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

{"title":"Improving the core functions of primary care in a Ugandan rural district.","authors":"Innocent K Besigye, Robert J Mash","doi":"10.4102/phcfm.v17i1.4782","DOIUrl":"10.4102/phcfm.v17i1.4782","url":null,"abstract":"<p><strong>Background: </strong> In many countries, the core functions of primary care (PC) continue to perform poorly and therefore need improvement, guided by interventions developed in collaboration with key stakeholders.</p><p><strong>Aim: </strong> This paper reports on the co-design of an intervention guided by the findings of the Primary Care Assessment Tool (PCAT) survey.</p><p><strong>Setting: </strong> The setting for the study was a rural Ugandan district.</p><p><strong>Methods: </strong> This was part of a multi-stage mixed methods study to evaluate the use of the PCAT in improving primary care performance. Key stakeholders in primary care system were purposively identified to participate in the design of the intervention. The intervention co-design involved presentation and discussion of the PCAT findings, two rounds of root cause analysis, selection of intervention focus area, design of the actual intervention and planning of implementation.</p><p><strong>Results: </strong> Ongoing care was selected for intervention among the poorly performing primary care core functions. Community members' low awareness of the available services and low affiliation to their local primary health care (PHC) facility were identified as major contributors to the poor performance of ongoing care. Community dialogues as form of community engagement were selected as an intervention to improve the core primary care functions.</p><p><strong>Conclusion: </strong> The PCAT can generate findings to guide the development of interventions at the facility and district level to potentially improve the core functions of primary care.Contribution: A co-design process helped to navigate the pathway from the findings to the intervention design and its implementation strategy.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e7"},"PeriodicalIF":1.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209877","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":"Promoting health and safety in public transportation: A call to action for sub-Saharan Africa.","authors":"Gugu G Mchunu, Dudu G Sokhela, Yugan Pillay, Ivan Niranjan, Celenkosini T Nxumalo","doi":"10.4102/phcfm.v17i1.4570","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4570","url":null,"abstract":"<p><p>Road Traffic Incidents (RTIs) are a major public health concern worldwide, particularly in low-income to middle-income regions such as sub-Saharan Africa. Data from sub-Saharan Africa suggests that the public transport industry accounts for the majority of fatal crashes that contribute to the high mortality and morbidity associated with RTIs. In this viewpoint, we advocate for integrated and comprehensive evidence-based health and safety interventions to address the challenge of RTIs in the public transport industry in sub-Saharan Africa. We provide evidence on the magnitude of the problem drawing on the state of mortality and morbidity and reported challenges associated with RTIs in the minibus taxi industry in South Africa as this is the most common mode of public transport in the region.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e5"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034253","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":"Exploring the gastric cancer care pathway in South Africa.","authors":"Anishka Ramadhar, Juliana Kagura, Mazvita Muchengeti, Cameron Gaskill, Natasha Khamisa","doi":"10.4102/phcfm.v17i1.4774","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4774","url":null,"abstract":"<p><strong>Background: </strong> Gastric cancer (GC) diagnosis and care data in South Africa (SA) is sparse, and SA has a high GC mortality rate. Mapping the GC care pathway is needed to explore its efficacy in association with the SA GC burden and mortality.</p><p><strong>Aim: </strong> The study aims to map the GC care pathway in SA from diagnosis to management by healthcare professionals (HCPs) involved in the GC patient journey and explore barriers and facilitators to the effective flow of the GC care pathway.</p><p><strong>Setting: </strong> Interviews conducted with South African HCPs were the data source used in this article for analysis. General physicians (GP) were the first contact point with chain-referral sampling sourcing other clinicians.</p><p><strong>Methods: </strong> Interviews were conducted via Microsoft Teams (MS Teams) and Google Meet with qualitative analyses via MAXQDA.</p><p><strong>Results: </strong> Themes identified were GC care pathway processes, public versus private healthcare system differences and care pathway challenges. Multidisciplinary team (MDT) care is practised for GC in SA, starting with the GP or nurse followed by gastroenterologist (GI), surgeon and pathologist. Thereafter, nurses, dieticians and palliative care specialists are involved. Healthcare sector differences are diagnosis time, GC staging, HCP and treatment access. Challenges include low GC index of suspicion by primary care clinicians (PCC) and Helicobacter pylori (H. pylori) detection.