Scielo RSS <![CDATA[African Journal of Primary Health Care & Family Medicine ]]> http://www.scielo.org.za/rss.php?pid=2071-293620220001&lang=pt vol. 14 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>One swallow does not a summer make: Twenty years of challenges and achievements of family medicine in Mozambique</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100001&lng=pt&nrm=iso&tlng=pt After 20 years of hard work, family medicine (FM) is flourishing in Mozambique, but the challenges are immense in a context of multiple health needs. This study aimed to describe strengths, opportunities, weaknesses and threats of the current scenario that can influence the development of FM and primary health care (PHC) in Mozambique. Case study of a series of virtual world-café meetings using the World Health Organization's Operational Framework for primary health care as a theoretical model. There is a young generation of Family Physicians (FPs) eager to improve PHC in Mozambique - a result of the reactivation of the Maputo Residency Programme and the creation of the Mozambican College of FP in 2010. The current Ministry of Health has taken this agenda forward, inviting medical societies (including FM) to jointly design plans to expand training of human resources for healthcare. This plan aims to create new training sites in five different provinces hoping that it will increase the number of FP in remote areas, fixing the unequal distribution of specialists in the country. The small number of FP practicing today and the limited financial resources of the National Government are important threats to this plan. We have many strengths already conquered and the current situation opens an opportunity for the expansion of FM in Mozambique. Hopefully, it will help PHC in our country move from verticalised and selective health programmes towards a more comprehensive, efficient and person-centred care. <![CDATA[<b>Facilitating sexual and reproductive health services for adolescent girls in the COVID-19 era: An urgent public health priority</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100002&lng=pt&nrm=iso&tlng=pt After 20 years of hard work, family medicine (FM) is flourishing in Mozambique, but the challenges are immense in a context of multiple health needs. This study aimed to describe strengths, opportunities, weaknesses and threats of the current scenario that can influence the development of FM and primary health care (PHC) in Mozambique. Case study of a series of virtual world-café meetings using the World Health Organization's Operational Framework for primary health care as a theoretical model. There is a young generation of Family Physicians (FPs) eager to improve PHC in Mozambique - a result of the reactivation of the Maputo Residency Programme and the creation of the Mozambican College of FP in 2010. The current Ministry of Health has taken this agenda forward, inviting medical societies (including FM) to jointly design plans to expand training of human resources for healthcare. This plan aims to create new training sites in five different provinces hoping that it will increase the number of FP in remote areas, fixing the unequal distribution of specialists in the country. The small number of FP practicing today and the limited financial resources of the National Government are important threats to this plan. We have many strengths already conquered and the current situation opens an opportunity for the expansion of FM in Mozambique. Hopefully, it will help PHC in our country move from verticalised and selective health programmes towards a more comprehensive, efficient and person-centred care. <![CDATA[<b>Maternity healthcare providers' self-perceptions of well-being during COVID-19: A survey in Tshwane Health District, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100003&lng=pt&nrm=iso&tlng=pt BACKGROUND: Mental health manifestations such as depression and anxiety disorders became more marked during the coronavirus disease 2019 (COVID-19) pandemic as frontline healthcare workers struggled to maintain high-quality intrapartum care and essential health servicesAIM: This study aimed to identify maternity healthcare providers' self-perceptions of changes in their feelings of mental well-beingSETTING: Ten midwife obstetric units and the labour wards of four district hospitals in Tshwane Health District, South AfricaMETHODS: We conducted an anonymous, cross-sectional survey amongst a convenience sample of 114 maternity healthcare workers to gauge the changes in healthcare workers' experience and perceptions of well-being during the COVID-19 pandemic. Four items measured the perceived changes on a scale of 0-10 for the periods before and during COVID-19, respectively, namely feelings of fear or anxiety, stress, depression and angerRESULTS: The majority of participants were professional nurses (37%) and advanced midwives (47%). They reported a significant change in well-being from before the pandemic to during the pandemic with regard to all four items (p < 0.0001). The biggest 'before-during' difference was in perceptions of fear or anxiety and the smallest difference was in perceptions of anger. A framework was constructed from the open-ended responses to explain healthcare workers' understanding and perceptions of increased negative feelings regarding their mental well-beingCONCLUSION: The observed trends in the changes in healthcare workers' self-perceptions of their mental well-being highlight the need for further planning to build resilient frontline healthcare workers and provide them with ongoing mental health support and improved communication pathways <![CDATA[<b>Challenges experienced by community health workers and their motivation to attend a self-management programme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100004&lng=pt&nrm=iso&tlng=pt BACKGROUND: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behavioursAIM: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programmeSETTING: The study was conducted in a low socio-economic urban area of the Western Cape, South AfricaMETHODS: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basisRESULTS: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspectiveCONCLUSION: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status <![CDATA[<b>Medical internship training during the COVID-19 pandemic - A case of 'sacrificial pawns' or not?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100005&lng=pt&nrm=iso&tlng=pt BACKGROUND: Newly qualified medical practitioners in South Africa (SA) are part of the frontline health care workers who face Africa's most severe coronavirus disease 2019 (COVID-19) pandemic. The experiences of interns during the pandemic reflect SA's preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contextsAIM: To explore the strengths, weaknesses, opportunities and threats posed during the first wave of the COVID-19 pandemic as reflected on by interns within the clinical training platforms in SASETTING: Public hospitals in KwaZulu-NatalMETHODS: An online questionnaire consisting of eight open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. All data were collected remotely via social media platforms. Data were thematically analysedRESULTS: Forty-six interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, communities of practice and the development and enhancement of clinical and non-clinical competencies. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback, broadening the intern curriculum and online trainingCONCLUSION: Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic <![CDATA[<b>Non-communicable disease care and management in two sites of the Cape Town Metro during the first wave of COVID-19: A rapid appraisal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100006&lng=pt&nrm=iso&tlng=pt BACKGROUND: Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparseAIM: This study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 waveSETTING: Two public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning siteMETHODS: A rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptivelyRESULTS: Qualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetesCONCLUSION: This study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation <![CDATA[<b>The prevalence and psychosocial risk factors of chronic low back pain in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100007&lng=pt&nrm=iso&tlng=pt BACKGROUND: Chronic low back pain (CLBP) is the leading cause of disability and has been extensively investigated in high-income countries (HICs), with little done in low-and middle-income countries. Biomechanical stressors do not have a major pathogenic role, but psychosocial predisposition is important. The occurrence and progression of CLBP are significantly affected by psychosocial risk factors. Guidelines recommend the early identification of psychosocial factors that could predict CLBPAIM: To determine the prevalence and psychosocial risk factors for CLBP amongst adults in KwaZulu-Natal, South AfricaSETTING: The study was conducted at five randomly selected public hospitals in KwaZulu-NatalMETHODS: Analytical cross-sectional hospital-based study utilising a self-administered questionnaire to collect data on (1) sociodemographic, (2) disability, (3) fear-avoidance beliefs and (4) illness behaviour. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for data cleaning and descriptive statistics. Chi-square test was used for categorical variables. Standard Edition of the Statistical Software for Data Science version 17.0 (STATA 17.0 SE) was used to identify risk factors using the logistic regression analysis. A p-value of ≤ 0.05 was deemed statistically significantRESULTS: Overall prevalence of CLBP was 22.2% (95% confidence interval [CI]: 18.8-25.9). Females had a higher prevalence of CLBP than males, 23.9% (95% CI: 19.4-28.9) and 19.7% (95% CI: 14.8-25.5), respectively; however, the difference was not significant p = 0.243. The multivariate regression analysis identified the following risk factors: female gender, middle-aged adults 38-47 years, obesity, disease conviction, affective disturbance, denial and fear-avoidance behaviour-work subscaleCONCLUSION: There is a high prevalence of CLBP amongst the study participants. Psychosocial factors (disease conviction, affective disturbance and fear-avoidance behaviour about work) are significant predictors of CLBP <![CDATA[<b>Satisfaction with life and psychological distress during the COVID-19 pandemic: An Egyptian online cross-sectional study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100008&lng=pt&nrm=iso&tlng=pt BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel sickness that emerged worldwide as an unprecedented crisis and led to major effects on the daily life of the general public as well as negative impacts on their mental well-beingAIM: This study aimed to assess satisfaction with life and psychological distress during the COVID-19 pandemic in EgyptSETTING: An online study was conducted in EgyptMETHODS: A cross-sectional online survey was fulfilled by 1056 Egyptian adults from 06 to 13 June 2020. Psychological distress and satisfaction with life were measured by Arabic validated versions of the Kessler Psychological Distress Scale (K10) and the Satisfaction with Life Scale (SWLSRESULTS: About half of the surveyed respondents (51%) were satisfied with their life, whilst 57.4% experienced severe psychological distress. The independent predictors of satisfaction with life are being married, satisfactory income, low distress, moderate distress and high distress (adjusted odds ratio [AOR] = 1.2, 3.0, 2.5, 6.9, 5.2 and 2.1, respectively). Being a female, having secondary education, > secondary education, unsatisfactory income and presence of mental illness are the independent predictors of mental distress (AOR = 2.3, 3.9, 1.9, 1.9, 1.6 and 4.0, respectivelyCONCLUSION: The study provides evidence about the high prevalence of psychological distress during the peak period of Egypt's COVID-19 pandemic. The study results highlight the enhancement of development interventions to promote psychological well-being and feeling of satisfaction with life during the pandemic <![CDATA[<b>Preparedness to implement national enteral nutritional therapy practice guidelines: An observational study of primary health care institutions in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100009&lng=pt&nrm=iso&tlng=pt BACKGROUND: Despite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settingsAIM: This study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for AdultsSETTING: This study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one householdMETHODS: Non-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the studyRESULTS: Observation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guidelineCONCLUSION: The study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation <![CDATA[<b>Vision screening as part of the school health policy in South Africa from the perspective of school health nurses</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100010&lng=pt&nrm=iso&tlng=pt BACKGROUND: Vision screenings of school-going children are essential in the early detection of visual anomalies common in different age categories, which may negatively affect their academic ability and social development. Hence, their inclusion in school health policies is imperative. The aim of this study was to assess the implementation of vision screening protocols in the current Integrated School Health Screening policy of South Africa from the perspective of school health personnelAIM: The study sought to explore the perceptions, experiences and attitudes of the school health nurses on vision screenings included as part of the school health screenings in Gauteng province (South AfricaSETTING: This study was located across three public healthcare facilities across Gauteng at primary healthcare levelsMETHODS: Three teams of 13 school health personnel from three primary healthcare facilities in the district of Ekurhuleni were invited to participate in the study. Focus group interviews were conducted for generating information on collective opinions and the rationale behind their viewsRESULTS: Results of the collected qualitative data revealed challenges related to training, vision screening tests, referral criteria and follow-ups or referral pathways. In addition, further challenges reported were related to communication, time, space and consent forms not signed by the parentsCONCLUSION: Improved cohesion and communication between all role players will enable reasonable and professional provision of validated vision screening services that have the best chance of early detection of children with vision anomalies to negate possible adverse effects on their scholarly performance <![CDATA[<b>South African men and women living with HIV have similar distributions of pain sites</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100011&lng=pt&nrm=iso&tlng=pt BACKGROUND: No studies have investigated sex differences in the location and number of pain sites in people living with human immunodeficiency virus (HIV) (PLWH), despite evidence that women, in general, bear a greater burden of pain than menAIM: To determine sex differences in the location and number of pain sites, and whether there were demographic or disease-related differences in the number of pain sitesSETTING: South African tertiary hospital HIV clinics and a community healthcare centreMETHODS: We conducted a retrospective analysis of records from South African PLWH who had painRESULTS: Of the 596 participant records, 19% were male (115/596) and the median number of pain sites for both sexes was 2 (interquartile range [IQR]: 1 to 3). Pain was most frequently experienced in the head (men: 12%, women: 38%), feet and ankles (men: 42%, women: 28%), abdomen (men = 19%, women = 28%) and chest (men = 20%, women = 20%). After correcting for multiple comparisons, males were less likely to experience headache than females (Fisher's exact text, odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.12 - 0.42, p = 0.000). Pain at other body sites was experienced similarly between the sexes. There was no meaningful variation in the number of pain sites between the sexes (logistic regression, p = 0.157CONCLUSION: A similar location and number of pain sites were experienced by male and female South African PLWH. The locations of pain sites were different from previous reports, however, suggesting that research into pain in PLWH cannot necessarily be generalised across cultures <![CDATA[<b>Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100012&lng=pt&nrm=iso&tlng=pt BACKGROUND: To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria's leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systemsAIM: To synthesise current knowledge on patient satisfaction with the NHISMETHODS: The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide InformationRESULTS: This search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing - although to differing degrees depending on the domainCONCLUSION: The beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion <![CDATA[<b>Community-oriented primary care for National Health Insurance in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100013&lng=pt&nrm=iso&tlng=pt This is a report on Chiawelo Community Practice (CCP) in Ward 11, Soweto, South Africa, a community-oriented primary care (COPC) model for National Health Insurance (NHI) in South Africa, developed by a family physician. A shift to capitation contracting for primary health care (PHC) under NHI will carry risk for providers - both public and private, especially higher number of patient visits. Health promotion and disease prevention, especially using a COPC model, will be important. Leading the implementation of COPC is an important role for family physicians in Africa, but global implementation of COPC is challenged. Cuba and Brazil have implemented COPC with panels of 600 and 3500, respectively. The family physician in this report has developed community practice as a model with four drivers using a complex adaptive system lens: population engagement with community health workers (CHWs), a clinic re-oriented to its community, stakeholder engagement and targeted health promotion. A team of three medical interns: 1 clinical associate, 3 nurses and 20 CHWs, supervised by the family physician, effectively manage a panel of approximately 30 000 people. This has resulted in low utilisation rates (less than one visit per person per year), high population access and satisfaction and high clinical quality. This has been despite the challenge of a reductionist PHC system, poor management support and poor public service culture. The results could be more impressive if panels are limited to 10 000, if there was a better team structure with a single doctor leading a team of 3-4 nurse/clinical associates and 10-12 CHWs and PHC provider units that are truly empowered to manage resources locally. <![CDATA[<b>Patient safety attitude among healthcare workers at different levels of healthcare in Sharqia Governorate, Egypt</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100014&lng=pt&nrm=iso&tlng=pt BACKGROUND: Patient safety (PS) has been identified as a significant healthcare challenge. A good safety attitude helps healthcare workers (HCWs) to decrease medical errors. AIM: This study aimed to assess the PS attitude and identify its determinants among HCWs. SETTING: This study was conducted in Sharqia Governorate at different levels of health care. METHODS: This was a comparative cross-sectional study that involved240 HCWs selected after using a multistage cluster sampling technique from Sharqia Governorate.In ordertto assess