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

{"title":"Strategies for effective and efficient delivery of primary health care by village health workers: A scoping review using the Rodgers' Evolutionary Concept Analysis Framework.","authors":"Ofhani Munyai, Azwinndini G Mudau, Ntsieni S Mashau","doi":"10.4102/phcfm.v16i1.4554","DOIUrl":"10.4102/phcfm.v16i1.4554","url":null,"abstract":"<p><strong>Background: </strong> Village health workers (VHWs), popularly known as community health workers (CHWs) in some contexts and settings, should effectively complement health care providers in primary health care (PHC) delivery in Zimbabwe. However, they continue to offer services that do not address current and emerging health issues.</p><p><strong>Aim: </strong> This study aims to review the literature and develop a conceptual framework to improve the effectiveness and efficiency of VHWs in service delivery.</p><p><strong>Method: </strong> Rodgers' evolutionary framework was used to analyse the concept of 'strategies for effective and efficient delivery of PHC by VHWs'. Articles and reports published in English from 2010 to 2022 in peer-reviewed journals from the PUBMED, EBSCO, ScienceDirect and Google Scholar databases were reviewed.</p><p><strong>Results: </strong> After screening and removal of duplicates a total of 52 articles and two reports were reviewed to identify antecedents, attributes and consequences of strategies to improve PHC services by village health workers. The antecedents included an enabling work environment, community participation, motivation, incentives, integration of community health into national health systems, and information and communication technology. The attributes consisted of ongoing training and skills development, mutual respect and trust, enhanced contact between VHWs and communities and supportive supervision. The consequences were equitable access to and improved quality of PHC service delivery.</p><p><strong>Conclusion: </strong> The concept of PHC service delivery by VHWs has evolved from health promotion to curative care through task shifting and is now an integral part of the health system. A supportive and enabling work environment, anchored in community participation, empowers VHWs to deliver equitable services effectively and efficiently.Contribution: The development of strategies for improving VHW service delivery and a conceptual framework informed by findings from the reviewed literature.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e13"},"PeriodicalIF":1.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graduate perceptions of their interprofessional practice: Lessons for undergraduate training.","authors":"Jana Müller, Elize Archer, Ian Couper","doi":"10.4102/phcfm.v16i1.4706","DOIUrl":"10.4102/phcfm.v16i1.4706","url":null,"abstract":"<p><strong>Background: </strong> Interprofessional education (IPE) during undergraduate training (UGT) is considered important for new graduates to collaborate inter-professionally. There are, however, well-documented workplace challenges that hinder their involvement in interprofessional collaborative practice (IPCP) such as professional hierarchy, poor role clarification and communication challenges.</p><p><strong>Aim: </strong> This article explores graduates' perceptions of the value rural undergraduate IPE had on their IPCP during their first year of work.</p><p><strong>Setting: </strong> Graduates were based in seven different provinces of South Africa ranging from tertiary-level institutions to community day clinics.</p><p><strong>Methods: </strong> A qualitative case study was conducted with 16 first-year graduate participants from 5 different health professions who participated in undergraduate IPE while placed on a rural platform. Individual semi-structured interviews were conducted in 2023.</p><p><strong>Results: </strong> Key factors related to UGT that facilitated IPCP during graduates' first year of work were interprofessional relationship development, practice-based IPE and the focus on holistic patient-centred care. Graduates were, however, challenged by self-doubt, communication barriers and hierarchy in the workplace. Their recommendations for undergraduate IPE included role modelled and contextually relevant interprofessional skills development, practical advocacy and communication training, longer placements or shared learning spaces.</p><p><strong>Conclusion: </strong> Findings indicate that IPE during undergraduate rural clinical placements promotes interprofessional relationship development that extends into the workplace after graduation. However, IPE must be role modelled in the clinical environment and aligned to the reality of the healthcare system for students to develop the skills required to navigate IPCP as graduates.Contribution: This article offers recommendations for responsive undergraduate IPE to promote IPCP after graduation.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e12"},"PeriodicalIF":1.