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Background: Data at primary healthcare (PHC) clinics are handwritten in registers by nurses for submission to the District Health Information System (DHIS). Compared to pen and paper, data capture, using handheld computers, has fewer errors, is more efficient and is readily accepted by users. This study describes the process of developing a tablet computer programme to capture data, and explores nurses' experiences of using tablets at a community health centre. Method: OpenDataKit® was used to design XForms for touchscreen entry. Data for tuberculosis screening were captured by nurses on Android® 9.7-inch tablets over a week. Their experience was explored by means of a focus group interview. Results: Data were recorded for 24 patients and seamlessly transferred for analysis. Nurses thought that the tablets were easy to use and saved time. They would be happy to use tablets in preference to pen and paper. They expressed a desire to extend the use of tablets to other areas of their work. Conclusion: Tablet computers were readily accepted by the nurses. They are a feasible alternative to pen and paper for recording data at point of care. This tablet-based system could be used to transfer PHC data directly to the DHIS. [ABSTRACT FROM AUTHOR]

Background: Mobile Health is the utilisation of mobile devices like cellphones and tablets for the delivery of health care. It is an up and coming intervention promising to benefit health services. Recent mobile health studies have tended to focus on mHealth for data collection and surveillance rather than on actual patient care. This paper highlights the potential and the challenges of mHealth use in the delivery of health care services. Objectives: This paper focused on determining the use of mHealth and identifying and describing the opportunities and the challenges faced by the medical doctors in using mHealth at a specific health care facility in Zimbabwe. Methods: A quantitative, descriptive, cross-sectional and analytical design was used to determine the rate of utilisation of selected mHealth "patient identification and treatment activities" by medical doctors. A structured questionnaire was used for data collection form 104 respondents. The number of the returned complete and usable questionnaires was 42. No sampling technique was done because the whole population was of interest to the researcher, accessible and available during data collection. Results: Fifty percent (50%) of the respondents indicated, lack of knowledge and unawareness in using mHealth to support chronically ill patients. The majority of the respondents (83.3%) believed that mHealth presented opportunities to improve health care delivery. The majority of the respondents (95%) indicated the potential for its future use. Conclusion: Given the challenges that were encountered mHealth program to be officially launched for mHealth use and the users to be developed on its utilisation. [ABSTRACT FROM AUTHOR]

Background: Although cervical cancer is preventable, it remains the most feared and second most common cancer in women worldwide, as well as the leading cause of cancer deaths in many lowand middle-income countries, including South Africa. Numerous studies conducted globally, in Africa and in South Africa revealed a knowledge gap about cervical cancer and its preventive strategies, including cervical cancer screening, among nurses and the general population. Aim: The purpose was to investigate and describe nurses' knowledge and management practices regarding cervical cancer screening in uMsunduzi Local Municipality, KwaZulu- Natal. Methods: The study was directed by a positivism paradigm. A quantitative research approach and nonexperimental descriptive design was used in this study. Probability random sampling was used, and a self-administered questionnaire was used to collect data. Eighty-three professional nurses participated in the study. Results: The study discovered that professional nurses working in selected clinics in uMsunduzi Local Municipality, KwaZulu-Natal, had a high level of knowledge about cervical cancer and its screening. Nonetheless, despite the high level of knowledge demonstrated, the level of practice remained low. Conclusion: Cervical cancer morbidity and mortality have long been a major health concern in South Africa's general population. The study found that PNs are knowledgeable about cervical cancer screening; conversely, practice was low. This paper includes recommendations for future research, nursing practice, nursing education and the Department of Health. Contribution: This study contributed vastly to the body of knowledge in managing cervical cancer screening practices, particularly in health promotion and prevention of diseases at primary care level. [ABSTRACT FROM AUTHOR]

Background: Midwifery students in South Africa place great value on the clinical support they receive from midwifery practitioners. Adequate clinical support should help midwifery students to practice procedures safely and independently, allowing them to be competent upon degree completion. Aim: To describe the clinical support and perceived competency levels of midwifery students. Setting: Public hospitals in KwaZulu-Natal. Methods: The researcher chose a quantitative research method using a descriptive design. An all-inclusive purposive and convenience sampling method was undertaken to recruit midwifery students from an undergraduate nursing programme at a university in KwaZulu-Natal. Gatekeepers permission and ethics approval was obtained from the university's registrar and research ethics committee. A self-evaluation questionnaire describing the clinical support and perceived competency levels was completed by 60 respondents. Data were analysed using International Business Machines Corporation Statistical Package for Social Sciences (IBM-SPSS) Version 27. Results: The results highlighted that the clinical support midwifery students received, was beneficial to their clinical learning outcomes. Eighty per cent of clinical support offered to midwifery students was obtained through clinical supervision. Ninety-three per cent of respondents revealed that the clinical support they received were from midwifery practitioners (without a speciality qualification). Although students rated themselves as competent in 88.6% of midwifery procedures, poor outcomes were identified in 11.4% procedures. Conclusion: Midwifery practitioners play a significant role in supporting midwifery students during clinical placement. Advancing the roles of midwifery practitioners through mentorship training is likely to strengthen the quality of clinical support provided and thus improve the competence levels of midwifery students. Contribution: The findings in this paper are valuable in developing clinical support training guidelines for midwifery practitioners. [ABSTRACT FROM AUTHOR]