</p><p><strong>Conclusion: </strong> A MDT approach for optimal treatment and patient care may be the best method for prolonged life.Contribution: A South African national consensus for GC care via a MDT, emphasising early diagnosis to aid in a robust treatment plan for improved patient outcomes is warranted.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001345","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":"Family physicians as advocates for primary health care in Botswana.","authors":"Billy M Tsima, Yaone Bogatsu, Keneilwe Motlhatlhedi, Claire Brockbank, Sunanda C Ray","doi":"10.4102/phcfm.v17i1.4908","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4908","url":null,"abstract":"<p><p>Advocacy for family medicine in Botswana has been facilitated by good cooperation between the University of Botswana (UB), the Botswana Association of Family Physicians and the Botswana Health Professions Council. The importance of family physician leadership in putting primary health care (PHC) at the centre of the health system has been recognised and acted on by the Ministry of Health. Family medicine teaching is integrated throughout the 5-year undergraduate medical curriculum at the UB Faculty of Medicine and takes place in rural and urban training complexes. Family medicine is a popular career choice but developing a critical mass of family physicians is limited by the low number of training posts available each year. Botswana has a strong PHC foundation with village health committees, village development committees and community home-based care teams, led by district health management teams (DHMTs). There are not enough family physicians currently in the public sector to provide sufficient clinical leadership for the DHMTs as well as to provide clinical supervision of medical officers and nursing staff in clinics, and primary and district hospitals, as well to be actively involved in advocacy for health equity and quality of care to policymakers. Active participation in regional initiatives to expand family physician training opportunities could contribute to strengthening the health workforce in Botswana.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e4"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021728","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":"Experiences of nurses in patient adherence to antiretoroviral therapy in Mpumalanga, South Africa.","authors":"Kabelo Moroko, Zelda Janse van Rensburg, Wanda Jacobs","doi":"10.4102/phcfm.v17i1.4841","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4841","url":null,"abstract":"<p><strong>Background: </strong> Human immunodeficiency virus (HIV) is a global health pandemic. Mpumalanga is a province with a high burden of HIV or acquired immunodeficiency syndrome (AIDS). Antiretroviral (ARV) therapy should be initiated for all HIV-positive patients. Monitoring of patients' adherence to ARV therapy is important to ensure continued viral suppression.</p><p><strong>Aim: </strong> The study aimed to report on the experiences of primary health care (PHC) nurses in monitoring patients' adherence to ARV therapy in PHC facilities in Mpumalanga, South Africa.</p><p><strong>Setting: </strong> Six PHC clinics in a district in Mpumalanga were purposively selected.</p><p><strong>Methods: </strong> Employing a qualitative, exploratory, descriptive research design, 12 PHC nurses were interviewed in 2023. The data were coded, categorised and clustered into themes and categories. Ethical considerations and measures to ensure trustworthiness were adhered to.</p><p><strong>Results: </strong> The findings revealed four themes: PHC nurses' experience in monitoring patients' adherence to ARV therapy in PHC facilities, experience of external challenges influencing patient's adherence to ARV therapy, experiences in internal challenges that influence patients' ARV therapy adherence, and the consequences of non-monitoring and poor adherence.</p><p><strong>Conclusion: </strong> Non-adhering patients were seen to be the greatest challenge. More awareness regarding the central chronic medicine dispensing and distribution (CCMDD) programme and the development of guidelines on the support of PHC nurses and patients are recommended.Contribution: The findings of the study may guide recommendations to assist PHC nurses, PHC management and policy makers at large to address challenges in the monitoring and adherence of patients on ARV therapy.