the respondents' attitudes towards PS, the modified Chinese Safety Attitudes Questionnaire (CSAQ) was used. RESULTS: The scale with the highest percentage of positive responses, on average, was safety climate (49.59%). The study found a statistically significant association between the level of health care and mean scores of 'teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition' and the overall CSAQ score. In regression analysis, the highest degree of education and job type were significant predictors of PS attitude among the HCWs under study (p = 0.031 and 0.011, respectively. CONCLUSION: According to the study's findings, PS is low among HCWs in both healthcare units and hospitals, with a significantly higher score among hospital workers than among primary care workers. All PS composites need improvement starting with regular assessment of PS culture along with continuous monitoring.. <![CDATA[<b>Perceptions of postgraduate family medicine supervision at decentralised training sites, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100015&lng=pt&nrm=iso&tlng=pt BACKGROUND: Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa. AIM: This study aimed to explore family physicians' and registrars' perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites. SETTING: The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg. METHODS: This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed. RESULTS: Two of the four themes identified, 'supervision is context-specific and supervisor-dependent', and 'the nature of engagement matters', involved strengths and challenges. The other two, 'supervision is not ideal' and 'the training environment is challenging', focussed on challenges. CONCLUSION: Supervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars' workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training. <![CDATA[<b>Demographic and clinical profiles of residents in long-term care facilities in South Africa: A cross-sectional survey</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100016&lng=pt&nrm=iso&tlng=pt BACKGROUND: The demand for long-term care facilities (LTCFs) amongst older people in South Africa (SA) is growing and there is insufficient information on the profile and healthcare needs of this population. AIM: This study was conducted to describe the demographic and clinical characteristics of residents in LTFCs in SA. SETTING: Three LTCFs in eThekwini district. METHODS: A cross-sectional design was used to collect data from a purposive sample of 102 (N = 204) residents. A structured questionnaire was used to collect demographic and clinical data. The data were entered into Microsoft Excel and analysed descriptively and inferentially using R version 3.5.1 software. RESULTS: The majority of the residents (59.8%) were between 65 and 80 years (78.9 ± 8.1 years) and 74.5% were women. The residents were white people (91.1%), SA born (82.4%) and widowed (54.9%). English was the primary language (91.1%), with the majority being christian (52.0%). Some residents had a university education, were previously employed and are financially independent. Ninety-three percent had clinical conditions, each suffering from at least three clinical conditions. Hypertension (63.7%), high cholesterol (53.9%), arthritis (38.2%), depression (37.3%) were the most prevalent clinical conditions recorded amongst the residents. Most residents were assessed to be intermediately frail, at risk of malnutrition and had mild depression as based on the respective mean frailty-, nutrition-, and geriatric depression scores. CONCLUSION: Residents in LTCFs in the eThekwini district are more likely to be white people; women, christian, widowed, intermediately frail and at risk of malnutrition <![CDATA[<b>Clinical associates and access to healthcare in the Eastern Cape province of South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100017&lng=pt&nrm=iso&tlng=pt BACKGROUND: Clinical associates (ClinAs) were introduced into South Africa as part of the remedy for the severe shortage of healthcare workers in rural areas. Walter Sisulu University (WSU) graduated 100 ClinAs between 2011 and 2014. These ClinAs were expected to be based at district hospitals where they would work under the supervision of doctors, reduce the workload of doctors and increase access to healthcare in the Eastern Cape. AIM: This study aimed to examine the role played by ClinAs in healthcare delivery in Eastern Cape district hospitals, and to determine whether the training of ClinAs adequately prepared them for this role. SETTING: The study was conducted in the Eastern Cape province of South Africa amongst ClinAs who graduated from WSU between 2011 and 2014, and healthcare workers from Madzikane KaZulu Memorial Hospital. METHODS: This was an exploratory cross-sectional mixed methods study with a convergent design. Surveys and in-depth interviews were conducted amongst ClinAs, nurses, doctors and one pharmacist. Both qualitative and quantitative data were analysed and reported RESULTS: Clinical associates are seen to improve the workload of doctors, and to increase access to healthcare. Thirty-four percent of ClinAs were no longer contributing to healthcare in the Eastern Cape. CONCLUSION: Clinical associates are making a significant contribution to access to healthcare in the Eastern Cape. Their supervision regimen needs to be revisited and factors that contribute to the attrition of ClinAs in the Eastern Cape need to be addressed <![CDATA[<b>Climate change and health within the South African context: A thematic content analysis study of climate change and health expert interviews</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100018&lng=pt&nrm=iso&tlng=pt BACKGROUND: Climate change presents an unprecedented and urgent threat to human health and survival. South Africa's health response will require a strong and effective intersectoral organisational effort. AIM: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments SETTING: Nationally in South Africa. METHOD: Twenty key expert interviews were conducted with South African experts in the field of climate change and health. Interview data was analysed by means of thematic content analysis. RESULTS: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme. CONCLUSION: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field. <![CDATA[<b>Building primary health care teams for universal health coverage in Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100019&lng=pt&nrm=iso&tlng=pt BACKGROUND: Climate change presents an unprecedented and urgent threat to human health and survival. South Africa's health response will require a strong and effective intersectoral organisational effort. AIM: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments SETTING: Nationally in South Africa. METHOD: Twenty key expert interviews were conducted with South African experts in the field of climate change and health. Interview data was analysed by means of thematic content analysis. RESULTS: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme. CONCLUSION: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field. <![CDATA[<b>Climate change and primary health care in Africa - A call for short reports</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100020&lng=pt&nrm=iso&tlng=pt BACKGROUND: Climate change presents an unprecedented and urgent threat to human health and survival. South Africa's health response will require a strong and effective intersectoral organisational effort. AIM: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments SETTING: Nationally in South Africa. METHOD: Twenty key expert interviews were conducted with South African experts in the field of climate change and health. Interview data was analysed by means of thematic content analysis. RESULTS: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme. CONCLUSION: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field. <![CDATA[<b>COVID-19 frontline primary health care professionals' perspectives on health system preparedness and response to the pandemic in the Mahalapye Health District, Botswana</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100021&lng=pt&nrm=iso&tlng=pt BACKGROUND: The World Health Organization issued interim guidelines on essential health system preparedness and response measures for the coronavirus disease 2019 (COVID-19) pandemic. The control of the pandemic requires healthcare system preparedness and response AIM: This study aimed to evaluate frontline COVID-19 primary health care professionals' (PHC-Ps) views on health system preparedness and response to the pandemic in the Mahalapye Health District (MHD SETTING: In March 2020, the Botswana Ministry of Health directed health districts to educate their health professionals about COVID-19. One hundred and seventy frontline PHC-Ps were trained in MHD; they evaluated the health system's preparedness and response METHODS: This was a cross-sectional study that involved a self-administered questionnaire using the Integrated Disease Surveillance and Health System response guidelines RESULTS: The majority (72.5%) of participants felt unprepared to deal with the COVID-19 pandemic at their level. Most of the participants (70.7%) acknowledged that the health system response plan has been followed. About half of the participants attributed a low score regarding the health system's preparedness (44.4%), its response (50.0%), and its overall performance (55.6%) to the COVID-19 pandemic. There was an association between participants' age and work experience and their overall perceptions of preparedness and response (p = 0.009 and p = 0.005, respectively CONCLUSION: More than half of the participants gave a low score to the MHD regarding the health system's preparedness and response to the COVID-19 pandemic. Further studies are required to determine the causes of such attitudes and to be better prepared to respond effectively <![CDATA[<b>Sickle cell disease prevention: How prepared are the senior secondary school students in Surulere Local Government Area, Lagos, Nigeria?