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Background: The increased popularity of complementary medicine has created the need for patients to receive accurate information from nurses who are front-line healthcare providers. Studies have demonstrated that patients are more likely to discuss other medication and therapy use with nurses, rather than with general practitioners or other health professionals. It is, therefore, important to determine nurses' knowledge and attitudes towards complementary medicine. Aim: The aim of this study was to determine nursing students' knowledge and attitudes toward the use of complementary medicine. Setting: The study was conducted with Baccalaureus Curationis (nursing) students registered at a large public university in Gauteng, South Africa. Methods: This research utilised a quantitative approach with a prospective, descriptive survey design. A convenience sample comprising registered Baccalaureus Curationis nursing students (n = 202) was utilized. Participants completed a 34-item, paper-and-pencil questionnaire to determine their knowledge, personal use and attitude toward complementary medicine modalities. Results: Questionnaires were completed by 126 nursing students with 119 questionnaires included for analysis. Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine. Almost half of the participants reported enquiring about its use in history taking and were willing to refer patients to a complementary medicine practitioner. Conclusion: A positive attitude towards complementary medicine modalities might suggest a willingness from students to improve their knowledge of the various modalities and to refer to a complementary medicine practitioner when indicated. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the views of students involved in rural community-based medical attachments during their final year at medical school. The programme has been in existence for some time, but no formal evaluation thereof has yet taken place. This paper describes the first two phases of what is described as a quality improvement project: namely to describe the problem state and to discuss possible activities to improve the programme. Design, setting and subjects: The study adopted a mixture of quantitative and qualitative type research. Data were collected by means of a self-administered questionnaire which students at Nelson R Mandela Medical School, University of KwaZulu-Natal, completed at the end of their Family Medicine rotation. Consent was obtained from the participants and ethical approval granted by the University of KwaZulu-Natal Humanities and Social Science Ethics Committee. Results: Students were generally positive about their rural attachment experience. The majority (86%) believed that their skills adequately prepared them to enter the community. Allocation of a supervisor and rostering were found to be of great importance. Academic activities provided adequate learning opportunities. The majority (76%) of students who used hospital accommodation found it to be satisfactory, although it was an area that needed attention. Technological support was lacking. Fewer than 50% of students had access to such facilities. Conclusion: Students' responses were generally positive about the rural attachment experience, but logistical and technological support issues, as well as that of accommodation, need to be addressed if the programme is to flourish. Community-based education in a rural district hospital can provide unique learning opportunities for students if the opportunities are identified and the programme is well managed. [ABSTRACT FROM AUTHOR]

Background: Musicians who play string instruments are affected more by musculoskeletal injuries when compared to other instrument playing groups. Musculoskeletal problems are commonly found in the upper extremities and trunk. Several risk factors such as gender, practice hours and instrument played are associated with the prevalence and distribution of musculoskeletal problems among string instrumentalists. Objectives: The aim of this study was to determine the prevalence, distribution, severity and risk factors for musculoskeletal problems among string instrumentalists. Method: A cross-sectional study design using both online and paper-based questionnaires were used to collect data from string instrumentalists playing in both amateur and professional orchestras in South Africa. Results: A total of 114 string instrumentalists participated in the study, of which 86 (77%) reported problems in one or more anatomic regions while 39 (35%) were currently experiencing musculoskeletal problems that affected their performance. The trunk and both shoulders were the most commonly affected body regions. The majority of the participants reported the severity of the complaints as mild to moderate with aching, soreness, tingling and fatigue being the most commonly used descriptors of the symptoms of playing-related musculoskeletal problems. Conclusion: The results of this study showed that the prevalence of musculoskeletal problems that affect performance is high among string instrumentalists in South Africa. An evaluation of associated risk factors with the aim of reducing injuries may be important in improving performance. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa. Methods: This was a cross-sectional design, using a piloted, structured and self-administered questionnaire. Results: Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30--39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%). Conclusion: This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem. [ABSTRACT FROM AUTHOR]

Background: Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa's primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff. Methods: Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital. Results: Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback. Conclusion: Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app. [ABSTRACT FROM AUTHOR]

Background: Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal. Methods: A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data. Results: A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation (n = 383) and extended focused assessment with sonography for trauma (n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours. Conclusion: Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HT) is a key contributor to cardiovascular diseases (CVDs). The improved management of HT in the community and primary care settings should be a priority for low- and middle-income countries (LMICs). Improving the prevention and management of HT in primary care settings should also be a priority for developing countries. There is a need for more studies using community-based approaches that show the impact of these programmes on HT outcomes, which may motivate policymakers to invest in such approaches. The ward-based outreach team or village healthcare worker models were meant to provide such approaches, but many of these have become lower levels of curative care. We conducted a scoping review to examine how community-based participatory research (CBPR) was being used to improve HT management. Methods: Several electronic databases were searched, namely PubMed, MEDLINE, Google Scholar and Web of Science, generating 798 references. The publications were screened through several rounds. Data were extracted and imported into a Microsoft Excel spreadsheet, numerically summarised and qualitatively analysed. Results: Nine articles were included. These publications originated from the United States, Colombia, Canada, China, South Africa and Zimbabwe. Mixed methods, qualitative, randomised control trials and quasi-experimental studies were used to implement CBPR in the studies included. All the studies addressed complex health problems and inequities among the minorities utilising multiple stakeholder participation. Academic--community coalitions were formed, which enabled engagement and sharing of power equitably. As a result, there was acceptability and sustainability of interventions. Conclusion: A CBPR framework can be used to define the context, group dynamics, implementation and outcomes of HT. It is possible to apply CBPR in HT management to appropriately address health disparities while emphasising a community-driven approach. To achieve this, tailored health education platforms should be developed and implemented. [ABSTRACT FROM AUTHOR]

