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

{"title":"Stopping antidepressants safely.","authors":"Mark Horowitz, Thomas L Perry","doi":"10.4102/phcfm.v18i1.5431","DOIUrl":"https://doi.org/10.4102/phcfm.v18i1.5431","url":null,"abstract":"<p><p>Long-term antidepressant pharmacotherapy is frequently continued beyond guideline-recommended durations. This occurs particularly among women, despite limited evidence of ongoing benefit for many people treated for mild-to-moderate depression and an increasing burden of adverse effects over time. In randomised trials, average symptom improvement over placebo is small (approximately 2 points on the 52-point Hamilton Depression Rating Scale), with an estimated number needed to treat of about 7-10 for a clinically meaningful benefit, underscoring the importance of planning for discontinuation once treatment is initiated. Antidepressant withdrawal is common yet under-recognised: at least half of people experience withdrawal symptoms when stopping, with risk and severity increasing with higher doses, longer duration of use and prior withdrawal experiences. This Therapeutic Letter outlines a practical, patient-centred approach to deprescribing that tailors tapering to individual risk, uses clinical response to guide the pace of reduction and emphasises careful differentiation of withdrawal symptoms from relapse. To minimise harms, abrupt discontinuation should be avoided; higher-risk patients may require very gradual tapering over months or years, often using hyperbolic dose reductions enabled by liquid formulations or dissolving tablets, with close follow-up every 2-4 weeks and the option to pause or reverse tapering if symptoms emerge. The guidance also highlights strategies for challenging presentations, including withdrawal-associated akathisia and protracted withdrawal, alongside patient education, shared decision-making and informed consent to support safer discontinuation and improved outcomes.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e6"},"PeriodicalIF":1.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595443","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}

{"title":"Operationalising palliative care integration: Experiences of implementers in South Africa.","authors":"Juanita O Arendse, Virginia Zweigenthal, Liz Gwyther","doi":"10.4102/phcfm.v18i1.5221","DOIUrl":"10.4102/phcfm.v18i1.5221","url":null,"abstract":"<p><strong>Background: </strong> South Africa's 2017 National Policy Framework and Strategy for Palliative Care mandated the integration of palliative care (PC) into the public health system using existing resources.</p><p><strong>Aim: </strong> To explore PC implementers' (1) experiences at least 1 year after implementation; (2) implementers' capability in providing PC; (3) approaches to PC integration at selected sites and (4) perceived enablers and obstacles requiring managerial support.</p><p><strong>Setting: </strong> Healthcare facilities in the Cape Metro District (CMD) of South Africa.</p><p><strong>Methods: </strong>A qualitative, exploratory design was employed in five primary healthcare facilities classified as higher- or lower-morphine-usage sites based on dispensing trends. Purposive sampling identified 29 stakeholders: 22 implementers (clinical and support staff) and seven operations managers. Data were collected in four virtual focus group discussions and one in-depth interview with implementers and one in-depth interview with managers.</p><p><strong>Results: </strong> Three main themes emerged: (1) Provider capability: implementers reported variable confidence in clinical skills and in providing psychosocial support; (2) health systems response: participants cited insufficient staffing and time, limited training opportunities and inconsistent multidisciplinary team functionality and (3) provision of patient-centred PC: stakeholders emphasised the need for clear referral pathways, interprofessional communication and supportive leadership to ensure continuity of care.</p><p><strong>Conclusion: </strong> Palliative care implementers' engagement in policy design and resource allocation is essential for sustainable implementation. Strengthening multidisciplinary teamwork, embedding PC content in undergraduate curricula and providing ongoing managerial support will enhance equitable access to quality palliative services.Contribution: Understanding how frontline stakeholders operationalise PC integration is essential for refining policy and practice in low-resource settings.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e12"},"PeriodicalIF":1.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595415","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":"Factors affecting the enrolment of men into a community adherence group in Kavango East Region, Namibia.","authors":"Andreas Nampola, Daniel O Ashipala, Epafras Anyolo","doi":"10.4102/phcfm.v18i1.5115","DOIUrl":"10.4102/phcfm.v18i1.5115","url":null,"abstract":"<p><strong>Background: </strong> Community adherence groups (CAGs) are an acceptable and effective strategy to provide social support for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), as well as for receiving their antiretroviral therapy (ART). However, in Namibia, it is estimated that 30% - 50% of men living with HIV are reluctant to access treatment through these groups, and little research exists on the factors affecting their enrolment.</p><p><strong>Aim: </strong> This study aimed to explore and describe factors affecting the enrolment of men in CAGs in Rundu District, Kavango East Region, Namibia.</p><p><strong>Setting: </strong> This study was carried out in the Kavango-East region, one of the 14 regions of Namibia.