Scielo RSS <![CDATA[African Journal of Primary Health Care & Family Medicine ]]> vol. 15 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Climate change and the burden of healthcare financing in African households</b>]]> Climate change is a mounting pressure on private health financing in Africa - directly because of increased disease prevalence and indirectly because of its negative impact on household income. The sources and consequences of the pressure constitute an important area of policy discourse, especially as it relates to issues of poverty and inequality. Relying on a panel dataset involving 49 African countries and the period 2000-2019, as well as a random effect regression analysis, this report shows that climate change has a positive and significant impact on the level of out-of-pocket health expenditure (OPHE) in Africa, and an increase in the level of greenhouse (CO2) emissions by 1% could bring about a 0.423% increase in the level of OPHE. Indirectly, the results show that, compared with the regional average, countries that have higher government health expenditure levels, above 1.7% regional average, and face higher climate change risk may likely record an increase in OPHE. Alternatively, countries with higher per capita income (above the regional annual average of $2300.00) are likely to record a drop in OPHE. Countries with lower climate change risk and a lower than the regional average age dependency (above the regional average of 80.4%) are also likely to record a drop in OPHE. It follows that there is a need for policy alignment, especially with regard to how climate change influences primary health care funding models in Africa. CONTRIBUTION: The results of this research offer policymakers in-depth knowledge of how climate change erodes healthcare financing capacity of government and shifts the burden to households. This raises concerns on the quality of accessible healthcare and the link with poverty and inequality <![CDATA[<b>Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria</b>]]> BACKGROUND: Electronic cigarette (e-cigarette) use is becoming popular among undergraduate students in Nigeria with a tendency for escalation because of the coronavirus disease 2019 (COVID-19) pandemic AIM: The aim of this study was to assess electronic cigarette use in COVID-19 era among undergraduate students of a tertiary institution in Lagos state, Southwestern Nigeria SETTING: A tertiary institution in Southwestern Nigeria METHODS: The study design was a descriptive cross-sectional study with a pretested, structured, close- and open-ended self-administered questionnaire used for collection of data on knowledge, attitude and use of e-cigarettes RESULTS: Data from 183 respondents were analysed. The mean age of respondents was 24.8 ± 3.38 years, most (63%) of whom were males. The prevalence of ever-use of e-cigarettes was 15.3% of which 60.7% reported increased use of e-cigarettes since the COVID-19 pandemic. Age, education, tribe and religion (p < 0.001) were significantly associated with higher odds of use of e-cigarettes CONCLUSION: This study found an increase in the quantity of e-cigarettes used and online purchase of the same by respondents since the COVID-19 pandemic. Paying attention to the rate of use and having control measures in place for online purchase of e-cigarettes by youths in Nigeria may be necessary in the years to come CONTRIBUTION: This study addresses a gap in the availability of knowledge of use of e-cigarettes among a growing population of youths in Nigeria <![CDATA[<b>The completeness of adverse drug reaction reports in South Africa: An analysis in VigiBase®</b>]]> BACKGROUND: Spontaneous reporting is regarded as a cornerstone of pharmacovigilance (PV) but presents many limitations, including varying quality and completeness of information, which is essential for causality assessment AIM: This study aimed to evaluate the completeness of adverse drug reaction (ADR) reports in South Africa based on the vigiGrade completeness score SETTING: The South African Health Products Regulatory Authority (SAHPRA METHODS: A cross-sectional, descriptive study of all reports received by SAHPRA and submitted to VigiBase® in 2017 was conducted. A report with a vigiGrade score > 0.8 is considered well-documented RESULTS: The mean completeness score for the 8438 reports received was 0.456 (s.d. = 0.221). Only 11.3% of reports had a completeness score > 0.8. The completeness of reports submitted by consumers professionals did not significantly differ from reports by physicians, pharmacists or other healthcare professionals (d ≤ 0.2). Reports of reactions that resulted in death (M = 0.572, s.e. = 0.007), disability (M = 0.491, s.e. 0.033) or were life threatening (M = 0.474, s.e. = 0.013) had a medium to large practically significant effect (0.5 ≥ d ≤ 0.8) on the completeness score compared with reports of congenital anomaly (M = 0.348, s.e. = 0.089 CONCLUSION: The completeness of reports submitted by consumers is comparable to those submitted by healthcare professionals. The completeness of reports was low and multiple measures to improve reporting are recommended CONTRIBUTION: This study describes the completeness of ADR reports in South Africa and the results can be used to improve training <![CDATA[<b>Adaptation and validation of the Ugandan Primary Care Assessment Tool</b>]]> BACKGROUND: Health systems based on primary health care (PHC) have better outcomes at lower cost. Such health systems need regular performance assessment for quality improvement and maintenance. In many low- and middle-income countries (LMICs), there are no electronic databases for routine monitoring. There is an urgent need for valid and reliable tools to measure PHC performance AIM: This study aimed to adapt and validate the Primary Care Assessment Tool (PCAT) in the Ugandan context SETTING: The experts that participated in the Delphi process were recruited from almost all over the country METHODS: The study utilised a Delphi process with a panel of 20 experts (14 district health officers, 4 academics in primary care and 2 ministry of health [MOH] technical staff) who responded to iterative rounds of questionnaires in order to reach consensus (defined as > 70% agreement RESULTS: Consensus was reached after two rounds of the Delphi. In round one, four items in the comprehensiveness domain (services available) were removed and five items needed rephrasing. A new domain on person-centredness with 13 items was suggested. In round two, the new domain with each and every single one of its items and the items for rephrasing all achieved consensus. The final Ugandan version of the PCAT (UG-PCAT) has 12 domains and 91 items CONCLUSION: The South African Primary Care Assessment Tool (ZA PCAT) was adapted and validated with an additional domain on person-centredness to measure primary care performance in the Ugandan context, and can now be used to measure the quality of core functions of primary care in Uganda CONTRIBUTION: The PCAT could fulfil the need for such a tool in a wider LMIC context. The UG-PCAT will be used to measure the