Background: A clinical associate (ClinA) is a mid-level health professional who may only practise under the supervision of a medical doctor. By extension, medical students need to be prepared for this responsibility. This study explored whether final-year medical students at one university were aware of this supervisory role, felt prepared and were knowledgeable about the ClinAs' scope of practice. Methods: A descriptive, cross-sectional study was conducted. The population included all final-year medical students who had completed their District Health and Community Obstetrics rotations (March to November 2017). After an end-of-rotation session, 151 students were given questionnaires to complete. A list of 20 treatments or procedures was extracted from the ClinAs' gazetted scope of practice for a 'knowledge test'. Data were analysed with Stata and Microsoft Excel. Ethical permission was granted. Results: The response rate was 77.4% (n/N = 117/151). The majority of participants (76.1%, n = 86) had worked with a qualified or student ClinA before and had a generally positive impression (81.4%; n = 70). Almost half (47.8%; n = 56) thought that the ClinAs' scope of work was similar to registered nurses rather than a doctor's (38.2%; n = 44). Most were unaware that they would be required to supervise ClinAs once qualified (65.8%; n = 77). On average, participants identified 12 out of 20 treatments or procedures that a ClinA could perform. Conclusion: Despite having worked with ClinAs, participants appeared largely unaware of their future legal obligation of supervision. Adequate clinical supervision is based on the knowledge of the scope of practice, which was variable. Formal training on the scope of the work of ClinAs is needed to prepare future doctors for their supervisory role. Medical schools have an obligation to adequately prepare their students in this regard as part of their transformative education with elements of interprofessional education. [ABSTRACT FROM AUTHOR]

Training institutions need to ensure that healthcare students learn the skills to conduct person-centred consultations. We studied changes in person-centred practice over time following a quality improvement (QI) intervention among Bachelor of Clinical Medical Practice undergraduate students. Students were randomised to intervention and control groups. The intervention group received training and did a QI cycle on their own consultation skills. Consultations with simulated patients were recorded during structured clinical examinations in June (baseline) and November (post-intervention) 2015. Matched consultations for 64 students were analysed. The total SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective and End the encounter scores) were significantly higher in the final assessment compared to baseline for both the whole group and the intervention group (p = 0.005 and 0.015, respectively). The improvement did not differ significantly between intervention and control groups (p = 0.778). Third-year students improved significantly more than second years (p = 0.007). The person-centred practice (including collaboration) of clinical associate students did improve over the period studied. The results show that students' learning of person-centred practice also happened in ways other than through the QI intervention. There is a need to develop students' collaborative skills during the medical consultation. [ABSTRACT FROM AUTHOR]

Globally, universal health coverage (UHC) has gained traction as a major health priority. In 2011, South Africa embarked on a UHC journey to ensure that everyone has access to quality healthcare services without suffering financial impoverishment. National Health Insurance (NHI) and primary healthcare (PHC) re-engineering were two vehicles chosen to reach UHC over a 14-year period (2012–2026). The first phase of health system strengthening (HSS) initiatives to improve the quality of health services in the public sector began in 2012. These HSS initiatives are still being carried out by the Department of Health in conjunction with other partners. A qualitative case study design utilising a theory of change (TOC) approach was employed. Data were collected from key informants (n = 71) during three phases: 2011–2012 (contextual mapping), 2013–2014 (Phase 1) and 2015 (Phase 2). In-depth face-to-face interviews were conducted with participants using a TOC interview guide, adapted for each phase. All interviews were audio-recorded and transcribed verbatim. An iterative, inductive and deductive data analysis approach was utilised. Transcripts were coded with the aid of MAXQDA 2018. Six broad themes emerged: make PHC work, transform policy development, transform policy implementation, establish public–private partnerships, transform systems and processes and adopt a systems lens. A third great transition seems to be sweeping the globe, changing how health systems are organised. Actors in our study have identified this need also. Health system transformation rather than strengthening, they say, is needed to make UHC a reality. Who is listening? [ABSTRACT FROM AUTHOR]

Background: Studies documenting the socioeconomic impact of education leading to employment of rural youth, specifically in the healthcare professions, are lacking. The Umthombo Youth Development Foundation (UYDF) is an NGO that provides financial support for rural students to train as healthcare professionals (HCPs) as a way of addressing staff shortages at rural hospitals. The aim of this study was to understand the social and economic impact on individuals and their families of qualifying as an HCP and being employed at a rural district hospital Methodology: A mixed methodology was used to collect data from 40 graduates at eight district hospitals in rural KwaZulu-Natal province. The research tools had qualitative and quantitative questions, with additional data being extracted from the UYDF database. The qualitative data were analysed thematically, with STATA software being used for the quantitative analysis. Results: The findings indicate that graduate household assets increased significantly, as did their socioeconomic circumstances, compared with before they qualified as HCPs. Graduates attached high value to education that led to their employment, which provided them with money to afford assets. Having a permanent job and regular income also transformed their families' lives, as they were able to care for their siblings and extended family members. Conclusions: Training rural youth for employment in scarce skills that leads to employment, such as a career in the health sciences, boosts their socioeconomic circumstances and that of their families. This contributes to the staffing of rural hospitals, job creation and the economic development of the country. [ABSTRACT FROM AUTHOR]

Background: National Health Insurance (NHI) intends to provide universal health coverage to all South Africans, with equity and quality as its tenets. The participation of private general practitioners (GPs) in NHI is essential. The aim was to explore perceptions of GPs on NHI in Chris Hani district, Eastern Cape, South Africa. Methods: A descriptive phenomenological qualitative study using semi-structured individual interviews of 12 GPs from six municipalities was undertaken. Data analysis used the framework method assisted by Atlas.ti software. Results: GPs in Chris Hani district felt that NHI would improve health and benefit society and be of particular benefit to poor and rural people as it will improve access to healthcare. Lack of governmental administrative capacity and a human resource plan were seen as barriers to implementation. They believed that NHI would benefit them through a single purchaser system and support more comprehensive care. GPs were concerned about a lack of information on primary care packages, accreditation, remuneration and patient allocation. They thought that NHI might disadvantage solo GPs. NHI implementation could be improved by actively engaging with GP organisations. Improvement of existing government health facilities and continued medical education were seen as possible ways to better implement NHI. Conclusion GPs in this study were generally positive about NHI and thought it would benefit both patients and providers. However, they had concerns regarding the capacity of government to implement NHI and the implications for solo GPs, and needed more information. Government needs to actively engage GPs. [ABSTRACT FROM AUTHOR]