</p><p><strong>Methods: </strong> This study followed a qualitative approach that utilised exploratory, descriptive, and contextual strategies. The researcher conducted semi-structured, face-to-face interviews with 15 men between 22 years and 56 years of age in Rundu in September 2024 and October 2024. The participants were purposively selected and the data were analysed thematically.</p><p><strong>Results: </strong> Participants described numerous barriers hindering men from enrolling in CAGs, including stigma, a lack of information, few perceived benefits, and poor continuity of care. Additionally, participants recommended that men-only groups would improve enrolment.</p><p><strong>Conclusion: </strong> The study's findings demonstrate that overcoming barriers to men's enrolment in CAGs is vital for improving access to HIV treatment. Strategies such as anti-stigma campaigns, increased awareness, incentives, and men-only groups are essential for fostering inclusive and effective HIV care for men.Contribution: This study highlights the barriers to enrolment in CAGs for men living with HIV, particularly stigma and lack of information, while recommending anti-stigma campaigns, increased awareness, incentives, and men-only groups for improved enrolment.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e10"},"PeriodicalIF":1.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595455","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":"Dr Zelra Malan (13 November 1963 - 22 November 2025).","authors":"Felicia Christians","doi":"10.4102/phcfm.v18i1.5408","DOIUrl":"https://doi.org/10.4102/phcfm.v18i1.5408","url":null,"abstract":"","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"5408"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844262","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}

{"title":"Dr Zelra Malan (13 November 1963 - 22 November 2025).","authors":"Felicia Christians","doi":"10.4102/phcfm.v18i1.5408","DOIUrl":"https://doi.org/10.4102/phcfm.v18i1.5408","url":null,"abstract":"","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"5408"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595437","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}

{"title":"The holistic management of menopausal symptoms among indigenous women in the Gauteng province.","authors":"Maphefo S Aphane, Ramadimetja S Mooa, Molatelo M Rasweswe","doi":"10.4102/phcfm.v18i1.5108","DOIUrl":"10.4102/phcfm.v18i1.5108","url":null,"abstract":"<p><strong>Background: </strong> Menopause is a natural process with exacerbating symptoms for some women. Indigenous practices offer culturally rooted options that need systematic evaluation for safety and efficacy, while hormonal therapy, though effective, carries recognised risks and requires monitoring. An evidence-informed understanding of both approaches is essential for safe, individualised and effective menopausal care.</p><p><strong>Aim: </strong> To investigate the role of indigenous traditional knowledge practitioners in the holistic management of menopausal symptoms among indigenous women in the Gauteng province, South Africa.</p><p><strong>Setting: </strong> Selected homes of the participants in the Tshwane district, Gauteng province.</p><p><strong>Methods: </strong> A qualitative focused ethnography approach utilised purposive and snowball sampling to select 10 indigenous knowledge users and holders and 10 traditional health practitioners. Data were collected through in-depth interviews and non-participant observation and analysed using Brewer's ethnographic analytical framework with computer-assisted qualitative data analysis software.</p><p><strong>Results: </strong> Pitsa (Pot) as a holistic traditional remedy and cultural existentialism emerged as main themes with three sub-themes. Cultural existentialism is a philosophy that situates menopausal meaning-making and care practices within the framework of cultural identity, heritage and shared traditional knowledge.</p><p><strong>Conclusion: </strong> The study shows that Pitsa is perceived by indigenous women as a cultural practice that supports their holistic menopausal experience. It is valued more for identity, meaning-making and cultural support than for proven clinical effectiveness. Recognising such an indigenous knowledge system in menopausal health discourse is important, alongside further empirical evaluation of its clinical effects.Contribution: The study highlights the need for understanding and supporting the practices preferred by menopausal women.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e12"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595571","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":"Corrigendum: Evaluating the efficacy of digital media platforms in disseminating public health information: A global review with implications for South Africa.","authors":"Hulisani Matakanye, Ndivhuwo D Sundani","doi":"10.4102/phcfm.v18i1.5425","DOIUrl":"10.4102/phcfm.v18i1.5425","url":null,"abstract":"","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"5425"},"PeriodicalIF":1.7,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345222","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":"Implementation of malaria control programmes during the COVID-19 pandemic in the Southern African Development Community Elimination 8 countries: A scoping review.","authors":"Daphne N Muzamhindo, Geldine Chironda, Joyce Mahlako Tsoka-Gwegweni","doi":"10.4102/phcfm.v18i1.5110","DOIUrl":"10.4102/phcfm.v18i1.5110","url":null,"abstract":"<p><strong>Background: </strong> Malaria is one of the communicable diseases affecting the whole world. The World Health Organization (WHO) African Region is the most affected, with the Southern African Development Community (SADC) and the Malaria Elimination 8 (E8) countries accounting for 90% and 95% of the cases, respectively. The WHO tasked the SADC Malaria E8 countries to eliminate malaria by 2030, yet the COVID-19 pandemic response disrupted health programmes.