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100022&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sickle cell disease (SCD), a common hereditary disease, can be prevented by preparing young people ahead of the conception of an affected foetus AIM: To assess the knowledge and attitude regarding SCD amongst senior secondary school students in Surulere Local Government Area (LGA), Lagos, Nigeria SETTING: Senior secondary schools in Surulere LGA METHODS: This was a descriptive cross-sectional study amongst 300 senior secondary school students. Data were collected using a self-administered questionnaire and analysed using Stata16. The Chi-square and Fisher's exact tests were used to determine the association between categorical variables. The level of significance was predetermined at p < 0.05 RESULTS: The mean age of the respondents was 15.2 (±1.3) years, with a male-to-female ratio of about 1:2. The majority (90.0%) of the respondents were aware of SCD, 63.0% had good knowledge, although less than half of them (46.3%) knew SCD to be a blood disorder, whilst about two-thirds (53.1%) knew that it was an inherited condition. About one fifth (24.4%) of them knew about prevention by genetic counselling. The majority (97.0%) of them had a positive attitude towards SCD. Over two-thirds (72.6%) were aware of their genotype. The prevalence of SCD was 2.0%, whilst 18.9% of them were carriers of the sickle cell trait. Knowing their SCD status but not necessarily their genotype was significantly associated with their attitude towards the disease (p = 0.014 CONCLUSION: The prevention of SCD was not known to the majority, and better attitudes were more likely when the SCD status was known. Therefore, routine screening and counselling could potentially aid SCD control <![CDATA[<b>Prevalence and associated risk factors for anaemia amongst pregnant women attending three antenatal clinics in Eswatini</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100023&lng=pt&nrm=iso&tlng=pt BACKGROUND: Anaemia is a global health problem affecting about a third of the world's population. In pregnancy, it is a public health concern with consequences for mothers and infants, including maternal death and infant mortality. In low-income countries (LICs), 25% indirect maternal mortality and 30% neonatal deaths are due to anaemia in pregnancy AIM: This study aimed to determine the prevalence and risks associated with anaemia amongst pregnant women attending antenatal clinic (ANC) in three health facilities in Eswatini SETTING: This study was conducted in three health facilities in Eswatini, namely Mankayane, Raleigh Fitkin Memorial (RFM) and Mbabane Hospital METHODS: This cross-sectional study used non-probability sampling in three hospitals of Eswatini, to select 550 pregnant women, aged 15-49 years. Data were collected from January to March 2021, using face-to-face interviews with a structured questionnaire. Logistic regression was used for statistical analysis RESULTS: A total of 550 pregnant women were included in the study. Anaemia prevalence amongst pregnant women was 43.1% with mild, moderate and severe cases of 21.3%; 21.1% and 0.7%, respectively. Prevalence was high amongst women aged 15-19 years (53.3%). Factors associated with anaemia included living in urban areas (odds ratio [OR]: 1.8; confidence interval [CI]: 1.19-2.72), having anaemia 6 months before pregnancy (OR: 4.64; CI: 1.15-18.71), and gestational age at first ANC: third trimester (OR = 10.42; CI: 4.27-25.4) and second trimester (OR: 1.62; CI: 1.02-2.60 CONCLUSION: Anaemia remains prevalent amongst pregnant women in Eswatini. A comprehensive anaemia prevention programme would be justified and could lower the country's burden of anaemia <![CDATA[<b>Culturally appropriate care to support maternal positions during the second stage of labour: Midwives' perspectives in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100024&lng=pt&nrm=iso&tlng=pt BACKGROUND: 'Doing what the Romans do in Rome' was an expression raised by one of the midwives following workplace culture and disregarding women's birth choices. Midwifery practice in South Africa caters for a culturally diverse ethnic groups of childbearing women. Culturally appropriate care highlights the importance of including women in decision-making concerning their birth preferences including maternal positions during labour. Women's right to choose their maternal position and cultural preferences during labour has been overlooked, leading to poor maternal healthcare provision and negative birth experiences AIM: In this article, the researchers aimed to describe and explore midwives' perspectives on culturally appropriate care to support maternal positions during the second stage of labour SETTING: Midwives working in the maternity ward in a public hospital in South Africa METHODS: A qualitative descriptive design using individual interviews was used to collect data. The participants were selected using the purposive sampling method. The study population comprised 20 midwives who volunteered to participate in the study. Data were transcribed manually and analysed using thematic analysis RESULTS: The four main themes are as follows: (1) Caring for women from various ethnic groups, (2) midwives disregard women's beliefs and culture, (3) midwife personal cultural attributes and (4) midwifery unit workplace culture CONCLUSION: The authors concluded that culturally appropriate care towards the women's choices of birth position during the second stage of labour should form an integral part of the midwifery care rendered <![CDATA[<b>Educational intervention to enhance the knowledge of Ghanaian health workers on Alzheimer's disease and related dementias</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100025&lng=pt&nrm=iso&tlng=pt BACKGROUND: Alzheimer's disease and related dementias (ADRDs) pose a major public health challenge in older adults. In sub-Saharan Africa, the burden of ADRD is projected to escalate amidst ill-equipped healthcare workers (HCWs AIM: This study aimed to assess ADRD knowledge amongst Ghanaian HCWs and improve gaps identified through a workshop SETTING: Study was conducted among HCWs attending a workshop in Kumasi, Ghana METHODS: On 18 August 2021, a workshop on ADRD was organised in Kumasi, Ghana, which was attended by 49 HCWs comprising doctors, nurses, pharmacists, social workers and nutritionists. On arrival, they answered 30 pre-test questions using the Alzheimer's Disease Knowledge Scale (ADKS). A post-test using the same questionnaire was conducted after participants had been exposed to a 4-h in-person educational content on ADRD delivered by facilitators from family medicine, neurology, geriatrics, psychiatry and public health RESULTS: The mean age of participants was 34.6 (± 6.82), mean years of practice was 7.7 (± 5.6) and 38.8% (n = 19) were nurses. The mean score of participants' overall knowledge was 19.8 (± 4.3) at pre-test and 23.2 (± 4.0) at post-test. Participants' pre-test and post-test scores improved in all ADKS domains. Factors associated with participants' knowledge at baseline were profession, professional rank and the highest level of education attained. After adjusting for age and sex, participant's rank, being a specialist (adjusted β = 14.44; 95% confidence interval [CI] = 7.03, 21.85; p < 0.001) was an independent predictor of knowledge on Alzheimer's disease CONCLUSION: Existing knowledge gaps in ADRD could be improved via continuous medical education interventions of HCWs to prepare healthcare systems in Africa for the predicted ADRD epidemic <![CDATA[<b>Lifestyle determinants of diabetes mellitus amongst people living with HIV in the Eastern Cape province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100026&lng=pt&nrm=iso&tlng=pt BACKGROUND: Type 2 diabetes mellitus (DM) has serious consequences for those affected. Little is documented on the lifestyle determinants of type 2 DM in people living with human immunodeficiency virus (PLWHIV AIM: This study aimed to assess the lifestyle determinants of type 2 DM amongst PLWHIV who were on antiretroviral treatment (ARV SETTING: This study was undertaken in 10 community health clinics and 140 clinics in South Africa's Eastern Cape province METHODS: This case control study was undertaken amongst PLWHIV who were on ARV in OR Tambo district RESULTS: Cases and controls showed statistically significant differences on the duration of time on ARV (p < 0.0001), vigorous work (p = 0.019), participation in moderate sport (p = 0.007) and consuming daily fruit and vegetable servings (p = 0.021). Those reporting to be on ARVs for 6 to 10 years were three times more likely to be diabetic than those who had only been on ARV for a year or less (odds ratio [OR] = 3.0; p = 0.017) and in comparison, to participants who reported having one serving, participants who had four fruit and vegetable servings daily were 3.2 times more likely to be diabetic (OR = 3.2; p = 0.002 CONCLUSION: This study revealed significant nutritional imbalances on fruit and vegetable servings and on participation in moderate sport resulting in poor diabetic control. Routine screening and measurements need to focus on dietary and physical lifestyle determinants of type 2 DM in order to counsel patients on ARV on balanced nutrition and optimise outcomes in the quality care of PLWHIV <![CDATA[<b>A Delphi study to guide the development of a clinical indicator tool for palliative care in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100027&lng=pt&nrm=iso&tlng=pt BACKGROUND: The South African National Policy Framework and Strategy on Palliative Care (NPFSPC) recommends that when integrating palliative care (PC) into the health