Introduction: Households' satisfaction is an important and commonly used indicator for measuring quality in health care. An amelioration of primary health care services at the level of households, by utilising community health workers, has led to a good healthcare system in many countries, such as Brazil. In South Africa, little is known about the satisfaction of households (HH) regarding the healthcare services they receive from ward-based outreach teams (WBOTs). A study was undertaken to determine this phenomenon. Methods: The study used a cross-sectional study design. Tshwane district had established 39 ward-based outreach teams at the time of the study and households were conveniently selected. Hence the study population was estimated to be 3 600. Using 99% confidence level and 5% confidence interval, the sample size was 660, and oversampled to 765 since all households present during the data collection were willing to be included in the survey. Data collected was captured on Microsoft Excel and analysed using SAS, version 9.2. Results: Interviews were held with members of the families, who were willing to participate. Participants' ages ranged from 18 to 110, mean age 53.1years (SD = 19.7). The study participants included more females (74.0%), and 45.2% were single. The majority (89.8%) were unemployed. Overall satisfaction was seen in 692 participants (90.7%). Outcome of satisfaction according to sex (91.9%), age (90.7%) and employment (90.8%) was not statistically significant with p-value < 0.05. Conclusions: The findings of households' satisfaction regarding the healthcare services rendered by the ward-based outreach team in Tshwane district, Pretoria, South Africa showed a high level of satisfaction from the households. This high level of satisfaction was referred to as excellent and was not associated with sex, age or employment status. A recommendation is made to all stakeholders that the ward-based outreach team programme cover all municipal wards in the country in order to raise the level of households' satisfaction with the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Health care generates a large amount of healthcare waste (HCW), which is complex to manage because of its variety and potential to create health and safety hazards if improperly handled. It is essential that healthcare workers have appropriate knowledge of and adhere to proper disposal methods for each category of HCW. Aim: The aim of this study was to assess the knowledge, attitudes and practices of staff working at a district hospital about HCW management, and measure associations between these variables. Setting: The setting for this study was a district hospital in KwaZulu-Natal province. Methods: This was an observational descriptive study among 241 professional and non-professional staff. Data were collected using a questionnaire and analysed using the Statistical Package for the Social Sciences. Results: Knowledge of HCW management was generally inadequate, with 42.7% of the participants scoring ‘poor’ overall. Just over half of the participants reported a good attitude towards the appropriate disposal of HCW but only 53.9% demonstrated good HCW management practices. There was a significant (p < 0.05) relationship between knowledge and practice and between attitudes and practices (p < 0.05). Conclusion: Appropriate training and supervision in HCW management as well as relevant and ongoing in-service training is needed to ensure appropriate knowledge, attitudes and safe practice among all members of staff. As poor practices have been reported on a number of occasions from different hospitals in South Africa, relevant training must also be introduced or improved at undergraduate level. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest number of patients on antiretroviral therapy (ART) globally. Various obstacles were identified that influence effective reporting of adverse drug reactions (ADRs) in resource-limited countries. This investigation aimed to identify, classify and analyse the prevalence of ART-related ADRs. Methods: This observational, quantitative and retrospective descriptive investigation utilised ADR forms completed by healthcare professionals in various healthcare facilities in the Tlokwe district, South Africa (January 2010 to December 2014). Descriptive and inferential analyses were carried out. Results: A total of 770 ART-related ADRs were included in the final analysis. The mean age was 40.1 (± 10.1%) years, with significantly higher ADRs reported in females (70.8%). In this study, 99% of the ADRs were reported by doctors. Abnormal fat distribution (58%), peripheral neuropathy (21.6%) and renal dysfunction (6.6%) were most frequently reported. Females presented with abnormal fat distribution and peripheral neuropathy at a significantly younger age (38.1 ± 4.6 vs. 43.4 ± 5.7 years,p < 0.0001 and 39.7 ± 1.1 vs. 45.1 ± 9.2 years,p < 0.001) respectively compared with males. Gender difference was practically significant (Cramer’sV = 0.3) for all three of the major reported ADRs. Conclusions: Gender was highly dependent among the major reported ADR categories, and women presented with abnormal fat distribution and peripheral neuropathy at a significantly earlier age than males. This retrospective analysis can serve as a platform for future ADR studies within this district. Sustainable and continuous efforts should be made to train and create more awareness among healthcare workers in this district. [ABSTRACT FROM PUBLISHER]