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053840","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":"Physical rehabilitation delivery by community health workers: Views of the users and caregivers.","authors":"Miriam Mapulanga, Thembelihle Dlungwane","doi":"10.4102/phcfm.v17i1.4852","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4852","url":null,"abstract":"<p><strong>Background: </strong> Community health workers are crucial in providing health services at the community level. However, in Zambia, there are limited opportunities for formal physical rehabilitation training for community health workers, leading some to provide rehabilitation services without the necessary training.</p><p><strong>Aim: </strong> This study sought to explore the experiences and perspectives of users and caregivers who receive physical rehabilitation services from community health workers without training in physical rehabilitation.</p><p><strong>Setting: </strong> Matero, a sub-district of Lusaka, Zambia.</p><p><strong>Methods: </strong> An exploratory qualitative approach using face-to-face, in-depth interviews was used to collect data from users and caregivers who receive physical rehabilitation services from untrained community health workers. The study included 12 participants, six service users and six primary caregivers. Data were transcribed and analysed using thematic analysis.</p><p><strong>Results: </strong> Six themes emerged from the analysis, namely access to services, perceived skills and competence of community health workers, satisfaction with community health worker-delivered physical rehabilitation services, values and attitudes of community health workers, perceived unmet needs of community health worker-delivered physical rehabilitation services and impact of community health worker-delivered physical rehabilitation.</p><p><strong>Conclusion: </strong> Physical rehabilitation rendered by community health workers positively impacted the users despite the gaps identified. Formalising training of community health workers in physical rehabilitation could enhance service coverage and improve the overall quality of care.Contribution: The scientific contribution has been made by the views of users and caregivers regarding their experiences and perspectives of community health workers-delivered physical rehabilitation services without training.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991350","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":"Lived experiences of motherhood among students in a university in KwaZulu-Natal, South Africa.","authors":"Lungisile Shange, Pranitha Maharaj","doi":"10.4102/phcfm.v17i1.4757","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4757","url":null,"abstract":"<p><strong>Background: </strong> Despite ongoing attempts to minimise pregnancies at a young age, early childbearing continues to be one of the world's most pressing social concerns. South Africa is not immune to this problem, with many young females becoming mothers at an early age. Although South Africa's fertility rate has decreased over time, the prevalence of early childbearing remains high.</p><p><strong>Aim: </strong> This study explores the experiences and perspectives of young mothers who are university students.</p><p><strong>Setting: </strong> The study was conducted in KwaZulu-Natal, South Africa.</p><p><strong>Methods: </strong> This was a qualitative study and employed an exploratory research design. In-depth interviews were conducted with 20 African women, aged 18-24 years, to learn about the challenges that young mothers face daily and how this affects their academic careers.</p><p><strong>Results: </strong> The mothers indicated that it was challenging to balance parenthood with their academic pursuits because both are incredibly demanding. As a result, the student mothers' academic performance suffers, reducing their future earning potential. Most young mothers were single and unemployed, so they relied on their parents to care for them and their children. Almost all the mothers reported limited assistance for young mothers at the university.</p><p><strong>Conclusion: </strong> A national education policy should require universities to adopt resources or specifically designed programmes to promote better support for student mothers.Contribution: This study highlights the need for a better understanding of, and continued research into the type of support structures that are available for student mothers.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054000","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":"Community caregivers' perceptions: Family-centred postnatal care in KwaZulu-Natal, South Africa.","authors":"Nontuthuzelo D Nyasulu, Myra Taylor, Nelisiwe Khuzwayo","doi":"10.4102/phcfm.v17i1.4817","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4817","url":null,"abstract":"<p><strong>Background: </strong> The family-centred postnatal care (FCPC) approach highlights the active participation of family members in supporting the care of the mother and newborn. It acknowledges the vital role of social support, practical assistance and emotional encouragement from family members.</p><p><strong>Aim: </strong> The study aimed to explore community caregivers' (CCGs) experiences and perceptions of the FCPC approach.