system, a PC indicators tool should be used to guide clinicians to recognise a patient who should receive PC. The policy document recommends 'a simple screening tool developed for use in South Africa that would assist healthcare professionals (HCPs) to recognise patients who may have unmet palliative care needs' AIM: This research study sought to develop South African consensus on indicators for PC to assist clinicians to recognise a patient in need of PC SETTING: The South African healthcare setting METHODS: A Delphi study was considered suitable as a methodology to develop consensus. The methodology was based on the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies to ensure rigour and transparency in conducting and reporting. Six different Delphi rounds were used to develop consensus. Each round allowed participants to anonymously rate statements with predefined rating scales RESULTS: Cognisant of the disparities in healthcare provision and access to equitable healthcare in South Africa, the expert advisory group recommended, especially for South Africa, that 'this tool is for deteriorating patients with an advanced life-limiting illness where all available and appropriate management for underlying illnesses and reversible complications has been offered'. The expert advisory group felt that disease-specific indicators should be described before the general indicators in the South African indicators tool, so all users of the tool orientate themselves to the disease categories first. This study included three new domains to address the South African context: trauma, infectious diseases and haematological diseases. General indicators for PC aligned with the original Supportive and Palliative Care Indicators Tool (SPICT) tool CONCLUSION: The Supportive and Palliative Care Indicators Tool for South Africa (SPICT TM-SA) is a simple screening tool for South Africa that may assist HCPs to recognise patients who may have unmet PC needs <![CDATA[<b>Relationships between physical activity, body mass index, waist circumference and handgrip strength amongst adults from the North West province, South Africa: The PURE study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100028&lng=pt&nrm=iso&tlng=pt BACKGROUND: Handgrip strength (HGS) serves as a proxy for the functional ability and its association with body composition (BC) and physical activity (PA) in South African adults are less clear AIM: We investigated the relationships between PA, body composition and HGS amongst adults SETTING: Rural and urban population from North West Province, South Africa METHODS: A cross-sectional study design was performed on 688 (198 men; 490 women) adults aged 35-70 years from the 2015 measurement wave of the Prospective Urban and Rural Epidemiological (PURE) study from the North West province of South Africa. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) assessed and a dynamometer determined HGS in kilogram. Body mass index (BMI) and waist circumference were used as measures of body composition. Spearman correlation coefficients determined the relationship between PA, BMI and HGS RESULTS: In the study, 22% and 26%, respectively, were overweight and obese with women being more overweight and obese compared to men. Sixty percent of the participants met the recommended 150 min or more of moderate to vigorous PA (MVPA) per week. Handgrip strength of the participants in the study was weaker than the published norms. Handgrip strength significantly (p < 0.05) differed by age. A significant positive association was found between HGS and BMI. Age negatively (r = -0.12; p = 0.001) correlated with MVPA per week CONCLUSION: High prevalence of overweight and obesity exists in the current adults' sample. It was also evident that poor upper limb muscle strength and MVPA were negatively associated with ageing. Given the health implications of poor strength indicators, PA intervention programmes, comprised of strength activities, for an adult population are urgently recommended <![CDATA[<b>Mothers' knowledge, attitude and home management of diarrhoea among children under five years old in Lagos, Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100029&lng=pt&nrm=iso&tlng=pt BACKGROUND: Diarrhoea is a leading cause of death among children under five years old globally. It remains a major cause of morbidity and mortality among this age group in Nigeria. Using simple home management, mothers play important roles in the prevention and control of diarrhoea among these children AIM: This study aimed to assess mothers' knowledge, attitude and practice in the prevention and home management of diarrhoeal diseases among children under five years old in Lagos, Nigeria SETTING: This study was conducted within the communities of Kosofe local government area of Lagos State, Nigeria METHODS: A descriptive cross-sectional study design was conducted using a multistage sampling technique. Data were collected using a structured interviewer-administered questionnaire and analysed using EPI info version 7.2.1. Chi-square statistic was used to test the association between variable at the level of significance of 5% RESULTS: A total of 360 respondents participated in this study. The mean age of the respondents was 32.5 ± 5.5 years. About 59.2% of respondents had good knowledge, 59.2% of them had positive attitude, and 53.1% of them had good practice towards prevention and home management of diarrhoea. Age (p = 0.007), occupation (p = 0.008) and level of education (p = 0.001) were significantly associated with practice of home management of diarrhoea among children under five years old CONCLUSION: Educated, employed, and married mothers were more likely to have good prevention and home management practices towards diarrhoea in their children under five years old <![CDATA[<b>The relationship between physical activity, body fatness and metabolic syndrome in urban South African school teachers: The sympathetic activity and ambulatory blood pressure in Africans study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100030&lng=pt&nrm=iso&tlng=pt BACKGROUND: Globally, the prevalence of metabolic syndrome (MS) is rising because of increased levels of physical inactivity and obesity. In South Africa, information about teachers' physical activity (PA), body fatness and MS is limited AIM: To assess the relationship between PA, body fatness and MS in urban South African teachers SETTING: The study setting was in Dr Kenneth Kaunda District in the North West province of South Africa METHODS: A cross-sectional study was conducted using secondary data drawn from the sympathetic activity and ambulatory blood pressure in Africans (SABPA) study of 216 teachers (aged 25-65 years). Variables included anthropometry, biochemical measurements, objectively measured PA and lifestyle behaviours RESULTS: Twenty-nine percent of the total participants were classified with MS, with 46% in men compared to 13% in women; 33% were sedentary and 67% participated in light activity. A weak significant negative relationship was found between the mean 7-day awake metabolic equivalent of tasks (METs) and triglycerides (r = −0.29; p = 0.02) and gamma-glutamyl transferase (r = −0.25; p = 0.06), activity energy expenditure (r = −0.24; p = 0.06) and PA level (r = −0.23; p = 0.07). After adjusting for age, self-reported smoking and alcohol use or consumption, a weak significant negative relationship between mean 7-day awake METs and triglycerides (r = −0.28; p < 0.01) was observed CONCLUSION: In the teachers with MS, only one MS marker (triglycerides) showed a negative association with PA. Physical activity could therefore be beneficial in the regulation of triglycerides. Participation in regular PA could be beneficial in the regulation of triglycerides. Focused PA interventions in school teachers that advocate the benefits of PA and healthy lifestyle choices to reduce dietary fat intake (and alcohol) are recommended <![CDATA[<b>Prevalence of and factors associated with contraceptive discontinuation in Kenya</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100031&lng=pt&nrm=iso&tlng=pt BACKGROUND: The overwhelming uptake of contraception in Kenya at 58% suggests huge potential for a continued increase, but discontinuation threatens efforts to achieve new targets. Further increases in contraceptive prevalence will depend more on continuation and re-adoption amongst past users because unintended pregnancies would increasingly result from discontinuation. Eliminating discontinuations from side effects and method failure could increase continuation rates by 10% AIM: To establish the prevalence and factors associated with contraceptive discontinuation SETTING: Kenya, with a successful family planning programme, but also the challenge of discontinuation rates of 31% METHODS: Contraceptive calendar data from the 2014 Kenya Demographic and Health Survey were used in the survival analysis approach RESULTS: Overall discontinuation rates were 37% (24 months) and 74% at (36 months), whilst discontinuation in need was 36%. Side effects accounted for 40% of discontinuations, whilst injection and pill recorded the highest rates. Current method emerged as a predictor of discontinuation at 24 months with the following hazard ratio (HR) at 95% confidence interval [CI]; intrauterine device (IUD) (HR = 0.466, CI = 0.254-0.857), injection (HR = 0.801, 95% CI = 0.690-0.930), implants (HR = 0.580, 95% CI = 0.429-0.784) and at 36 months, injection (HR = 0.808, 95% CI = 0.722-0.904) and implants (HR = 0.585, 95% CI = 0.468-0.730). Age (15-24 years) displayed influence only at 36 months (HR = 1.219, 95% CI = 1.044-1.424 CONCLUSION: The study showed a close link between contraceptive method used and discontinuation and thus the need to address method-related issues in an attempt to minimise discontinuation in Kenya. Expanding contraceptive options and improving the