Background: Achieving guideline-recommended blood pressure is imperative in reducing the rising tide of uncontrolled hypertension and its attendant sequelae, which are major causes of morbidity and mortality globally. The aim of the study was to describe the pattern of blood pressure control and identify the factors influencing blood pressure control among patients with primary hypertension seen at family medicine clinics of FMC, Abeokuta. Methods: This was a descriptive cross-sectional hospital-based study. A systematic random sampling technique was used in selecting 360 hypertensive respondents over four months. Data were collected through a pre-tested interviewer-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) version 17.0 was used to analyse data. Results: Blood pressure was controlled in 167 (46.4%) of the respondents. The independent predictors of blood pressure control were female gender (p = 0.001, OR = 2.494, 95% confidence interval (CI) = 1.477-4.214), regular use of medication (p = 0.001, OR = 2.900, 95% CI = 1.508-5.577), regular clinic attendance (p < 0.001, OR = 3.512, 95% CI = 1.772-6.960), and absence of diabetes mellitus (p < 0.001, OR = 7.357, 95% CI = 3.190-16.966). Conclusions: The rate of blood pressure control among the hypertensive respondents was low. Multiple independent predictors of controlled blood pressure call for a team-based approach as well as multiple approaches including education of patients, expansion of a community-based health insurance programme and intensification of treatment efforts when managing hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction is known to positively influence patients’ compliance with medical advice. In Africa, and specifically Uganda, this interaction has rarely been put to scientific inquiry. This study aimed to determine the level of patient satisfaction and identify factors influencing satisfaction with medical consultations among adults attending Mulago Assessment Centre. Methods: This was a quantitative descriptive cross-sectional study where 384 respondents were interviewed using a structured questionnaire adapted from the Medical Interview Satisfaction Scale (MISS-21) with a four-point Likert scale. Patient satisfaction was measured using four dimensions namely: information provision, clinicians’ communication skills, perceived consulting time and patient’s confidence in the clinician. Respondents’ mean scores were categorised as satisfied or dissatisfied. Multivariate linear regression analysis assessed the effect of independent variables on the regression factor score of the dependent variable. Significance level was set atp < 0.05. Final data analysis was done using STATA version 11.0. Results: Of the sample, 53.9% were satisfied with the medical consultation. Patients’ average scores showed lowest satisfaction for information provision (2.7 points) compared with communication skills (3.22 points), patient confidence in the clinicians (3.22 points) and consultation time (3.05 points). Being older, employed, living further away from the health centre and frequently visiting the centre were positively associated with patient satisfaction. Conclusions: Patient satisfaction was largely affected by interpersonal factors. This highlights the need for training of clinicians on the importance of adequate information provision, good communication skills and technical competences like thorough examination of patients and relieving worries about illness during the consultation. [ABSTRACT FROM AUTHOR]

Background: Patients with adverse cutaneous drug reactions (ACDRs) are frequently referred from primary care to tertiary centres for further management. This causes a loss of information regarding ACDRs as these patients discontinue primary care follow-up upon referral to tertiary care. The aim of this study is to determine the prevalence and characteristics of ACDR, and to use this valuable information to enhance awareness of primary care physicians regarding this condition. Method: A retrospective cross-sectional study on ACDR was done at the Dermatology Clinic, Kuala Lumpur General Hospital from January 2009 to December 2010. Results: The prevalence of ACDR was 0.2%. The majority of patients (71.6%) were below 59 years of age. ACDR commonly (55.2%) occurs within hours to days of drug ingestion and is of mild to moderate severity (74.6%). About 27.6% of affected patients took 1 to 5 drugs concurrently. Common cutaneous manifestation of ACDR includes maculopapular rash (22.4%) and Stevens-Johnson syndrome (SJS, 9.7%). Antibiotics (36.6%), traditional and complementary medicine (TCM, 17.9%) and analgesics (13.4%) were the most frequent agents responsible for ACDR. Conclusion: The prevalence of ACDR in this study is low and the majority were of mild to moderate severity. The most common cutaneous manifestation was a maculopapular reaction and Stevens-Johnson syndrome. Antibiotics were the commonest causative agent for ACDR followed by traditional and complementary medicine and analgesics. Patients presenting with cutaneous disorders in primary care should be assessed for possible ACDR. A detailed drug history, time of initiation and duration of drug consumption are all valuable information required for an accurate diagnosis and proper evaluation of ACDR. It is hoped that the findings of this study will facilitate early recognition of ACDR followed by identification and elimination of any possible offending drugs that may be prescribed in primary care practice. [ABSTRACT FROM AUTHOR]

Objective: To describe aspects that create positive experiences for emergency obstetric care (EmOC) clients in public health facilities in Ethiopia. Design: A qualitative contextual descriptive phenomenological design was used in this study. Subjects and setting: In-depth interviews were conducted with women who had complications during childbirth and received EmOC in three hospitals in Addis Ababa. Outcome measures: Content analysis was used to analyse data as it complies with the phenomenological data analysis. The data were analysed using the Atlas ti version 6.2 qualitative data analysis software. Results: Care that is life-saving, safe, timely, responsive and given in a clean environment, where the service carers show humility, respect, equal treatment and encouragement in an effort to meet the clients' needs and expectations, creates a good experience. Conclusion: Clients' experiences during the provision of EmOC influence their future decisions on whether to seek care or not. The findings of the study along with the developed guidelines will assist in the improvement of the provision and utilisation of EmOC at public health facilities in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Adolescent obesity is increasingly more common in low- and middle-income countries like Nigeria. Obesity has been associated with metabolic derangement in adolescents in developed countries. This study compared the metabolic parameters in obese and non-obese adolescents in a developing country. Method: A cross-sectional study was performed on 1 000 adolescents selected by multi-stage sampling from eight secondary schools in Osun State, south-western Nigeria. Socio-demographic information was collected with the aid of a questionnaire. Using the International Obesity Task Force (IOTF) body mass index (BMI) cut-off points, 29 obese adolescents were identified, and 29 suitably matched controls selected. The means for the anthropometric indices [height, weight and waist circumference (WC)], as well as blood pressure (BP), fasting blood glucose and the blood lipid levels of the obese and non-obese participants were compared using an independent t-test and one-way analysis of variance. Data were analysed using SPSS® 16.0 version. A p-value < 0.05 was taken to be statistically significant. Results: The mean age of the respondents was 13.7 years (standard deviation 2.04). Eight of 100 (7.7%) respondents were overweight and 2.9% obese. More female than male adolescents were overweight or obese. The means for the anthropometric indices and BP increased in general across the spectrum of weight categories, from normal weight to obese. Weight, BMI, WC, and systolic and diastolic blood pressure were significantly higher (p < 0.05) in the obese adolescents than in the non-obese controls. The controls had a significantly higher mean high-density lipoprotein value (1.46 mmol/l) than the obese adolescents (1.21 mmol/l). Conclusion: Obese adolescents are at higher risk of metabolic diseases than non-obese adolescents. Obese adolescents in low- to middle-income countries should be targeted to adopt lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: Suicidal behaviour is highly prevalent and increasing at an alarming rate among all socio-demographic groupings in South Africa. Approximately 9.5% of all unnatural deaths in young people in South Africa are due to suicide. The ratio of non-fatal suicide attempts to attempts with fatal outcomes varies between 20:1 and 40:1 depending on the geographical region and the community composition being studied. Although depression is a common co-existing finding in many studies involving patients with suicidal behaviour, current evidence suggests that it is either not detected or it is inappropriately managed in clinical practice. Aim: This study compared self-reported perceived and objectively assessed personal physical and mental well-being of adults attempting suicide and being admitted to two local community-based public hospitals in South Africa. Method: Validated questionnaires were used to elicit relevant data from 688 adults attempting suicide and being admitted to two community-based public hospitals in Durban which was analysed using SPSS®. Results: The majority of participants were female, single, younger age group, unemployed, low education and low income level. Only 30.3% of participants reported long-standing illnesses lasting more than 6 months. The majority perceived their physical and mental health to be normal. However, an objective assessment revealed a large number of participants to be suffering from varying levels of depression. Conclusion: The study population comprised mainly the younger age group in both sexes, and showed that depression is an important co-morbid risk factor in suicidal behaviour in this and other groups. This finding cannot be ignored, and the authors endorse the call for a scaling up of screening strategies to diagnose depression, and for an improved prevention and management framework. [ABSTRACT FROM AUTHOR]

