLWH) and HTN, and healthcare providers in Integrating HIV and hEART health in South Africa (iHEART-SA) intervention clinics.

Setting:  The study was conducted in six primary health care facilities in Johannesburg.

Methods:  A qualitative study design using in-depth interviews (IDIs) was conducted with 18 healthcare providers and 13 PLWH and HTN. Data were gathered using a semi-structured interview guide. Interviews were conducted in English and audio recorded for transcription and analysis. MAXQDA was used for analysis.

Results:  The use of simple language, empowerment through knowledge and perceived health improvements were identified as facilitators of acceptability. Emotional discomfort attributable to booklet colours, diagnosis denial and staff shortages, were barriers. Ongoing training was the preferred strategy to enhance acceptability.

Conclusion:  Acceptability of patient education among participants was high and can be enhanced via continuous trainings. Future research should further explore these aspects to refine and tailor interventions for diverse populations.Contribution: The study contributes to the body of literature about the acceptability of patient education for HTN self-management among healthcare providers and people with HIV and HTN. Findings can be used in improving education interventions using innovative approaches.

Background:  Primary healthcare plays a crucial role in health system, acting as the first line of assistance in preventing, treating and caring for diseases. In Angola, primary healthcare is a recent and developing reality.

Aim:  To evaluate the strengths and weaknesses of the Angolan General and Family Medicine speciality training programme, identifying areas for improvement and promotion of medical education quality.

Setting:  Primary healthcare doctors in Angola, including General and Family Medicine specialists and residents in training.

Methods:  A cross-sectional study was conducted from April 2024 to June 2024 using an online structured questionnaire. The survey was distributed via email and messaging platforms to all primary care doctors practising in Angola. Participants were asked about their opinions regarding the education process and training conditions. Two open-ended questions complemented the data collection.

Results:  A total of 584 doctors responded (61.1% females), with a mean age of 40.6 years. The most positively evaluated dimensions were faculty and mentoring, supervision, resident guidance, and programme evaluation. Conversely, the quality of infrastructure and access to educational resources were identified as major weaknesses in the training process.

Conclusion:  Despite limitations in teaching materials and infrastructure, the overall perception of General and Family Medicine training in Angola is positive. There is a recognised opportunity to expand and strengthen the programme nationally.Contribution: These findings reflect the perspectives of primary care doctors in Angola and provide valuable insights for policymakers and medical institutions to reinforce a speciality essential to national health system development and population health outcomes.

Background:  Sexually transmitted infections (STIs) are a widespread public health concern, disproportionately impacting young adults. This group is at higher risk due to factors like limited knowledge, misconceptions about sexual health, inconsistent condom use, multiple sexual partners, and barriers to youth-friendly sexual and reproductive health services. Partner notification (PN) strategies are critical in STI control. Effective notification and communication with sexual partners can help break the infection chain and encourage early diagnosis and treatment. However, the dynamics of PN in young individuals remain unclear.

Aim:  To explore PN practices and experiences of STI-diagnosed patients with their sexual partners in the Ekurhuleni East sub-district, Gauteng, South Africa.

Setting:  The study was conducted in five healthcare facilities in Ekurhuleni East.

Methods:  Thirty participants were selected purposively, using an exploratory design. A semi-structured interview guide and in-depth face-to-face interviews were used. Data were analysed using thematic content analysis, following Braun and Clarke's six-phase approach: familiarisation, coding, theme identification, theme review, theme definition, and report production.

Results:  The study identifies key areas for improving STI prevention and PN. Low understanding and cultural attitudes around STIs highlight the need for culturally relevant health education. PN presents emotional and relational issues, including intimate partner abuse and casual relationships, indicating the need for supportive and adaptable notification methods.

Conclusion:  The study highlights the importance of addressing knowledge gaps and cultural beliefs about STIs and promoting open communication in relationships.Contribution: This study contributes insights to healthcare policymakers and practitioners to improve STI management and safer sexual practices among young people.

Background:  Namibia has made tremendous progress in controlling the HIV epidemic. The progress has resulted in significant incidence and AIDS-related mortality reductions. However, new infections continue to persist.

Aim:  The study aimed to measure the clients' retention rate in pre-exposure prophylaxis (PrEP) care and associated factors.

Setting:  Engela District, in Namibia's Ohangwena region.

Methods:  We chose an analytical cross-sectional study design for this study. We selected 275 participants using a proportional stratified random sampling method. We used a self-administered questionnaire to collect data. We employed Chi-square tests and logistic regression for data analysis.