quality of these core functions in Uganda and to assist with the improvement of PHC <![CDATA[<b>Self-reported continuity and coordination of antenatal care and its association with obstetric near miss in Uasin Gishu county, Kenya</b>]]> BACKGROUND: Continuity and coordination of care are core principles of high-quality primary health care. Optimising continuity and coordination improves maternal satisfaction. However, their association with morbidity and mortality outcomes is unclear. The obstetric near-miss approach can be used to investigate whether continuity and coordination influences the occurrence of a severe maternal outcome AIM: To compare self-reported continuity and coordination of care between obstetric near-miss survivors and those without near miss during pregnancy, delivery and postpartum SETTING: Uasin Gishu county, Rift Valley region, Kenya METHODS: A cross-sectional survey targeting 340 postnatal mothers. Continuity of care index (COCI) and modified continuity of care index (MCCI) were used to estimate longitudinal continuity. The Likert scale was administered to measure perceived continuity and coordination of care. Mann-Whitney U test and binomial logistic regression were used for hypothesis testing RESULTS: COCI and MCCI were lower among near-miss survivors (COCI = 0.80, p = 0.0026), (MCCI = 0.62, p = 0.034). Near-miss survivors scored lower on items assessing coordination between a higher-level provider and usual antenatal clinic (mean = 3.6, p = 0.006) and general coordination of care during pregnancy (mean = 3.9, p = 0.019). Presence of a non-life-threatening morbidity in pregnancy was associated with occurrence of near miss (aOR = 4.34, p = 0.001 CONCLUSION: Near-miss survivors scored lower on longitudinal continuity and coordination of care across levels. Further research should focus on strengthening coordination, determining the optimal level of longitudinal continuity and improving systems for early identification and management of morbidities in pregnancy CONTRIBUTION: The results of this study show that while longitudinal and relational COC is important during the antenatal period, the presence of a non-life-threatening condition in pregnancy remains the most important predictor of the occurrence of a near miss <![CDATA[<b>Primary health care nurses' knowledge, self-efficacy and performance of diabetes self-management support</b>]]> BACKGROUND: Patients living with diabetes are primarily managed and supported by nurses in primary health care (PHC). Therefore, PHC nurses require knowledge of diabetes and confidence (self-efficacy) to perform diabetes self-management support (SMS AIM: This study evaluated the diabetes knowledge, self-efficacy and performance of diabetes SMS by PHC nurses SETTING: Primary health care facilities in King Sabata Dalindyebo subdistrict, O.R. Tambo district, Eastern Cape METHODS: A quantitative cross-sectional and simple correlational design was used. Registered nurses (n = 100) completed a validated self-reporting questionnaire to measure diabetes knowledge, self-efficacy and performance of SMS RESULTS: Participants' diabetes knowledge mean scores were high (mean of 11.9, standard deviation [s.d.] 1.8, out of 14). Self-efficacy scores (mean 18.91, s.d. 3.2 out of 24) were higher than performance of SMS scores (mean 17.81, s.d. 3.3 out of 24). Knowledge was not associated with self-efficacy or performance, but self-efficacy was positively correlated with performance of SMS (r = 0.78, p < 0.01). Nurses with a postgraduate qualification in primary care nursing had significantly higher diabetes knowledge scores (mean = 92.9 vs. 83.8; p = 0.03), and years of experience as a nurse were positively correlated with the performance of SMS (r = 0.21, p = 0.05 CONCLUSION: Diabetes knowledge of PHC nurses in this study does not translate into self-efficacy and the performance of SMS in practice, indicating the need for specific SMS training, support by experienced mentors, appropriate guidelines and comprehensive integrated chronic care systems CONTRIBUTION: This is the first study to report on the SMS self-efficacy and performance of PHC nurses in South Africa <![CDATA[<b>Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa</b>]]> BACKGROUND: Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme AIM: To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme SETTING: This qualitative study was conducted with 19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa METHODS: Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling's thematic networks framework RESULTS: The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty CONCLUSION: Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded CONTRIBUTION: Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery <![CDATA[<b>Combating coronavirus disease (COVID-19) in rural areas of Malawi: Factors affecting the fight</b>]]> BACKGROUND: Owing to their detachment from urban areas, people living in rural areas of Malawi are on the receiving end of health services and socio-economic benefits. The study therefore explored how Malawians living in these areas are adhering to coronavirus disease 2019 (COVID-19) containment measures and the factors that affect the COVID-19 fight amongst this population AIM: The study investigated how the rural population in Malawi adheres to COVID-19 containment measures SETTING: The study was conducted in two districts in Northern Malawi METHODS: Data were collected from 263 participants. The chi-square (χ²) test was performed to determine the association between demographic variables and COVID-19 prevention practices and factors affecting the COVID-19 fight RESULTS: Education was significantly associated with wearing of masks (p = 0.01), use of sanitisers (p < 0.01) and practising social distancing (p = 0.07). Monthly income was associated with the use of sanitisers (p < 0.01). Women were more exposed to fake news about COVID-19 (p = 0.09); older people were more likely to disregard COVID-19 containment measures for cultural reasons (p = 0.07); and monthly income was associated with a lack of resources for following COVID-19 containment measures (p < 0.01 CONCLUSION: Findings show that factors affecting the COVID-19 fight are influenced by various socio-economic factors which should therefore be taken into account in policy planning aiming at controlling the pandemic CONTRIBUTION: The study provides health stakeholders with a policy direction that enhances better coordination, implementation and monitoring of COVID-19 response and recovery activities in rural areas in Malawi. The findings have implications on controlling current and future communicable diseases; the proposed strategies might be employed in fighting similar current and future pandemics <![CDATA[<b>Chronic diseases of lifestyle curriculum: Students' perceptions in primary health care settings</b>]]> BACKGROUND: Community-based primary health care (PHC) forms the foundation of healthcare in South Africa. Medical programmes need to equip future health practitioners to face the challenges of the rising burden of chronic diseases of lifestyle (CDL) in different communities. Community-based education (CBE) contributes to developing knowledge, skills and attitudes appropriate to the challenges experienced in the PHC context AIM: To explore medical students' perceptions of the current CDL curriculum and related programmes during CBE rotations SETTING: The study was conducted among fourth- and fifth-year medical students at the University of the Free State, South Africa METHODS: Focus group discussions were conducted and data were analysed thematically RESULTS: Themes included perceptions of the CDL curriculum, relevance thereof for the PHC setting and barriers and challenges to implementing PHC programmes. This study identified foundational CDL content that needs to be incorporated or revisited at strategic points. Participants identified the need to contextualise educational programmes and focus on affordable, culturally acceptable and holistic healthcare prevention strategies. Barriers and challenges included high patient load, resource constraints, the lack of continuous care and focus on communicable diseases. Community-based education rotations were described as meaningful opportunities to develop professional attributes, competencies and skills CONCLUSION: This study identified foundational concepts to consider at key points throughout the curriculum. Incorporating creative and reflective learning activities in CDL modules can prepare students for the realities of PHC settings CONTRIBUTION: This study provides insight into medical students' perceptions of the CDL curriculum and informs future curriculum content for CDL modules <![CDATA[<b>Experiences of primary health care practitioners dealing with emergencies - 'We are on our own'</b>]]> BACKGROUND: Primary health care (PHC) focuses on health promotion and disease prevention; however, acute episodes and emergencies still occur at this level of care. The World Health Organization (WHO) proposes strengthening emergency care at a PHC level as a way of lessening the burden of disease on the overall health system. It is not known how health care practitioners at the PHC level experience management of emergencies AIM: To explore and describe the experiences of PHC practitioners dealing with emergencies at PHC facilities in Gauteng, South Africa SETTING: The study was conducted in the District Health Services of Gauteng province in South Africa, including clinics, community health care centres and district hospitals METHODS: Using a qualitative approach, semi-structured interviews were conducted with a purposively selected sample of professional nurses and doctors from various levels of the district health care system. Data were transcribed and analysed using qualitative thematic analysis RESULTS: Various themes were identified related to the individual confidence and competence of the PHC practitioner, the team approach, the process of role and task allocation and the need for training CONCLUSION: The study provided a voice for the needs of health care practitioners dealing with emergencies at the PHC level. The designing of a targeted and contextually appropriate approach to emergency care training of health care practitioners in the PHC setting that improves team dynamics and team performance, is recommended CONTRIBUTION: The insights of PHC practitioners dealing with emergencies contribute contextual relevance to any strategic improvement of care at this level <![CDATA[<b>Protocol for a cross-sectional study on COVID-19 vaccination programmes in primary health care</b>]]> BACKGROUND: An integrated primary health care approach, where primary care and public health efforts are coordinated, is a key feature of routine immunisation campaigns AIM: The aim of the study is to describe the approach used by a diverse group of international primary health care professionals in delivering their coronavirus disease 2019 (COVID-19) vaccination programmes, as well as their perspectives on public health and primary care integration while implementing national COVID-19 vaccination programmes in their own jurisdictions SETTING: This is a protocol for a study, which consists of a cross-sectional online survey disseminated among a convenience sample of international primary health care professional through member-based organisations and professional networks via email and online newsletters METHODS: Survey development followed an iterative validation process with a formative committee developing the survey instrument based on study objectives, existing literature and best practices and a summative committee verifying and validating content RESULTS: Main outcome measures are vaccination implementation approach (planning, coordination service deliver), level or type of primary care involvement and degree of primary care and public health integration at community level CONCLUSION: Integrated health systems can lead to a greater impact in the rollout of the COVID-19 vaccine and can ensure that we are better prepared for crises that threaten human health, not only limited to infectious pandemics but also the rising tide of chronic disease, natural and conflict-driven disasters and climate change CONTRIBUTION: This study will provide insight and key learnings for improving vaccination efforts for COVID-19 and possible future pandemics <![CDATA[<b>Child health promotion during the COVID-19 pandemic: A health and welfare sector collaboration</b>]]> BACKGROUND: Fragmented service provision and a lack of efficient cooperation between health and welfare sectors serving children and families remain ongoing challenges in South Africa. The coronavirus disease 2019 (COVID-19) pandemic escalated this fragmentation. A community of practice (CoP) was established by the Centre for Social Development in Africa to promote collaboration between the sectors and to assist communities in their environments AIM: To explore and describe collaboration on child health promotion between professional nurses and social workers, who formed part of the CoP during the COVID-19 pandemic SETTING: The study was conducted in five public schools from four of the seven district regions of the City of Johannesburg, Gauteng province METHODS: A qualitative, exploratory, descriptive research design was employed to conduct psychosocial and health screenings of children and their families. Focus group interviews were conducted, and field notes were used to collect and confirm data from the team RESULTS: Four themes emerged. Participants shared their positive and negative experiences faced during the fieldwork, their realisation of the value of collaboration between various sectors and their desire and capacity to do more CONCLUSION: Participants indicated that collaboration between the health and welfare sectors is vital to support and promote the health of children and their families. The COVID-19 pandemic highlighted the need for collaboration between these sectors in the children and their families' ongoing struggles CONTRIBUTION: The importance of these sectors being engaged as a team highlighted the multisectoral influence shaping child development outcomes, supporting