Background: In South Africa, the data about risk factors for pulmonary tuberculosis (PTB) is limited. Therefore, the assessment of risk factors for PTB is an important step to identify which risk factors are unique in every specific population context and in this way gain a better understanding of them. The aim of this research was to assess contributory risk factors for PTB among adult patients suffering from Human Immunodeficiency Virus (HIV) attending the Wellness Clinic at Themba Hospital. Method: A cross sectional descriptive design was employed. A total of 300 participants were interviewed using a structured questionnaire to collect data on socio-demographic information, behavioural factors and medical history of patients in the research. Data were analysed using Stata Release 11 software. Univariate and multivariable logistic regression models were used to determine factors associated with PTB. Results: The results of this investigation showed that being of single marital status (OR = 1.96; 95% CI = 1.01-3.79), moderate/ heavy drinkers (OR = 3.46; 95% CI = 1.56-7.69) and living in a dusty outdoor environment (OR = 2.05; 95% CI = 1.16-3.61) were statistically associated with pulmonary tuberculosis for the study participants in multivariable logistic regression models. Conclusion: Single marital status, dusty outdoor environment and moderate/heavy drinkers were strongly associated with an increased risk of PTB among HIV positive patients. Pulmonary tuberculosis control and prevention strategies among HIV positive patients should be focused on reducing or limiting the impact of these risk factors. [ABSTRACT FROM AUTHOR]

Background: Globally, unintended births among unmarried adolescent girls are a major contributor to maternal and childhood mortality, the vicious cycle of ill-health, poverty, and truncated educational opportunities. Nigeria has the highest rates of adolescent fertility in sub-Saharan Africa. Over 900 000 births to adolescents occur annually and 150 out of every 1000 women who give birth in Nigeria are 19 years old or under. Objective: To document and investigate socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls. Methods: Data for this study were drawn from the 2008 Nigeria Demographic and Health Survey. Univariate and multivariate statistical analyses were used to assess the relationship between adolescent pregnancy and socio-demographic contextual factors focusing on sex and age of household head, adolescent girls' age, and educational attainment, place of residence, religious affiliation, and household wealth index. All data were analysed using STATA Version 11. Results: Non-pregnant adolescents had older household heads; such households were wealthy, and parents of such households had higher educational standing. Female-headed households were less likely to experience unwanted adolescent pregnancy compared to those of the reference group category (OR = 0.56, 95% CI = 0.3920-0.8073). Conclusion: There is a significant relationship between age and sex of household head and risk of unintended adolescent pregnancy among unmarried adolescent girls. Adolescent girls from households headed by young adults are more likely to experience adolescent pregnancy compared to adolescent girls from households headed by older adults. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe the current macro- and micronutrient intake of children (both boys and girls) in two selected communities in the Breede Valley, Worcester. Design: This was a quantitative cross-sectional study. Setting: The study focused on two disadvantaged communities in Worcester (Avian Park and Zweletemba) in the Breede Valley, Western Cape province. Subjects: The study subjects were 248 children (Avian Park, n = 117; Zweletemba, n = 131) aged 12-36 months. Method: The macro-and micronutrient intake of the children was determined using a validated, interviewer-administered quantitative food frequency questionaire, and compared against the estimated average requirement (EAR) and adequate intake (AI) of nutrients. The nutrient adequacy ratio was calculated, as well as percentage deviation from the EAR and AI. Results: More than 20% of the children had a calcium and folate intake that deviated by more than 50% below the EAR in both communities and for both genders. More participants in Zweletemba had an intake that deviated by more than 50% above the EAR and AI, compared to Avian Park, for carbohydrate, thiamine, niacin and iron. Conclusion: With the exception of folate, calcium and selenium, the average reported nutrient intake of the children (boys and girls) in both the communities was adequate. [ABSTRACT FROM AUTHOR]