</p><p><strong>Setting: </strong> The study took place in uMgungundlovu municipality, KwaZulu-Natal Province.</p><p><strong>Methods: </strong> A qualitative study design using a grounded theory approach was used. Participants were selected using purposive sampling. Four focus group discussions were held with 23 CCGs from the seven sub-districts. Data were analysed manually following the grounded theory steps.</p><p><strong>Results: </strong> Five themes emerged from the data analysis. These include perceptions of CCGs about the strength of antenatal care in enhancing postnatal care (PNC), experiences of CCGs in FCPC, non-attendance of postnatal visits by mothers and newborns, attitudes of CCGs towards healthcare professionals, and recommended activities for the CCGs in FCPC.</p><p><strong>Conclusion: </strong> The data analysis highlights the vital contributions of CCGs in improving maternal health and neonatal outcomes. These findings underscore the critical areas for improving support and outcomes for mothers and newborns.Contribution: The experiences and perceptions of CCGs on FCPC provide valuable insights into the importance of involving family members in supporting mothers and newborns. Their perspectives highlight practical challenges, opportunities for improved care, and family engagement's critical role in enhancing postnatal outcomes.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e9"},"PeriodicalIF":1.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039397","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":"Patients' palliative care needs in rural health and a proposal for palliation services.","authors":"Deidre Pretorius, Lesley G Mahole","doi":"10.4102/phcfm.v17i1.4866","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4866","url":null,"abstract":"<p><p>Few patients and their families receive palliative care (PC), and if provided, it is usually in the end stages of the disease. In the past, these services were rendered by non-governmental organisations (NGOs), but after the dedicated South African palliative care policy was released, the responsibility of PC service delivery is at the provincial level. Department of Health's National Policy Framework and Strategy on PC was a major step forward in palliation; however, the services are not yet reaching the rural areas in North West province. This article highlights the need for PC for patients and their families in rural health. A model is suggested to facilitate these services under the leadership of a family physician.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e4"},"PeriodicalIF":1.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054104","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":"Exploring stakeholders' experiences on implementing family medicine in urban South Africa.","authors":"John M Musonda, Shabir Moosa","doi":"10.4102/phcfm.v17i1.4675","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4675","url":null,"abstract":"<p><strong>Background: </strong> South Africa recognised family medicine as a medical speciality in 2007. The discipline plays a significant role in strengthening primary health care. However, the experiences of family physicians, private general practitioners and other stakeholders on implementing family medicine in urban South Africa remain unexplored.</p><p><strong>Aim: </strong> To explore stakeholders' experiences in urban South Africa on implementing family medicine.</p><p><strong>Setting: </strong> All participants were from Gauteng province, South Africa.</p><p><strong>Methods: </strong> The evaluated lived experiences of implementing family medicine as a clinical discipline. A descriptive, explorative qualitative study was undertaken using semi-structured, in-depth interviews with purposively selected individuals from October 2019 to December 2020. Thematic data analysis used MAXQDA version 2020.</p><p><strong>Results: </strong> Four major themes emerged. Most participants felt a disparity between private and public primary care services, with the latter having optimistic views about health reforms. Further, private general practitioners' clinical skills and competencies needed strengthening, and mixed staffing for primary care teams was envisioned. Many participants had ill-defined ideas about family medicine's impact and prospects but agreed that more resources were needed to improve it.</p><p><strong>Conclusion: </strong> The study highlights the participants' first-hand involvement in implementing family medicine. The findings may enhance knowledge of primary care services, clinical skills and staff composition. Further research is recommended.Contribution: The study provides insight into recognising family medicine, which preceded the government's efforts to introduce Universal Health Coverage to be funded through the National Health Insurance.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056182","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}