Results:  Participants' retention rate in PrEP care at 3 months was 35.6%, 95% CI (35.2% - 36.0%). Binomial logistic regression showed that men and the unemployed were less likely to be retained in PrEP, crude odds ratio (OR) = 0.52, 95% CI (0.30-0.91), and OR = 0.27, 95% CI (0.15-0.49), respectively. Participants who were divorced or in a relationship were also less likely to be retained in PrEP care, OR = 0.41, 95% CI (0.18-0.96), and OR = 0.43 95% CI (0.23 - 0.80), respectively. Furthermore, participants at Engela District Hospital were less likely to be retained in PrEP care, OR = 0.52, 95% CI (0.29 -0.93).

Conclusion:  Addressing the specific challenges unemployed individuals face in continuing on PrEP is crucial. Strategies should include decentralising PrEP services in the district and employing community-based models.Contribution: In addition, comprehensive PrEP education targeting men should be provided in diverse settings to improve their PrEP knowledge.

Background:  Delivery of a comprehensive and integrated primary health care service to increase healthcare access, quality, equity and efficiency requires an effective working environment.

Aim:  To explore perceptions of primary health care nurses in the Eastern Cape, South Africa, regarding the adequacy of their working environment for integrated primary health care service delivery.

Setting:  Selected public primary health care clinics in a subdistrict of the Nelson Mandela Bay metropole, Eastern Cape, South Africa.

Methods:  A qualitative descriptive explorative design was used. Semi-structured interviews were conducted with nine nurses working in the selected facilities. Data were thematically analysed.

Results:  Availability of members of the multidisciplinary primary health care team, nurse competency, responsiveness and productivity levels compromise integrated primary health care. Service delivery is further negatively impacted by a lack of resources and non-optimal collaboration among members of the primary health care team.

Conclusion:  Challenges to rendering an effective integrated primary health care service exist within the primary health care working environment. To significantly increase comprehensive and integrated primary health care service delivery as a quality component of South African healthcare, these challenges need to be addressed.Contribution: An evidence-based description of aspects of primary health care workspaces that compromise integrated primary health care delivery is provided. This information can be used to improve integrated primary health care services. Integrated services are a prerequisite for the Ideal Clinic Initiative, which is a foundation of the implementation of the National Health Insurance (NHI) scheme for South Africa.

Background:  Success in incorporating Ubuntu principles in the integrated management of childhood illness (IMCI) requires collaboration between health professionals and families and assistance from their communities. Despite this, the literature reviewed is silent about exploring caregivers' perspectives regarding the barriers and facilitators of incorporating Ubuntu principles in managing childhood illness.

Aim:  The study explored and described the barriers and facilitators of incorporating Ubuntu principles in managing childhood illness.

Setting:  The study was conducted in selected primary healthcare settings, community health centres and clinics in the Mafikeng sub-district of the North West province.

Methods:  The study was conducted using exploratory descriptive contextual, qualitative design. The 36 participants were selected using purposeful sampling. Data were collected through focus group discussions, and thematic analysis was used to analyse the data.

Results:  The study revealed three themes: the negative attitude of professional nurses, communication barriers and facilitators enhancing the incorporation of Ubuntu into IMCI. The findings indicated that health education of caregivers is crucial, the right allocation of nurses will facilitate the inclusion of Ubuntu into IMCI and the unannounced visit of government authorities will also facilitate the incorporation.

Conclusion:  The study illustrated that caregivers face several barriers hindering the incorporation of Ubuntu in IMCI. These findings support the need for healthcare providers to prioritise the incorporation of Ubuntu principles for better management of childhood illness for children under the age of five.Contribution: This is the first study to report the barriers and facilitators of incorporating Ubuntu principles into IMCI.

Implementation research (IR) focuses on understanding and closing the gap between evidence-based interventions and practice. Key elements to evaluate include the design of the intervention itself, contextual barriers and enablers to implementation, the use of implementation strategies as well as the achievement of implementation outcomes. This article gives an overview of IR for doctoral-level researchers in the fields of family medicine and primary care. The consolidated framework for IR and socioecological model are considered for making sense of the contextual factors. A typology of implementation strategies is also described to make conceptualisation, reporting and sharing of findings easier. Standard implementation outcomes are described, such as coverage or reach, acceptability, adoption, appropriateness, feasibility, fidelity, costs and sustainability. The RE-AIM framework for implementation outcomes is described. Finally, different study designs are discussed, including hybrid effectiveness-implementation designs and approaches to reporting using the IR logic model.