Background: Most anaesthesia-related mortality that occurs in level 1 hospitals in South Africa is avoidable. Improving training during internship, and consequently the skills of community service officers, could lead to safer anaesthesia practices. Objectives: The objectives of the study were to determine whether or not the timing of the anaesthesia rotation during internship and other factors affected the outcome of the assessment at the end of the anaesthesia rotation, and to compare the perceptions of first- and second-year interns regarding their confidence levels at the end of their rotation. Method: We conducted a retrospective study that compared 298 intern assessments over a three-year period. It included the assessment of interns by senior doctors in respect of three cases, an overall assessment of the interns' performance, and the number of cases carried out by them. In addition, a questionnaire was used to assess the interns' confidence levels at the end of the rotation. Results: Little variation in the results was evident across comparisons of the year of internship, gender and age. Comparison according to university showed a slight variation. A wide variation in the number of obstetric cases (range 5-58) and endotracheal intubations (range 6-54) was observed. Over 80% of interns, regardless of the year, were confident enough to administer general anaesthesia and perform an endotracheal intubation. However, this perception of confidence by interns did not relate to the assessment of their competence. Conclusion: The variance in the ability of interns to perform anaesthesia could not be accounted for by the training year, institution of undergraduate study, age or gender. It is likely that the assessment technique used did not provide a true reflection of the acquired skills or longevity of knowledge by interns. Further research in this area is recommended. [ABSTRACT FROM AUTHOR]

Background: Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time Master of Family Medicine (MFamMed) to a full-time Master of Medicine (Family Medicine) [MMed(Fam)] degree, with changes in the curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the postgraduate programme for Family Medicine, at the University of the Free State, and if necessary, to produce a valid and reliable assessment tool that is user-friendly. Method: An action research approach was used in this study, using mixed methods. Firstly, marks given by 15 assessors for four mini-dissertations using the current assessment tool were analysed quantitatively. In Phase 2, the regulation of the assessment bodies and the quantitative results of Phase 1 were discussed by assessors during a focus group interview, and data were analysed qualitatively. An adapted, improved assessment tool (Phase 3) was developed and re-evaluated in Phase 4. Results: The current assessment tool complied with the regulations of the assessment bodies. The scores allocated to specific categories varied with a median coefficient of variation of more than 15% in four of the possible 12 assessment categories. During the focus group interview, reasons for this were identified and the assessment tool adapted accordingly. During reassessment of the tool, individual assessors were identified as the reason for poor reliability. Conclusion: The current assessment tool was found to be valid, but was not reliable for all assessment categories. The adapted assessment tool addressed these areas, but identified lack of training and experience in the assessment of extensive mini-dissertations by certain assessors as the main reason for unreliable assessment. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to determine the perceptions of a spouse about the influence of his or her partner's hearing loss on their relationship as it may have an impact on aural rehabilitation. Design: A descriptive survey design was utilised. A questionnaire, adapted from The Significant Other Scale for Hearing Disability was used for data collection. Subjects: Through purposive sampling, 35 individuals who reported experiencing no hearing difficulties and who were married to a person with an acquired hearing loss contributed data for this study. These data were analysed using Stata® version 9. Results: The majority of the participants identified a range of communication-related difficulties within their marriage, such as repeating themselves extensively in conversation with their hearing-impaired partners (97%), raising the volume of their voices (83%), and having to maintain face-to-face contact with their spouse (74%). These difficulties may have led to negative feelings within the marriage as during communication, 69% of participants reported feeling frustrated because of difficulties experienced in respect of their partner's hearing impairment. Participants reported that they had to accept a hearing impairment in their marriage. Seventy-one per cent of participants expressed concern for their hearing-impaired partners, and specifically with regard to fearing for their safety, e.g. when alarms or warning bells were not heard. Conclusion: A partner's acquired hearing impairment may lead to the development of negative feelings within a marriage. Therefore, audiologists must be aware of the perceptions of spouses with normal hearing when providing aural rehabilitation to both the hearing-impaired individuals and their partners, and thereby preventing disharmony in the marriage, while ensuring effective service delivery. [ABSTRACT FROM AUTHOR]

Objectives: Most of the research on suicidal behaviour in youth focuses on developed countries. Less is known about the prevalence of suicidal behaviour and associated risk factors in community samples of youth who do not present for mental health care in developing countries. This study investigated the prevalence of suicidal behaviour and associated risk factors in grade 8 learners in Durban. Setting and subjects: Grade 8 learners in a government-run, co-educational school were approached to participate in the study after parental consent and child assent were obtained. A descriptive, cross-sectional method was used to gather quantitative data. The grade 8 learners were asked to complete demographic questionnaires and various psychometric assessment scales. Design: The gathered data were divided into two groups, i.e. those who reported personal suicidal behaviour and those who did not. The various variables in these two groups were compared using bivariate and multivariate statistical analyses. Results: The study established that 22 participants (33.8%, n = 75) reported suicidal behaviour (thoughts, plans or attempts in this regard). They also had higher levels of depression, perceived stress, hopelessness and anger (p-value < 0.01) than those who did not report any suicidal behaviour . The same participants had lower scores on scales that assessed self-esteem and perceived social support from family (p-value < 0.01), compared to those who did not report any suicidal behaviour. Logistic regression analysis that was undertaken indicated that a friend's suicidal thoughts [odds ratio (OR) 4.27, p-value < 0.01], alcohol use (OR 3.08, p-value < 0.01), perceived stress (OR 1.05, p-value < 0.01) and depression (OR 1.04, p-value < 0.01), were strong predictors of personal suicidal behaviour in this sample. Conclusion: There is a high prevalence of suicidal behaviour in grade 8 learners in Durban. The identiied risk factors were similar to those found in developed countries. Healthcare providers and other professionals, such as school counsellors, should consider the identiied risk factors when assessing suicidality and planning interventions for youth. [ABSTRACT FROM AUTHOR]