quality of service can scale up switching and thus help reduce discontinuation and unintended births <![CDATA[<b>Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100032&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction AIM: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations SETTING: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas METHODS: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data RESULTS: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time CONCLUSION: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care <![CDATA[<b>Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100033&lng=pt&nrm=iso&tlng=pt BACKGROUND: Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health AIM: This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum SETTING: Healthcare settings in Tanzania METHODS: Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students RESULTS: Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines CONCLUSION: A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate <![CDATA[<b>Current state of preconception care in sub-Saharan Africa: A systematic scoping review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100034&lng=pt&nrm=iso&tlng=pt BACKGROUND: Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries' existing maternal health services AIM: This study aims to review the current literature on the knowledge, utilisation and provision of PCC SETTING: This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries METHODS: Arksey and O'Malley's scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study RESULTS: Out of the 451 retrieved articles, 39 were relevant. In most studies, women's utilisation and HCW's provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs' knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least CONCLUSION: The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions <![CDATA[<b>Research activity, facilitators and barriers amongst trainee and early-career family physicians in sub-Saharan Africa: A cross-sectional survey</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100035&lng=pt&nrm=iso&tlng=pt BACKGROUND: Primary health care systems in sub-Saharan Africa (SSA) need context-specific evidence to address current challenges. Increased family physician (FP) research activity could help fill this gap AIM: To describe the research activity, facilitators and barriers amongst AfriWon Renaissance members SETTING: An online programme was designed to improve research activity amongst members of AfriWon Renaissance, an organisation of early-career and trainee FPs in SSA. This article provides a baseline description of their research activity METHODS: All AfriWon Renaissance members were invited to participate in an online survey. A content-validated study tool assessed research activity, including participation in research meetings, engagement in research mentorship, number of projects and published articles. Facilitators and barriers were assessed via Likert scales and two open-ended questions. The researchers conducted descriptive statistics using Epi Info 7, a content analysis of open-ended responses and triangulation RESULTS: Amongst the 77 respondents, 49 (63.6%) were still in training. Over two-thirds (71.4%) had participated in a research discussion in the past month. Whilst more than half (63.5%) reported having a manuscript under development, only 26 (33.8%) reported a recent publication. Nearly all (94.8%) intend to continue research in their FP careers. The most common facilitators were the institutional requirement to conduct research and having supportive peers and mentors. The most predominant barriers were time constraints and a lack of training on analysis CONCLUSION: There is a cohort of committed young FP researchers who would benefit from efforts to address identified barriers and support for their ongoing research activity, in order to increase primary care research outputs in SSA <![CDATA[<b>Factors affecting the implementation of a complex health intervention to improve insulin management in primary care: A SWOT analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100036&lng=pt&nrm=iso&tlng=pt BACKGROUND: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention AIM: To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability SETTING: Tshwane District, Gauteng province, South Africa METHODS: We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13 RESULTS: Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention CONCLUSION: Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions <![CDATA[<b>Evaluation of the child growth monitoring programme in two Zimbabwean provinces</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100037&lng=pt&nrm=iso&tlng=pt BACKGROUND: The child growth monitoring (CGM) programme is an important element of nutrition programmes, and when combined with other child health programmes, it can assist in successful management and control of malnutrition in children AIM: This study aimed to assess the extent to which the CGM programme is able to identify instances of childhood malnutrition and how much this contributes towards malnutrition reduction in Zimbabwe SETTING: The study was conducted in Manicaland and Matabeleland South provinces of Zimbabwe. The two provinces were purposively selected for having the highest and least proportion of children affected by stunting in the country METHODS: The CGM programme in Zimbabwe was evaluated using the logic model to assess the ability of the programme to identify growth faltering and link children to appropriate care RESULTS: Records from 60 health facilities were reviewed. Interviews were conducted with 60 nurses, 100 village health workers (VHWs) and 850 caregivers (300 health facility exit interviews, 450 community based). Nearly all (92%) health facilities visited had functional measuring scales. Twelve health facilities (20%) had no functional height board, with five using warped height boards for measuring children's height. Less than a quarter (21%) of the children had complete records for weight for age and height for age. A large proportion of children eligible for admission for the management of moderate (83%) and severe malnutrition (84%) were missed CONCLUSION: The CGM programme in Zimbabwe is not well equipped for assessing child height for age and management of children identified with malnutrition, thus failing to timely identify and manage childhood stunting <![CDATA[<b>South African men and women living with HIV have similar distributions of pain sites</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100038&lng=pt&nrm=iso&tlng=pt BACKGROUND: No studies have investigated sex differences in the location and number of pain sites in people living with human immunodeficiency virus (HIV) (PLWH), despite evidence that women, in general, bear a greater burden of pain than men AIM: To determine sex differences in the location and number of pain sites, and whether there were demographic or disease-related differences in the number of pain sites SETTING: South African tertiary hospital HIV clinics and a community healthcare centre METHODS: We conducted a retrospective analysis of records from South African PLWH who had pain RESULTS: Of the 596 participant records, 19% were male (115/596) and the median number of pain sites for both sexes was 2 (interquartile range [IQR]: 1 to 3). Pain was most frequently experienced in the head (men: 12%, women: 38%), feet and ankles (men: 42%, women: 28%), abdomen (men = 19%, women = 28%) and chest (men = 20%, women = 20%). After correcting for multiple comparisons, males were less likely to experience headache than females (Fisher's exact text, odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.12 - 0.42, p = 0.000). Pain at other body sites was experienced similarly between the sexes. There was no meaningful variation in the number of pain sites between the sexes (logistic regression, p = 0.157 CONCLUSION: A similar location and number of pain sites were experienced by male and female South African PLWH. The locations of pain sites were different from previous reports, however, suggesting that research into pain in PLWH cannot necessarily be generalised across cultures <![CDATA[<b>Position paper on undergraduate Palliative Medicine education for doctors in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100039&lng=pt&nrm=iso&tlng=pt BACKGROUND: Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality AIM: This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor SETTING: Palliative Medicine programme leads and teachers from eight medical schools in South Africa METHODS: A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers RESULTS: Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum CONCLUSION: Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC <![CDATA[<b>Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100040&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction AIM: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations SETTING: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas METHODS: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data RESULTS: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time CONCLUSION: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care <![CDATA[<b>Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100041&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking AIM: This study aimed to explore doctors' and patients' perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction SETTING: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province METHODS: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used RESULTS: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints CONCLUSION: A disconnect between patients and doctors caused by the doctors' perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care <![CDATA[<b>Erectile dysfunction