children's human rights and advancing social and economic justice <![CDATA[<b>Practice, attitudes and views of right to access of sexual and reproductive health services by LGBTQI among primary health care nurses in Tshwane</b>]]> BACKGROUND: Sexual and reproductive healthcare services (SRHS) are crucial investments for improving individual well-being and granting an opportunity to exercise sexual and reproductive rights. Primary health care (PHC) nurses are described as gatekeepers, preventing many individuals, including the members of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) community, from accessing much-needed healthcare services AIM: The study aimed at exploring the experiences and perceptions of PHC nurses during the provision of SRHS for members of the LGBTQI community SETTING: The study was conducted among eight clinics around Tshwane in South Africa METHODS: Twenty-seven professional nurses were selected purposively, using an exploratory design approach. A semistructured interview guide and in-depth face-to-face interviews were used to gather data. Data were analysed using thematic content analysis (TCA RESULTS: Four themes emerged: understanding of SRHS, attitudes of PHC nurses, frequency of rendering services based on utilisation of SHR and views of nurses on the right to access SRHS CONCLUSION: A heteronormative approach was mostly indicated when rendering SHRS to the members of the LGBTQI community. Members of the LGBTQI community do not use the SRHS as often as heterosexual patients; lack of training, skills and knowledge were identified as barriers to rendering much-needed SRHS for members of the LGBTQI community CONTRIBUTION: The findings of this study assisted in demonstrating the PHC nurses' perceptions, experiences, skills and knowledge of LGBTQI SRHS, thus improving the members of the LGBTQI community's accessibility and utilisation of SRHS <![CDATA[<b>Early cervical cancer screening: The influence of culture and religion</b>]]> BACKGROUND: Screening for cervical cancer at an early stage is essential for providing women with a better chance of receiving effective treatment for both precancers and cancer. Delaying screening until cancer has advanced can be detrimental, resulting in late presentation of cervical cancer and, as a result, cancer metastasis AIM: The purpose of this study was to assess the extent to which culture and religion influence early cervical cancer screening in women SETTING: The research was conducted in one of the rural districts in Manicaland Province of Zimbabwe METHODS: A qualitative exploratory and contextual design was utilised, and data were gathered by means of semistructured interviews. At 17 semistructured interviews, data saturation was reached and further data collection terminated. Data were thematically analysed RESULTS: Five themes that described participants' perceptions on culture and religion as barriers to early cervical cancer screening emerged from the data. These included a lack of knowledge, stigmatisation, cultural beliefs and values, religion and a lack of resources. These all negatively affected participants' motivation to seek early screening services CONCLUSION: According to the study findings, culture and religion constitute impediments to early cervical cancer screening for rural women. Interventions that encourage screening, such as targeted health education and health promotion materials, must consider cultural and religious views if behaviour change in diverse groups is to be accomplished CONTRIBUTION: The study has the potential to inform Zimbabwean health policy and contribute to prospective interventions or health education that encourage women to attend early cancer screening <![CDATA[<b>Facilitators and barriers to <i>in vitro</i> diagnostics implementation in resource-limited settings: A scoping review</b>]]> BACKGROUND: The World Health Organization (WHO) developed the model list of essential in vitro diagnostics (EDL) to guide countries to develop and update point-of-care (POC) per their disease priorities. The EDL includes POC diagnostic tests for use in health facilities without laboratories; however, their implementation might face several challenges in low- and middle-income countries (LMICs AIM: To identify facilitators and barriers to POC testing service implementations in the primary health care facilities in the LMICs SETTING: Low- and middle-income countries METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. A comprehensive keyword search for literature was conducted in Google Scholar, EBSCOhost, PubMed, Web of Science and ScienceDirect using the Boolean terms ('AND' and 'OR'), as well as Medical Subject Headings. The study considered published articles in the English language from 2016 to 2021 and was limited to qualitative, quantitative and mixed-method studies. Two reviewers independently screened the articles at the abstract and full-text screening phases guided by the eligibility criteria. Data were analysed qualitatively and quantitatively RESULTS: Of the 57 studies identified through literature searches, 16 met this study's eligibility criteria. Of the 16 studies, 7 reported on both facilitators and barriers; and the remainder reported on only barriers to POC test implementation such as inadequate funding, insufficient human resource, stigmatisation, et cetera CONCLUSION: The study demonstrated a wide research gap in facilitators and barriers, especially in the general POC diagnostic test for use in health facilities without laboratories in the LMICs. Extensive research in POC testing service is recommended to improve service delivery CONTRIBUTION: This study's findings contribute to a few works of literature on existing evidence of POC testing <![CDATA[<b>COVID-19 impact on newly initiated and restarted antiretroviral treatment patients in the Eastern Cape, South Africa</b>]]> BACKGROUND: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. AIM: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. SETTING: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. METHODS: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. RESULTS: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. CONCLUSION: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. CONTRIBUTION: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa. <![CDATA[<b>Caregivers' health-seeking behaviour for children participating in an integrated school health programme in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Caregivers are active members of the healthcare team, and the uniqueness of their role in caring for a sick child is holistic, as no other healthcare team member is consistently aware of all the facets of the child's life. The integrated school health programme (ISHP) aims to improve access to healthcare services and promote equity for school-going children by delivering comprehensive healthcare services. However, not much attention has been paid to understanding caregivers' health-seeking experiences within the context of the ISHP. AIM: This study sought to understand caregivers' health-seeking behaviour for their children