</p><p><strong>Aim: </strong> The review aims to map and synthesise the evidence on malaria control programmes during the COVID-19 pandemic in the SADC E8 countries to identify gaps, inform policy, enhance planning for future pandemics and promote the attainment of the SADC 2030 Malaria E8 goal.</p><p><strong>Method: </strong> The reviewers conducted this review using the Joanna Briggs Institute (JBI) methodology. The population, concept and context (PCC) guided inclusion and exclusion criteria. Information relevant to the review questions was extracted using data extraction tools.</p><p><strong>Results: </strong> Of the 658 articles retrieved, only 7 met the inclusion criteria. Half of the publications were done in 2021, and nothing was published in 2020. The publishers were predominantly public health experts.</p><p><strong>Conclusion: </strong> There is limited research on the malaria programmes during the COVID-19 pandemic in the Malaria E8 countries.Contribution: The review brings out the need for research on the topic, policies that promote the continuation of malaria programmes during a pandemic and the employment of coping strategies.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e12"},"PeriodicalIF":1.7,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345275","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":"Transitioning to midwifery models of care: Implementation insights from focus groups with Health leaders in two African countries.","authors":"Lise-Lotte Franklin Larsson, Solomon Hailemeskel, Helena Lindgren, Ulrika Byrskog, Michael B Wells, Johanna Blomgren, Joyce Jebet Cheptum, Kaddy Ceesay, Kerstin Erlandsson","doi":"10.4102/phcfm.v18i1.5238","DOIUrl":"10.4102/phcfm.v18i1.5238","url":null,"abstract":"<p><strong>Background: </strong> Midwifery models of care, endorsed by the World Health Organization (WHO), offer rights-based, person-centred care with proven benefits for safer maternal and newborn care worldwide. Despite these demonstrated benefits, the successful adoption of midwifery models of care depends on context-specific factors, making it essential to understand how healthcare leaders perceive and approach such transitions.</p><p><strong>Aim: </strong> To examine healthcare leaders' perceptions of transitioning to midwifery models of care in Ethiopia and The Gambia, and to identify key barriers and facilitators influencing implementation.</p><p><strong>Setting: </strong> The study was conducted in Ethiopia and The Gambia within their respective maternal health system contexts, focusing on national and sub-national leadership perspectives.</p><p><strong>Methods: </strong> A qualitative study using open-ended, semi-structured interviews. An inductive thematic analysis was applied to explore leaders' insights on midwifery models of care and system readiness for transition.</p><p><strong>Results: </strong> Facilitators included midwives' active advocacy for women's rights and strong community engagement in maternal health decision-making. Common barriers across both countries were workforce shortages, limited health system infrastructure, donor dependency, and persistent gaps in access for rural populations. Additional barriers included inadequate transport networks, geographic inaccessibility, financial challenges limiting women's ability to reach skilled care, hierarchical governance structures that restrict midwives' professional autonomy, insufficient facility readiness, and cultural resistance to evidence-based midwifery practices.</p><p><strong>Conclusion: </strong> Transitioning to midwifery-led models of care requires context-specific strategies aligned with the World Health Organization implementation guidance, with particular attention to strengthening infrastructure, financing, and workforce capacity.Contribution: The study underscores the need to integrate midwives more fully into policy and governance structures. Strengthening their leadership and advocacy roles may enhance the visibility, influence, and overall contribution of the midwifery profession within national health systems.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e9"},"PeriodicalIF":1.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345273","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":"Health services and programmatic responses to improving adolescent HIV care in Lusaka, Zambia: A descriptive qualitative study.","authors":"Kaala Moomba, Talitha Crowley, Brian Van Wyk","doi":"10.4102/phcfm.v18i1.5189","DOIUrl":"10.4102/phcfm.v18i1.5189","url":null,"abstract":"<p><strong>Background: </strong> Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care.</p><p><strong>Aim: </strong> This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District.</p><p><strong>Setting: </strong> The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents.</p><p><strong>Methods: </strong> A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis.</p><p><strong>Results: </strong> Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery.</p><p><strong>Conclusion: </strong> Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia's progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade.Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"18 1","pages":"e1-e13"},"PeriodicalIF":1.7,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345237","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}