predictors in hypertensives at a primary care clinic in Southern Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100042&lng=pt&nrm=iso&tlng=pt BACKGROUND: Erectile dysfunction (ED) has been described as an important public health problem by the National Institutes of Health Consensus Development Conference Panel. It causes significant distress in men and dysfunctional family dynamics AIM: This study sought to identify the relationship between level of education and ED amongst hypertensive men (aged 30-89 years) attending outpatient clinics (OPCs) at the Federal Medical Centre (FMC), Asaba SETTING: This study was conducted in the OPCs at 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 semistructured, interviewer-administered questionnaire adopted from the International Index of Sexual Health Inventory for Men. The study complied with the principles of Helsinki and Good Clinical Practice RESULTS: The mean age ± standard deviation and range of the respondents were 55.1 (±12.4) and 30-89 years, respectively. On logistic regression, higher level of education (secondary school and above) (odds ratio [OR] = 15.943, 95% confidence interval [CI] = 1.517-167.502) was found to be a predictor of ED amongst the study participants CONCLUSION: This study showed that formal education up to secondary level and use of diuretics were significantly associated with ED amongst adults with hypertension <![CDATA[<b>Corrigendum: Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100043&lng=pt&nrm=iso&tlng=pt BACKGROUND: Erectile dysfunction (ED) has been described as an important public health problem by the National Institutes of Health Consensus Development Conference Panel. It causes significant distress in men and dysfunctional family dynamics AIM: This study sought to identify the relationship between level of education and ED amongst hypertensive men (aged 30-89 years) attending outpatient clinics (OPCs) at the Federal Medical Centre (FMC), Asaba SETTING: This study was conducted in the OPCs at 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 semistructured, interviewer-administered questionnaire adopted from the International Index of Sexual Health Inventory for Men. The study complied with the principles of Helsinki and Good Clinical Practice RESULTS: The mean age ± standard deviation and range of the respondents were 55.1 (±12.4) and 30-89 years, respectively. On logistic regression, higher level of education (secondary school and above) (odds ratio [OR] = 15.943, 95% confidence interval [CI] = 1.517-167.502) was found to be a predictor of ED amongst the study participants CONCLUSION: This study showed that formal education up to secondary level and use of diuretics were significantly associated with ED amongst adults with hypertension <![CDATA[<b>Erratum: The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100044&lng=pt&nrm=iso&tlng=pt BACKGROUND: Erectile dysfunction (ED) has been described as an important public health problem by the National Institutes of Health Consensus Development Conference Panel. It causes significant distress in men and dysfunctional family dynamics AIM: This study sought to identify the relationship between level of education and ED amongst hypertensive men (aged 30-89 years) attending outpatient clinics (OPCs) at the Federal Medical Centre (FMC), Asaba SETTING: This study was conducted in the OPCs at 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 semistructured, interviewer-administered questionnaire adopted from the International Index of Sexual Health Inventory for Men. The study complied with the principles of Helsinki and Good Clinical Practice RESULTS: The mean age ± standard deviation and range of the respondents were 55.1 (±12.4) and 30-89 years, respectively. On logistic regression, higher level of education (secondary school and above) (odds ratio [OR] = 15.943, 95% confidence interval [CI] = 1.517-167.502) was found to be a predictor of ED amongst the study participants CONCLUSION: This study showed that formal education up to secondary level and use of diuretics were significantly associated with ED amongst adults with hypertension <![CDATA[<b>A study on willingness to take the COVID-19 vaccine at a tertiary institution community in Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100045&lng=pt&nrm=iso&tlng=pt BACKGROUND: South Africa is aiming to achieve herd immunity against the coronavirus disease 2019 (COVID-19) by the first quarter of 2022. The success of the COVID-19 vaccination roll-out depends primarily on the willingness of the population to take the vaccines. AIM: This study aimed to examine the willingness to take the COVID-19 vaccine, along with the factors of concern, efficacy and preferences of the individual, which may increase the willingness to be vaccinated. SETTING: This study was conducted at the University of the Witwatersrand, Johannesburg, amongst adult students and academic and professional staff. METHODS: A cross-sectional online survey from 27 July 2021 to 14 August 2021 was conducted. We performed descriptive and inferential analysis to determine the factors associated with willingness to take the COVID-19 vaccine. RESULTS: A total of 2364 participants responded to a survey link and 82.0% were students, 66.8% were in the 18-29 years age band and females represented 64.0%. A total of 1965 participants (83.3%) were willing to receive a COVID-19 vaccine, the most preferred vaccines were Pfizer (41%) and J (23%), local pharmacy (29%) and General Practitioner (GP) (17%) were the preferred places for vaccination and the trusted sources of information on COVID-19 vaccines were the general practitioners (40.6%) and specialists (19.2%). Perceptions that vaccines are safe (adjusted odds ratio [aOR] = 31.56, 95% confidence interval [CI]: 16.02-62.12 for affirmative agreement) and effective (aOR = 5.92, 95% CI: 2.87-12.19 for affirmative agreement) were the main determinants of willingness to taking a COVID-19 vaccine CONCLUSION: It is imperative to reinforce the message of COVID-19 vaccine safety and efficacy and to include the GPs and the community pharmacies in the vaccination roll-out in South Africa. <![CDATA[<b>Exploring experiences with sensitivity to cultural practices among birth attendants in Kenya: A phenomenological study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100046&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sensitivity to women's cultural needs and expectations by care providers is essential. Skilled birth services for women are as essential as traditional birth services. Therefore, collaborative skilled and cultural care optimises childbearing experiences. AIM: This study explored the experiences of birth attendants (BAs) with sensitivity to cultural practices (CPs) during pregnancy and birth among the Keiyo community in Kenya. SETTING: The study was conducted in the purposively selected public health centres and dispensaries offering maternity services and the villages in Keiyo South Sub County in Kenya. METHODS: A qualitative interpretive phenomenological study of BAs was conducted. Iterative and inductive interviews using a semistructured guide were conducted with 11 skilled BAs (SBAs) and eight traditional BAs (TBAs). Audio-recorded interviews were transcribed and analysed using ATLAS.ti software version 8.4.4 (1135), following Van Manen's five thematic analysis steps. RESULTS: Three themes emerged: birth attendants' cultural encounters, response to cultural encounters and collaboration. Birth attendants' responses to different cultural encounters revealed their awareness of CPs. The response was experienced as a sensitivity to the need for a triad (woman, TBAs and SBAs) collaborative care, enabling collaborative, woman-centred and culturally safe care. CONCLUSION: Birth attendants are exposed to cultural encounters, and their responses determine their awareness of enabling sensitive care for optimal childbearing experiences. The study illuminated the need for further collaborative engagements between the BAs and the community to facilitate positive experiences by women through woman-centred, culturally safe care. <![CDATA[<b>Carers' needs assessment for patients with dementia in Ghana</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100047&lng=pt&nrm=iso&tlng=pt BACKGROUND: Carers of people with dementia (PWD) face a myriad of challenges. As dementia prevalence surges in the sub-Saharan population, the provision of data on the met and unmet needs of caregivers has become paramount. AIM: This study aimed to identify the needs of carers of older adults living with dementia in Ghana. SETTING: This study was conducted in Kumasi, Ghana, among participants ≥ 18 years old, serving as carers for PWD. METHODS: This was a multicentre cross-sectional study involving carers of patients (≥ 50 years) with dementia. The authors administered the Carer's Needs Assessment for Dementia (CNA-D) questionnaire, containing 18 problem areas with interventions for each problem area. Pearson's correlation analysis was performed to establish a relationship between demographic characteristics, problem areas and intervention score. RESULTS: Fifty participants were recruited with a mean age of 48.8 (± 16.9) years, 72.0% were female participants and 98.0% were family members of PWD. The problem area most frequently identified as no/mild problem was 'legal issues' (92.0%, n = 46), and 'lack of information about dementia' was assessed as severe (48.0%, n = 24). The commonest unmet need was 'printed information material' (84.0%, n = 42), and the commonest met need was 'diagnosis and treatment of carer by a general practitioner' (42.0%, n = 21). There was a statistically negative correlation between age of carer and number of unmet needs (r = −0.308, p = 0.011) and a positive correlation between problem area score and number of unmet needs (r = 0.308, p = 0.030 CONCLUSION: Effective public education and provision of information on dementia to carers are essential interventions needed to equip them in performing their roles. CONTRIBUTION: Carers in this study revealed that they lacked information on dementia but their commonest met need was accessibility to their general practitioner. This highlights the importance of promoting knowledge and awareness of dementia among primary care practitioners. <![CDATA[<b>Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100048&lng=pt&nrm=iso&tlng=pt BACKGROUND: Few data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult. AIM: This study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa. SETTING: Tanzania, East Africa. METHODS: Outreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated. RESULTS: In the sample of 300 participants, 17.0% of participants were identified as 'transsexual or transgender' (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms 'transsexual and transgender' or their explanation in Swahili, reported by interviewers. CONCLUSION: In this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers. <![CDATA[<b>Prevalence and pattern of intimate partner violence among men and women in Edo State, Southern Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100049&lng=pt&nrm=iso&tlng=pt BACKGROUND: Intimate partner violence (IPV) is a growing concern in Nigeria and globally. Although women are at greater risk of IPV, men are also affected, but this is less reported. AIM: This study sought to determine the prevalence and pattern of IPV among the respondents and to compare the pattern of IPV among the male and female respondents. SETTING: The study was conducted in six towns (local government headquarters) across the three senatorial districts in Edo State, Southern Nigeria. METHODS: The study was a descriptive, cross-sectional, community-based study. A multistage sampling technique was used in selecting 1227 respondents from Edo State, Southern Nigeria. A semistructured, interviewer-administered questionnaire and the Extended Hurt, Insult, Threaten, Scream (E-HITS) tool were used to collect data, which were analysed with Epi Info version 7.1.2.0. RESULTS: The study found an IPV prevalence of 37.7% among the respondents (confidence interval [CI]: 95%, odds ratio [OR]: 0.169-0.294). The mean age was 38 ± 12 and respondents were mostly female (725, 59.1%), married (770, 62.8%) and unemployed (406, S33.1%), with a tertiary level of education (766, 62.4%). Intimate partner violence was significantly higher among women compared with men (95% CI: 4.474, OR: 3.425-5.846). The pattern of IPV showed a lower OR between sexual and physical IPV (95% CI: 0.276, OR: 0.157-0.485). There was a higher likelihood of IPV among married women (95% CI: 1.737, OR: 1.279-2.358. CONCLUSION: There is a need to improve the socio-economic status of the Nigerian populace, especially women. Healthy, nonviolent and safe relationships should be promoted in communities by signalling what is socially unacceptable and strengthening sanctions against perpetrators. <![CDATA[<b>Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100050&lng=pt&nrm=iso&tlng=pt BACKGROUND: The availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services. AIM: This study assessed maternal and child health (MCH) services' specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria. SETTING: The study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020. METHODS: A descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p < 0.05. RESULTS: Overall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p < 0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p < 0.001). CONCLUSION: The overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended. <![CDATA[<b>Building the foundation for universal healthcare: Academic family medicine's ability to train family medicine practitioners to meet the needs of their community across the globe</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100051&lng=pt&nrm=iso&tlng=pt BACKGROUND: The Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs AIM: This study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians METHODS: An anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs RESULTS: Twenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration LESSONS LEARNT: This study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration <![CDATA[<b>The contribution of family physicians to African health systems</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100052&lng=pt&nrm=iso&tlng=pt BACKGROUND: Africa is the last region to incorporate family physicians into its health systems. They are still a relatively new concept in many countries, small in numbers and deployed in a variety of ways. There is a need for more evidence on their contribution to African health systems to guide policymakers. AIM: The aim of this study was to review the special collection of short reports on the contribution of family physicians to African health systems, published in the African Primary Health Care and Family Medicine Journal in 2021. METHOD: Seventeen short reports from eight countries were qualitatively and thematically analysed in ATLAS.ti. Codes, which were derived inductively, were organised into categories according to the World Health Organization's primary health care monitoring framework RESULTS: In the domain of health system determinants, family physicians made little contribution to governance, adjustment to population health needs or financing. They did, however, contribute substantially to the capacity of the health workforce, supply of equipment, functioning of the health information system and use of digital technologies. In the domain of service delivery, they strengthened the model of care and championed systems for improving the quality of care. This translated into improved availability and utilisation of services, core functions of primary care, quality of care and patient safety. CONCLUSION: Family physicians described their important contribution to service delivery in district hospitals and primary health care. This should lead to improvements in outcomes and impact for the health system. Their contribution to the concept of resilient facilities and health services needs further exploration. <![CDATA[<b>Developing and prioritising strategies to improve the implementation of maternal healthcare guidelines in South Africa: The nominal group technique</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100053&lng=pt&nrm=iso&tlng=pt BACKGROUND: In South Africa, maternal healthcare guidelines are distributed to primary health care (PHC) facility for midwives to refer and implement during maternal healthcare services. Different training was offered for the use of maternal care guidelines. However, poor adherence and poor implementation of guidelines were discovered. AIM: This study aimed to develop and prioritise strategies to improve the implementation of maternal healthcare guidelines at PHC facilities of Limpopo province, South Africa. METHOD: Strengths, weaknesses, opportunities and threats analysis and its matrix together with the nominal group technique were used to develop the current strategy. Midwives, maternal, assistant and operational managers from PHC facilities of the two selected district of the Limpopo province were selected. Criterion-based purposive sampling was used to select participants. Data collection and analysis involved the four steps used in the nominal group technique. RESULTS: Strategies related to strengths and weaknesses such as human resources, maternal health services and knowledge deficit were identified. Opportunities and threats such as availability of guidelines, community involvement and quality assurance as factors that influenced the provision of maternal healthcare services were identified. CONCLUSION: Researchers formulated actions that could build on identified strengths, overcome weaknesses such as human resources, explore opportunities and mitigate the threats such as quality assurance. Implementation of the developed strategies might lead to the reduction of the maternal mortality rate. <![CDATA[<b>A tribute to Dr Muriel Fallala</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362022000100054&lng=pt&nrm=iso&tlng=pt BACKGROUND: In South Africa, maternal healthcare guidelines are distributed to primary health care (PHC) facility for midwives to refer and implement during maternal healthcare services. Different training was offered for the use of maternal care guidelines. However, poor adherence and poor implementation of guidelines were discovered. AIM: This study aimed to develop and prioritise strategies to improve the implementation of maternal healthcare guidelines at PHC facilities of Limpopo province, South Africa. METHOD: Strengths, weaknesses, opportunities and threats analysis and its matrix together with the nominal group technique were used to develop the current strategy. Midwives, maternal, assistant and operational managers from PHC facilities of the two selected district of the Limpopo province were selected. Criterion-based purposive sampling was used to select participants. Data collection and analysis involved the four steps used in the nominal group technique. RESULTS: Strategies related to strengths and weaknesses such as human resources, maternal health services and knowledge deficit were identified. Opportunities and threats such as availability of guidelines, community involvement and quality assurance as factors that influenced the provision of maternal healthcare services were identified. CONCLUSION: Researchers formulated actions that could build on identified strengths, overcome weaknesses such as human resources, explore opportunities and mitigate the threats such as quality assurance. Implementation of the developed strategies might lead to the reduction of the maternal mortality rate.