participating in the ISHP. SETTING: Three low-resource communities were chosen within the eThekwini District of the KwaZulu-Natal province, South Africa. METHODS: This study utilised a qualitative research design. We recruited 17 caregivers using purposive sampling. Semistructured interviews were conducted, and the data were analysed using thematic analysis. RESULTS: Caregivers explored multiple means of care, ranging from managing the children's health conditions based on previous experiences to visiting traditional healers and administering traditional medicines. Caregivers delayed health seeking due to low literacy levels and financial barriers. CONCLUSION: Although ISHP has expanded its coverage and the range of services provided, the study suggests the need to implement interventions focused on providing support to caregivers of sick children within the ISHP context. CONTRIBUTION: The findings of the study highlight the need to develop potential schemes to address transportation barriers to accessing healthcare services for school-going children. <![CDATA[<b>Losses along the tuberculosis sputum sample referral cascade for Mpongwe District, Zambia</b>]]> BACKGROUND: In resource limited-settings, timely tuberculosis (TB) diagnosis depends upon referral of sputum samples from non-diagnostic to diagnostic facilities for examination. The TB programme data for 2018 suggested losses in Mpongwe District's sputum referral cascade. AIM: This study aimed to identify the referral cascade stage where loss of sputum specimen occurred. SETTING: Primary health care facilities in Mpongwe District, Copperbelt Province, Zambia. METHODS: Data were retrospectively collected from one central laboratory and six referring health facilities between January and June 2019, using a paper-based tracking sheet. Descriptive statistics were generated in SPSS version 22. RESULTS: Of the 328 presumptive pulmonary TB patients found in presumptive TB registers at referring facilities, 311 (94.8%) submitted sputum samples and were referred to the diagnostic facilities. Of these, 290 (93.2%) were received at the laboratory, and 275 (94.8%) were examined. The remaining 15 (5.2%) were rejected for reasons such as 'insufficient sample'. Results for all examined samples were sent back and received at referring facilities. Referral cascade completion rate was 88.4%. Median turnaround time was six days (IQR = 1.8). CONCLUSION: Losses in the sputum referral cascade for Mpongwe District mainly occurred between dispatch of sputum samples and receipt at diagnostic facility. Mpongwe District Health Office needs to establish a system to monitor and evaluate the movement of sputum samples along the referral cascade to minimize losses and ensure timely TB diagnosis. CONTRIBUTION: This study has highlighted, at primary health care level for resource limited settings, the stage in the sputum sample referral cascade where losses mainly occur. <![CDATA[<b>Knowledge, attitude and practice on screening and early diagnosis of prostate cancer of primary health care providers in the Free State</b>]]> BACKGROUND: Prostate cancer is topmost in terms of incidence and mortality among men in sub-Saharan Africa, including South Africa. Prostate cancer screening is beneficial only to certain categories of men, making a rational screening approach necessary. AIM: This study aimed to assess the knowledge, attitudes and practice (KAP) regarding prostate cancer screening among primary health care (PHC) providers in the Free State, South Africa. SETTING: Selected district hospitals, local clinics and general practice rooms. METHODS: This was a cross-sectional analytical survey. Participating nurses and community health workers (CHWs) were selected through stratified random sampling. All available medical doctors and clinical associates were approached to participate, totalling 548 participants. Relevant information was obtained from these PHC providers using self-administered questionnaires. Both descriptive and analytical statistics were computed using Statistical Analysis System (SAS) Version 9. A p-value < 0.05 was considered significant. RESULTS: Most participants had poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%). Female PHC providers, lower cadre nurses and CHWs had lower mean knowledge scores. Not participating in prostate cancer-related continuing medical education was associated with poor knowledge (p < 0.001), negative attitudes (p = 0.047) and poor practice (p < 0.001. CONCLUSION: This study established appreciable KAP gaps relating to prostate cancer screening among PHC providers. Identified gaps should be addressed through the preferred teaching and learning strategies suggested by the participants. CONTRIBUTION: This study establishes the need to address KAP gaps regarding prostate cancer screening among PHC providers; therefore necessitating the capacity-building roles of district family physicians. <![CDATA[<b>Planetary health and environmental sustainability in African health professions education</b>]]> CliMigHealth and the Education for Sustainable Healthcare (ESH) Special Interest Group of the Southern African Association of Health Educationalists (SAAHE) call for the urgent integration of planetary health (PH) and environmental sustainability into health professions curricula in Africa. Education on PH and sustainable healthcare develops much-needed health worker agency to address the connections between healthcare and PH. Faculties are urged to develop their own 'net zero' plans and to advocate for national and sub-national policies and practices that promote the Sustainable Development Goals (SDGs) and PH. National education bodies and health professional societies are urged to incentivise innovation in ESH and to provide discussion forums and resources to support the integration of PH into curricula. CONTRIBUTION: This article provides a position statement for integrating planetary health and environmental sustainability into African health professions education curricula. <![CDATA[<b>Prevalence of excess weight and associated socio-demographic factors among postmenopausal women: A population-based study in Ghana</b>]]> BACKGROUND: Excess weight (obesity and overweight) is a pervasive condition that is considered a global epidemic and a threat to public health. Furthermore, numerous changes in fat deposits occur with the advent of menopause, leading to a change in the distribution of body fat. Knowledge of sociodemographic factors and prevalence can inform the effective management of these women. AIM: This study aimed to investigate the prevalence of excess weight among postmenopausal women in Ghana's Bono East (Techiman) region. SETTING: This study was conducted in Bono East regional capital, Techiman, Ghana. METHODS: This is a cross-sectional study conducted over 5 months at Bono East regional capital, Techiman in Ghana. Anthropometric parameters such as body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were obtained using physical measurements while socio-demographic data were gathered using questionnaires. Data analysis was performed using IBM