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimising inhaled corticosteroids for COPD.","authors":"Benji Heran, Thomas L Perry, Ken Bassett","doi":"10.4102/phcfm.v16i1.4756","DOIUrl":"10.4102/phcfm.v16i1.4756","url":null,"abstract":"<p><p>This Therapeutic Letter considers the evidence for inhaled corticosteroids (ICS) as a treatment for Chronic Obstructive Pulmonary Disease (COPD). Drug therapy aims to alleviate symptoms, enhance functional capacity and prevent exacerbations, but has not consistently shown to reduce mortality or improve quality of life based on randomised trials.Inhaled corticosteroids have shown limited benefits for COPD symptoms and exacerbations but increased risks of serious harms. Guidelines recommend limiting ICS to severe COPD and only for repeated exacerbations. Studies show withdrawing ICS can be done safely for stable COPD patients with infrequent exacerbations, especially those with lower eosinophil counts. Provincial, national and international guidelines now recommend limiting ICS prescriptions to severe COPD stages. Long-term ICS use may lead to serious side effects, including pneumonia and fractures. Initial COPD therapy should focus on short-acting bronchodilators, not ICS. Adding long-acting bronchodilators is recommended before considering ICS because of limited benefits and risks of serious harms. For persistent symptoms, long-acting muscarinic antagonists (LAMA) or long-acting beta2 agonists (LABA) are recommended, with the addition of ICS reserved for those with repeated exacerbations and severe COPD. Deprescribing ICS can be considered in clinically stable patients, particularly for those with infrequent exacerbations and mild COPD. When applicable, tapering ICS over several months is advised for patients with elevated eosinophil counts. Overall, the risks of serious harms from ICS typically outweigh their limited benefits for mild COPD patients in primary care.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e3"},"PeriodicalIF":1.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An audit of completeness of Road to Health Booklet at a community health centre in South Africa.","authors":"Pfunzo Machimana, Suzan L N Nyalunga, Edith N Madela-Mntla, Doudou K Nzaumvila","doi":"10.4102/phcfm.v16i1.4654","DOIUrl":"10.4102/phcfm.v16i1.4654","url":null,"abstract":"<p><strong>Background: </strong> For continuity and quality of care, accurate record-keeping is crucial. Complete care is facilitated by completing a child's Road to Health Booklet (RTHB) as well as prompt interpretation and appropriate action. This could result in a decrease in child morbidity and mortality.</p><p><strong>Aim: </strong> The study was aimed at assessing the completeness of the RTHB of children younger than 5 years.</p><p><strong>Setting: </strong> Temba Community Health Centre (CHC), Tshwane District, South Africa.</p><p><strong>Methods: </strong> A cross-sectional study was conducted using a data collection sheet adopted from previous studies.</p><p><strong>Results: </strong> Children less than 1-year-old accounted for 70.2% of the 255 RTHBs. The mean ± s.d. age was 11.5 ±10.76 months. The study finding showed no section was 100% fully completed. Of the 255 records studied, 38 (14.9%) human immunodeficiency virus (HIV)-exposed babies were recorded at birth, 39.5% were negative at 6 weeks and 60.5% were not recorded. Ninety-one (35.7%) children were unexposed. The HIV status of 126 (49.4%) children was not recorded. Sixty-six per cent (66%) of recorded maternal syphilis was negative. Immunisations, weight-for-age, neonatal information, and details of the family and child were fully completed in 80% of the booklets. Developmental screening was 17.2% completed, and oral health was 1.6% partially completed. The overall completeness was 40.3%.</p><p><strong>Conclusion: </strong> The completeness of RTHBs was found to be suboptimal.Contribution: The present study's findings should serve as a reminder that healthcare practitioners must complete RTHBs in their totality in order to improve continuity and care quality, as the results indicated that RTHB completion was below ideal.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of dissemination strategies of maternal clinical guidelines: A narrative review.","authors":"Eunice N Atsali, Doreen Kaura, Mark Tomlinson","doi":"10.4102/phcfm.v16i1.4494","DOIUrl":"10.4102/phcfm.v16i1.4494","url":null,"abstract":"<p><strong>Background: </strong> Maternal clinical guidelines (MCGs) provide evidence-based recommendations for skilled birth professionals (SBPs) at the point of care. The dissemination strategies and use of MCGs are inconsistent among skilled birth providers despite their potential to improve the maternal care outcomes.</p><p><strong>Aim: </strong> This study examined the effectiveness of dissemination strategies of MCGs by SBPs in a primary care setting.</p><p><strong>Method: </strong> We searched in Medline, PubMed, CINAHL and Google Scholar. Search terms were effectiveness, dissemination and use, MCGs, SBPs and primary health care facilities. Studies published in English, conducted between 2010 and 2023 and focussing on dissemination strategies and use of MCGs were included. The final articles were presented in narrative format.</p><p><strong>Results: </strong> The search yielded 212 studies. After removing duplicates, seven articles that met the inclusion criteria for the review were included. The narrative review summarised the findings as: Use of MCGs which showed the barriers and enablers for the use of maternal guidelines. The level of adherence to MCGs was summarised, and one study showed the use of support supervision and collaboration improved aspects of MCGs.</p><p><strong>Conclusion: </strong> The findings show how skilled attendants acknowledge that MCGs can contribute to improving maternal outcomes. They further describe how, in practice, they are rarely used at the facility level. There is a need for more research on dissemination strategies to ensure improved use of MCGs in primary health care facilities.Contribution: We highlight the key gap in the dissemination of MCGs at primary health care facilities which if improved can potentially improve the use of MCGs.