Background: Before 2006, the uptake into the prevention of mother-to-child transmission (PMTCT) for HIV programme was low in South Africa. We determined PMTCT programme uptake, and identified factors that affected enrolment into the PMTCT programme in the rural Limpopo province. Method: This cross-sectional study, conducted from 21 July to 20 August 2008, involved 200 consecutive women who met the inclusion criteria in the immediate postpartum period. An interviewer-administered questionnaire was used to obtain information on participants' knowledge and experience of, satisfaction with, and motivation for, enrolling in the PMTCT programme. Main outcome measures included voluntary counselling and testing (VCT) and PMTCT programme uptake rates, and factors reported to influence enrolment into the programme. Results: Of the 200 invited women, 169 (84.5%) responded. The mean age of participants was 25 years ± standard deviation. The human immunodeficiency virus prevalence rate was 23.6%. VCT and PMTCT programme uptakes were 96.9% and 90.9% respectively. Participants reported being aware of (95.2%) and satisfied with (81.6-97.4%) various aspects of the PMTCT programme. The safety of their babies was reported by most participants to be their motivation for enrolment (71.1%). Participants in the age-group 20-29 years were more likely than others to enrol in the PMTCT programme (p-value = 0.01). Conclusion: VCT and PMTCT programme uptakes were high and influenced by good knowledge, satisfaction with the PMTCT programme and participants' concern for the safety of their babies. [ABSTRACT FROM AUTHOR]

Objectives: This study was a qualitative assessment of a diabetes group education programme presented in community health centres of the Cape Town Metro District. The programme offered four sessions of group education and was delivered by trained health promoters using a guiding style derived from motivational interviewing. The aim of the study was to evaluate the programme by exploring the experiences of the patients who attended. Design: This was qualitative research that utilised in-depth interviews. Thirteen patients who had attended the educational programme, and who each came from a different health centre in the intervention arm of a larger randomised controlled trial, were purposively selected. The interviews were audiotaped, transcribed and then analysed using the framework approach. Setting and subjects: Patients with type 2 diabetes from community health centres in the Cape Town Metro District. Results: Patients gained useful new knowledge about diabetes and reported a change in their behaviour, especially with regard to diet, physical activity, medication and foot care. The educational material was experienced positively and enhanced recall and understanding. Health promoters were competent, utilised useful communication skills and structured the material well. There were organisational and infrastructural problems, especially with regard to space within which the groups could meet, and communication of the timing and location of the sessions. Conclusion: This study supports wider implementation of this programme, following consideration of recommendations resulting from patient feedback. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently, none of the community health centres (CHCs) in Cape Town test for microalbuminuria, and there are concerns about its costs and feasibility. Objectives: The aim of this study was to assess the practicality, costs and consequences of introducing a screening test for microalbuminuria into primary care. Design: Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening, costs and consequences was evaluated. Setting and subjects: Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcome measures: Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria. Results: Of the patients with diabetes, 14.6% already had macroalbuminuria. Of the eligible patients, 69.9% completed the screening process which led to a diagnosis of microalbuminuria in another 11.7%. Of those who were positively diagnosed, the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20%, while 49.2% had ACE inhibitors initiated, or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed. Conclusion: The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal, compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient). [ABSTRACT FROM AUTHOR]

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs. Design, setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata), using probability proportional to size. Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services), unmet need for family planning and factors inhibiting use of these services. Results: The study revealed that 25% of the older women used some type of FP method. Of this number, 67.9% were aged 50-59 years, 17.4% 60-69 years, 10.1% 70-79 years, and 72% had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome, sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy, lack of education, financial constraints, a perception that healthcare planners limited SRH needs to antenatal and obstetrical services, a cultural reluctance to discuss SRH in public and domestic issues. Conclusion: The study recommends comprehensive public health education for older women on human sexuality and fertility, contraceptive use, access to services, effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of research on humour among adolescents in South Africa. This article examines cognitive flexibility and humor. The objective was to investigate the roles of gender and language as possible moderating variables in the relationship between adolescents' cognitive flexibility and sense of humour. Design: A correlational research design was used in which pupils were asked to complete the Multidimensional Sense of Humor Scale to assess their sense of humour. In order to determine the cognitive flexibility of the sample group, Martin and Rubin's Cognitive Flexibility Scale was applied. Setting and subjects: The initial sample comprised 1 203 adolescents (Grade 11 and 12 pupils) randomly selected from the Eastern Cape, Gauteng and Mpumalanga. Of these, a final 392 adolescents qualified after eliminating criteria had been applied. Results: No significant correlations were found between the total group or for the two genders. Significant positive correlations were found between cognitive flexibility and two of the scores for humour (creating and expressing humour), as well as for the total score for Afrikaans-speaking participants. Significant negative correlations were found between cognitive flexibility and all five of the scores for humour for the Nguni language speakers. Conclusion: This study recommends that culturally sensitive measuring instruments should be developed. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to assess improvement, or lack thereof, in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN). Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time, the number of pregnant women tested for human immunodeficiency virus (HIV), the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis, and the service ratio, an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand, five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value < 0.01). The uptake of HIV testing was 87%, with a monthly average increase of 17.8 women tested per facility (p-value < 0.01). ARV prophylaxis uptake rose from 3.3-5.4 women per facility per month (p-value < 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value < 0.01). Applying risk reduction estimates of different ARV regimens, it was estimated that between 88-169 MTCT events were averted pre-intervention, and 143-276 events, post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria. [ABSTRACT FROM AUTHOR]

Objectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART). Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals. Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province. Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents' experience before and after HAART. Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them. Conclusion: Sexuality in HIV is complex, with components described as the "Ps" of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. This discussion will enhance healthcare professionals' understanding of patients' experiences of their illness and should allow for a more effective patient-centred approach to care. [ABSTRACT FROM AUTHOR]