SPSS 25. RESULTS: The mean age of the 378 women who participated in the study was 60.09 ± 6.24 years. Body mass index, WHtR and WHR indicated excess weight of 73.2%, 91.8% and 91.0%, respectively. Education and ethnicity were predictors of excess weight (WHR). Women of the Ga tribe with high school education have 4.7- and 8.6-times increased odds of having excess weight. CONCLUSIONS: There are higher prevalence rates of excess weight (obesity and overweight) among postmenopausal women using BMI, WHtR and WHR. Education and ethnicity are predictors of excess weight. CONTRIBUTION: The study's findings can be used to develop interventions that focus on addressing excess weight in postmenopausal women within the Ghanaian context. <![CDATA[<b>The start of sexual health curriculum development and evaluation at Stellenbosch University</b>]]> BACKGROUND: Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS), developed a sexual health course to be integrated throughout the revised medical curriculum. AIM: To use the Sexual Health Education for Professionals Scale (SHEPS) to gather baseline and future follow-up data to inform curriculum development and evaluation. SETTING: The first-year medical students (N = 289) of the FMHS SU. METHODS: The SHEPS was answered before the start of the sexual health course. The knowledge, communication and attitude sections were answered with a Likert-type scale. Students had to describe their perceived confidence in their knowledge and communication skills to care for patients within specific sexuality-related clinical scenarios. The attitude section measured the students' level of agreement or disagreement on sexuality-related opinion statements. RESULTS: The response rate was 97%. Most students were female, and 55% of the class were first taught about sexuality in the age group 13-18 years. The students had more confidence in their communication skills than knowledge before any tertiary training. The attitude section revealed a binomial distribution, ranging from acceptance to a more restrictive attitude towards sexual behaviour. CONCLUSION: It is the first time the SHEPS has been used in a South African context. The results provide novel information about the range of perceived sexual health knowledge, skills and attitudes of first-year medical students before they start tertiary training CONTRIBUTION: Findings from this study will guide content development and evaluation of the sexual health course at the institution where the study was conducted, as well as allow for culture sensitive education. <![CDATA[<b>Community Health Worker programmes' integration into national health systems: Scoping review</b>]]> BACKGROUND: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing. AIM: This review presents evidence on CHW programmes' integration into National Health Systems for improved health outcomes in SSA. SETTING: Sub-Saharan Africa. METHOD: Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form. RESULTS: A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region. CONCLUSION: Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region. CONTRIBUTION: The study presents synthesized evidence on CHW programmes integration into national health systems in SSA. <![CDATA[<b>Mental health symptoms among homeless shelter residents during COVID-19 lockdown in Tshwane, South Africa</b>]]> BACKGROUND: In order to contain the spread of COVID-19 in South Africa during the national state of emergency, the Gauteng Department of Social Development established temporary shelters and activated existing facilities to provide basic needs to street-homeless people in Tshwane, which facilitated primary health care service-delivery to this community. AIM: This study aimed to determine and analyse the prevalence of mental health symptoms and demographic characteristics among street-homeless people living in Tshwane's shelters during lockdown. SETTING: Homeless shelters set up in Tshwane during level 5 of the COVID-19 lockdown in South Africa. METHODS: A cross-sectional, analytical study was conducted using a Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-based questionnaire that looked at 13 mental health symptom domains. RESULTS: Presence of moderate-to-severe symptoms were reported among the 295 participants as follows: substance use 202 (68%), anxiety 156 (53%), personality functioning 132 (44%), depression 85 (29%), sleep problems 77 (26%), somatic symptoms 69 (23%), anger 62 (21%), repetitive thoughts and behaviours 60 (20%), dissociation 55 (19%), mania 54 (18%), suicidal ideation 36 (12%), memory 33 (11%) and psychosis 23 (8%). CONCLUSION: A high burden of mental health symptoms was identified. Community-oriented and person-centred health services with clear care-coordination pathways are required to understand and overcome the barriers street-homeless people face in accessing health and social services. CONTRIBUTION: This study determined the prevalence of mental health symptoms within the street-based population in Tshwane, which has not previously been studied. <![CDATA[<b>Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management</b>]]> BACKGROUND: Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected. AIM: The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM. SETTING: The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa. METHODS: A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed. RESULTS: Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person's identity. Despite the users' awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life. CONCLUSION: Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident. CONTRIBUTION: By listening to the adolescent's voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management. <![CDATA[<b>Factors contributing to the low number of blood donors among employed residents in Oshatumba village, Namibia</b>]]> BACKGROUND: Blood transfusion plays a significant role in maternal and child-care interventions, as well as by saving lives following natural disasters. Ignorance and fear among the general population in Namibia limit the numbers of blood donors, leaving the Namibian Blood Transfusion Services (NAMBTS) with insufficient donations for hospital patients. A review of the literature did not disclose publications on the factors that contribute to the low number of blood donors in Namibia, despite the urgent need for an increased pool of blood donors. AIM: The aim was to explore and describe the factors contributing to the low number of blood donors among the employed residents of the Oshatumba village, Oshana Region, Namibia SETTINGS: Interviews were conducted at a peri-urban village located in the eastern part of the Oshakati District in the Oshana Region. METHODS: A qualitative methodology utilising explorative, descriptive and contextual strategies. Data were collected by means of individual, in-depth, semi-structured interviews with 15 participants, who were selected through convenience sampling. RESULTS: The study discovered three themes: (1) the concept of blood donation; (2) factors contributing to low blood donations and (3) practical