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing West African family medicine curriculum through entrustable professional activities.","authors":"Bolatito B Fatusin, Musa Dankyau, Akye Essuman, Abraham N Gyuse, Akinfemi J Fatusin, Louis S Jenkins","doi":"10.4102/phcfm.v16i1.4691","DOIUrl":"10.4102/phcfm.v16i1.4691","url":null,"abstract":"<p><p>The training of Family Medicine residents in the West Africa College of Physicians (WACP) has steadily upscaled to a competency-based approach over the years. The latest review of the curriculum (2022) includes self-directed online modules on clinical postings, health management, patient safety, quality assurance research and medical education among others. The operationalisation of the revised curriculum involves the use of workplace-based tools for formative assessments. However, some shortcomings of the traditional work place based assessment (WPBA) have been observed, including a lack of standardisation, time consumption, variability in the assessors' judgements and systematic biases. These shortcomings can be mitigated through the adoption of entrustable professional activities (EPA) along with the use of WPBA.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e5"},"PeriodicalIF":1.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Innovative educational methods for Family Medicine and Primary Care training.","authors":"Sunanda C Ray","doi":"10.4102/phcfm.v16i1.4833","DOIUrl":"10.4102/phcfm.v16i1.4833","url":null,"abstract":"","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e2"},"PeriodicalIF":1.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unimpaired vision is an indispensable prerequisite for safe driving.","authors":"Josef Finsterer","doi":"10.4102/phcfm.v16i1.4810","DOIUrl":"10.4102/phcfm.v16i1.4810","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e2"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life orientation teachers' perspectives on intersectoral collaboration management of sexuality education.","authors":"Zoe Pillay, Faniswa H Mfidi","doi":"10.4102/phcfm.v16i1.4703","DOIUrl":"10.4102/phcfm.v16i1.4703","url":null,"abstract":"<p><strong>Background: </strong> According to the United Nations Fund for Population Activities, sexuality education (SE) requires building a multisectoral team and developing an operational plan. Hence, teaching comprehensive sexuality education (CSE) in collaboration with relevant stakeholders is a managerial approach to provide school-going adolescents with the knowledge and skills to make informed decisions that will safeguard their health.</p><p><strong>Aim: </strong> To report on Life Orientation (LO) teachers' perspectives on intersectoral collaboration management of SE in secondary schools in KwaZulu-Natal (KZN) province, South Africa.</p><p><strong>Setting: </strong> Four selected secondary schools in the sub-district of uMhlathuze, KZN.</p><p><strong>Methods: </strong> The study employed a qualitative design. The population of this study comprised of 16 LO teachers who were selected by means of homogeneous sampling through focus group discussions. Emerging patterns were observed once the data were transcribed and subjected to thematic analysis.</p><p><strong>Results: </strong> The study revealed that schools were not being supported in the management of intersectoral collaboration in SE implementation in secondary schools in KZN province, South Africa.</p><p><strong>Conclusion: </strong> The results made it evident that more needs to be done to enhance and fortify intersectoral collaboration management to strengthen CSE in secondary schools.Contribution: The study recommended innovative and improved SE programmes and projects throughout the implementation and evaluation process to identify successes and promptly correct errors, to guarantee appropriate coordination of intersectoral collaboration management.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e7"},"PeriodicalIF":1.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary lipoarabinomannan for diagnosis of Tuberculosis in an HIV-negative population: A scoping review.","authors":"Omishka Hirachund, Somasundram Pillay","doi":"10.4102/phcfm.v16i1.4733","DOIUrl":"https://doi.org/10.4102/phcfm.v16i1.4733","url":null,"abstract":"<p><strong>Background: </strong> Tuberculosis (TB) remains a leading cause of mortality in low-resource settings and poses a diagnostic challenge in human immunodeficiency virus (HIV)-negative populations because of limitations in traditional diagnostic methods such as sputum smear microscopy (SSM) and sputum Xpert Ultra. There is a lack of effective, non-invasive diagnostic options for TB diagnosis in HIV-negative populations. This scoping review explores the potential of urinary lipoarabinomannan (ULAM) as a point-of-care diagnostic tool for Mycobacterium tuberculosis (MTB) in HIV-negative individuals.</p><p><strong>Aim: </strong> To evaluate the diagnostic performance of ULAM in detecting TB among HIV-negative populations and assess its feasibility as a rapid, non-invasive diagnostic method.</p><p><strong>Method: </strong> A systematic search was conducted across PubMed, Google Scholar and Scopus. Articles were selected based on relevance to the topic.</p><p><strong>Results: </strong> The search yielded 210 articles, with 11 meeting our inclusion criteria. These studies reported varying diagnostic performance metrics for ULAM: sensitivity ranged from 10.0% to 66.7% and specificity from 90.0% to 98.1% among different assays. Notably, the studies demonstrated that the novel assays such as Electrochemiluminescence LAM and the second-generation FujiLAM showed higher sensitivities of 66.7% and 53.2%, respectively. Despite these advancements, the overall effectiveness of ULAM in HIV-negative populations remains limited, with standard assays exhibiting sensitivities as low as 10.0%.</p><p><strong>Conclusion: </strong> While ULAM holds potential as a diagnostic tool in HIV-associated TB, its application in HIV-negative populations is constrained by low sensitivity of the currently available assays.Contribution: The development and validation of high-sensitivity assays are crucial for broadening the utility of ULAM in these populations.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"16 1","pages":"e1-e6"},"PeriodicalIF":1.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}