Background:  Childhood diarrhoea is a major health problem in developing countries.

Aim:  The aim of this study was to evaluate the impact of a structured teaching programme on mothers' knowledge and use of oral rehydration solution in the treatment of diarrhoea in children under 5 years of age.

Setting:  The study was conducted at Life-changing Eudaimonia Hospital, Jos, Nigeria.

Methods:  A quasi-experimental research design was used, based on a pre- and post-test with one group. Seventy mothers of children under 5 years of age suffering from diarrhoea were recruited as subjects. However, two withdrew, resulting in a response rate of 97.1%. Data were collected by administering a pretest to the respondents and a post-test after a 3-h structured teaching programme on the preparation and utilisation of oral rehydration solution in the treatment of diarrhoea.

Results:  The t-test analysis revealed that the mean knowledge and utilisation of oral rehydration solution in the treatment of diarrhoea significantly increased, with paired t-values of 3.528 (p = 0.001) and 20.382 (p  0.001) respectively.

Conclusion:  We concluded that the structured teaching programme significantly improved mothers' knowledge and utilisation of oral rehydration solution in the management of diarrhoea in children under 5 years of age at Life-changing Eudaimonia Hospital, Jos.Contribution: Based on the findings of this study, we suggest that policy makers should develop programmes that support education campaigns on oral rehydration therapy among family caregivers, especially in rural areas with poor access to health care.

Background:  The integration of diagnostic services presents a critical opportunity to improve health outcomes in low- and middle-income countries (LMICs), potentially averting up to 1 million premature deaths annually. Antenatal care provides a critical platform for diagnosing multiple diseases in an integrated manner.

Aim:  This study explored the experiences of healthcare providers and pregnant women using integrated diagnostic services at a primary care facility in Zimbabwe.

Setting:  A qualitative case study was conducted at Mabvuku Polyclinic in Harare, Zimbabwe.

Methods:  Using purposive sampling, 14 healthcare workers and 22 pregnant women participated in interviews. Observations and semi-structured interviews were recorded, transcribed and analysed using NVivo software. Thematic analysis was applied to identify key themes related to access, patient-provider interactions and systemic barriers.

Results:  According to the interviewees' reports, challenges such as limited resources, medical equipment and staff hinder efforts to integrate diagnostic services. The women strongly preferred integrated diagnosis, even if it meant enduring long waiting times, and valued the convenience of receiving all necessary services in a single visit. The study highlighted the hidden socio-economic barriers to 'free' healthcare and underscored the importance of addressing systemic inefficiencies.

Conclusion:  The insights gained from this study are transferable and contribute to the understanding of integrated diagnostic services in maternal healthcare contexts.Contribution: They offer practical recommendations for improving service delivery and health outcomes in similar settings.

Background:  Antenatal care (ANC) is a branch of primary health care service universally accessible for promoting positive maternal and neonatal outcomes globally. Pregnant women are encouraged to initiate ANC as soon as pregnancy is diagnosed. Early ANC allows a series of diagnostic procedures and investigations to exclude early, potential and actual pregnancy risks. However, the rate of late initiation of ANC remains high.

Aim:  To explore and describe factors influencing late antenatal booking based on pregnant women's perceptions in selected antenatal clinics in the Tshwane district.

Setting:  The study took place at the two selected facilities rendering ANC to the public in Tshwane district.

Methods:  A qualitative, explorative, descriptive and contextual research design was followed, and 10 purposively sampled pregnant women attended semi-structured interviews. Collaizi's descriptive method was used to analyse and organise data into themes and categories.

Results:  Although the participants had some awareness of ANC and the benefits attached, there were hindrances to the early seeking of ANC. The participants brought to light the factors that hinder early seeking of ANC under three themes: Theme 1 listed the patient-related factors; Theme 2 detailed ANC routine factors; and lastly, Theme 3 described midwives-related factors.

Conclusion:  The information dissemination methods of reproductive health and childbirth need to be revisited to ensure awareness and increase uptake of the ANC services.Contribution: The study findings have the potential to guide policymakers in addressing the factors that hinder the uptake of ANC as perceived by pregnant women - the primary consumers of the service. Additionally, the uptake of ANC may contribute to a decline in maternal and neonatal mortalities.