suggestions to increase the low uptake of blood donations. CONCLUSION: The findings of this study revealed that individual health status, religious beliefs and misconceptions associated with blood donations are among the factors that cause a low level of blood donations. CONTRIBUTION: The research findings can be used to develop strategies and targeted interventions to increase the number of blood donors. <![CDATA[<b>Risk factors for mild cognitive impairment among older adults in a hospital in southern Nigeria</b>]]> BACKGROUND: About 63% of people living with mild cognitive impairment (MCI) and dementia live in low- and middle-income countries (LMICs). Emerging evidence suggests that early risk factors for the development of MCI and dementia can be modified by public health and preventive intervention approaches. AIM: This study aimed to assess the prevalence of MCI in older adult patients and its relationship with some risk factors. SETTING: The study was conducted among older adults at the Geriatric Clinic of the Family Medicine Department of a hospital in southern Nigeria. METHODS: A cross-sectional study was carried out involving 160 subjects aged 65 years and above over a period of 3 months. Socio-demographic and clinical data were obtained using an interviewer-administered questionnaire. Subjects were accessed for impaired cognition using the 10-word delay recall test scale. Data were analysed using SPSS version 23. RESULTS: There were 64 males and 96 females; male to female ratio was 1:1.5. Majority of the study population were in age range of 65-74 years. The overall prevalence of MCI was 59.4%. Respondents with tertiary education were 82% less likely to have MCI on logistic regression analysis (OR = 0.18, 95% CI = 0.465-0.719. CONCLUSION: Mild cognitive impairment was prevalent among older adults in this study and was found to be significantly associated with low level of education. CONTRIBUTION: It is therefore recommended that screening for MCI and known risk factors should be prioritized at geriatric clinics. <![CDATA[<b>Clinical recommendations for chronic musculoskeletal pain in South African primary health care</b>]]> BACKGROUND: Chronic musculoskeletal pain (CMSP) is prevalent globally and places a significant burden on individuals, healthcare systems and economies. Contextually appropriate clinical practice guidelines (CPGs) on CMSP are advocated to translate evidence into practice. AIM: This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). SETTING: The PHC sector in South Africa (SA). METHODS: Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. RESULTS: Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. CONCLUSION: A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors. CONTRIBUTION: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA. <![CDATA[<b>Teaching comprehensive sexuality education using a praxis co-created with adolescents</b>]]> BACKGROUND: Despite its reported positive deliverables, comprehensive sexuality education (CSE) in South African schools is unable to document an influence in reducing alarming statistics regarding adolescent sexual health. Prior research points to a gap that exists between what studies suggest and what is implemented in practice. AIM: Drawing on Freire's theory of praxis, the aim of this study was to involve the voice of adolescents in reforming CSE - specifically, how the programme could be developed with the objective to co-construct a praxis in order to support sexuality educators in a delivery of CSE that is more responsive to the needs of adolescents. SETTING: Ten participants were purposively selected from all five school quintiles in the Western Cape province of South Africa to take part in this study. METHODS: A qualitative descriptive design with aspects of a phenomenological approach was utilised. Rich data were collected by means of semistructured interviews and were analysed thematically with ATLAS.ti. RESULTS: The results illustrate the suggestions made by the participants towards the improvement of the CSE programme. They reported on approaches and strategies used to teach CSE that imply that it is often not delivered comprehensively - confirming the disjuncture between what the curriculum envisages and what is executed in practice. CONCLUSION: The contribution might lead to change in disconcerting statistics and consequently an improvement in the sexual and reproductive health of adolescents. CONTRIBUTION: The participants from this study assisted in co-constructing a praxis for CSE teachers to inform their practice. <![CDATA[<b>Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria</b>]]> BACKGROUND: Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship. AIM: This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria SETTING: This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria. METHODS: After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice. RESULTS: The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life. CONCLUSION: This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function. CONTRIBUTION: This study contributes to holistic approaches to patient care. <![CDATA[<b>Education for primary health care in Africa</b>]]> BACKGROUND: Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship. AIM: This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria SETTING: This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria. METHODS: After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice. RESULTS: The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life. CONCLUSION: This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function. CONTRIBUTION: This study contributes to holistic approaches to patient care. <![CDATA[<b>Nurses' and patients' experiences of family planning services in a rural district, South Africa</b>]]> BACKGROUND: Family planning (FP) is a key component of primary health care (PHC). Nurses are the first source of FP information to women outside their social context. There is a paucity of research regarding clients' lived experiences of FP, particularly understanding both the client's and the healthcare worker's experiences in the same clinical context and community. AIM: This study aims to explore the lived experiences of nurses and female clients regarding FP services at PHC clinics. SETTING: Two PHC clinics in a rural sub-district in South Africa. METHODS: A descriptive qualitative study using semi-structured interviews was conducted. Clients and nurses were selected using criterion-based purposive sampling and interviewed by female research assistants in a home language in a private setting. Transcription and translation of audio recordings were done. Data were analysed inductively using the framework method. RESULTS: Ten clients and eight nurses were interviewed, with an equal number from each clinic. The median age of clients was 28.5 years and of nurses was 47.5 years. Four themes emerged: (1) Stigma, culture and the teenage girl; (2) Bad effects - the Big Five, clustered around weight changes, blood blockages and abnormal bleeding, pain, fertility and cancer; (3) FP social dynamics; and (4) FP and the health system. CONCLUSION: Family planning is highly moralised and stigmatised. Negative effects of FP were not adequately recognised by the health system. Family planning outreach into the community and dedicated FP resources at clinics were suggestions to improve the service CONTRIBUTION: This work helps to better understand patients' experiences of family planning services. <![CDATA[<b>Training needs of professional nurses in primary health care in the Cape Metropole, South Africa</b>]]> BACKGROUND: In the fast-changing healthcare environment, it is important to ensure that primary health care (PHC) nurses are suitably qualified and have access to appropriate and relevant ongoing education. AIM: The aim of this study was to determine the training needs of professional nurses working in PHC facilities. SETTING: The research was conducted in PHC facilities in the Cape Metropole, Western Cape, South Africa. METHODS: A quantitative descriptive survey with all-inclusive sampling was used. All professional nurses (N = 303), employed for at least a minimum of 6 months in PHC facilities were included in the study. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire was used to collect the data on professional tasks training needs and open-ended questions for specific PHC contextual training needs. Importance and performance means for each of the TNA subsections and training needs were calculated. Open-ended questions were analysed using content analysis, identifying training domains and topics in terms of frequency and ranking. RESULTS: The TNA identified 'Research' as the highest training need. Research tasks were significantly rated as the least important and the lowest rated performance compared to other domains. Child mental health was rated as the most important specific training need CONCLUSION: The results of this survey provide insight into the training needs of professional nurses employed in PHC facilities and highlight the need for child mental healthcare and research training in this setting. CONTRIBUTION: The study contributes to the understanding of the training and education needs of professional nurses working in PHC facilities. <![CDATA[<b>Factors associated with depressive symptoms in patients with benign prostatic enlargement</b>]]> BACKGROUND: Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE) AIM: To determine the prevalence and factors associated with depressive symptoms among BPE patients. SETTING: This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa. METHODS: The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 and International Prostate Symptom Score (IPSS) were used to assess depressive symptoms and lower urinary tract symptoms (LUTS), respectively. Association between depressive symptoms and LUTS was determined. Factors associated with depressive symptoms were analysed by logistic regression. RESULTS: Prevalence of depressive symptoms among patients with symptomatic benign prostatic enlargement (sBPE) was 42.90%. Factors associated with depressive symptoms included comorbid conditions, medication side effects, reduced libido, alcohol use, disturbed sleep at night and anxiety in regard to the prostate condition. CONCLUSION: There is a high prevalence of depressive symptoms among men with BPE. Assessment and early intervention for depressive symptoms among men with BPE should be initiated before clinical depression sets in. CONTRIBUTION: The study has created a knowledge base on factors associated with depressive symptoms among men with sBPE in the African context. <![CDATA[<b>Context counts: Investigating pain management interventions in HIV-positive men living in a rural area</b>]]> BACKGROUND: Pain remains a prevalent and burdensome complaint for people living with human immunodeficiency virus and/or aquired immunodeficiency syndrome (LWHA). Positive Living (PL), a multimodal pain intervention, reduced pain in female South Africans LWHA. We investigated the efficacy of the PL programme in South African males living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (MLWA) in a rural community. AIM: To determine the effects of a multimodal pain intervention in MLWHA. SETTING: Various primary care clinics in Manguzi, Kwa-Zulu Natal, South Africa. METHODOLOGY: Therapeutic relationship (TR) intervention alone or in combination with the PL programme were allocated to HIV-positive men between the ages of 18-40. Pain intensity and interference were the primary outcome measures. Secondary outcome measures included physical function, health-related quality of life, depressive symptoms and self-efficacy. RESULTS: Forty-seven men (mean age 35 ± 3 years) were recruited with baseline mean pain severity of 5.02 (± 3.01) and pain interference of 4.6 (± 3.18). Nineteen men were allocated to the TR intervention alone, 28 were allocated to the TR intervention and PL programme. Attendance at the intervention sessions varied from 10% to 36%. No changes in any outcomes were recorded. CONCLUSION: Poor attendance at the intervention and follow-up sessions make these results an unreliable reflection of the intervention. Contextual factors including internal migration and issues around employment were identified. These may influence healthcare utilisation for MLWHA living in rural settings. CONTRIBUTION: Unmet healthcare needs of MLWHA in a rural community have been identified. If we are to 'leave no one behind', healthcare interventions should account for context and be 'rural-proofed'. <![CDATA[<b>Awareness and interventions to reduce dehydration in pregnant, postpartum women, and newborns in rural Kenya</b>]]> Extreme heat exposure is associated with adverse outcomes in pregnancy and has the potential to impact maternal, neonatal and child health for a lifetime. In an extremely hot climate, pregnant women face an increased risk of premature birth, stillbirth, low birth weight, congenital anomalies and pre-eclampsia. In low- and middle-income countries (LMICs), socio-demographic and behavioural practices may negatively affect body hydration during high temperatures. The possible causes and consequences of dehydration in the heat are poorly understood and have been little discussed in the literature. Living in a hot climate poses various challenges, including dehydration, where biological mechanisms and insufficient access to water can lead to dehydration in women and children, with consequences for the health of both mothers and children, particularly in relation to breastfeeding habits. During pregnancy, increased metabolic and cardiovascular demands interact with heat exhaustion and reduced availability of fresh water, which can affect the child's growth and development. In this opinion piece, we emphasise the possible causes and impacts of dehydration in extreme heat on the health and well-being of mothers and children. We encourage more research, focused on biology and epidemiology, related to raising awareness and implementing adaptations to reduce the risk of dehydration in pregnant, postpartum women and newborns in the context of climate change-related heat exposure.