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This article provides information on the reasons for inserting an arterial line, how to insert this line, the equipment required to insert an arterial line, and the possible complications that may arise from this procedure. It is hoped this information will guide primary care practitioners working in the South African environment and increase their confidence for inserting arterial lines.

Background: Regardless of how tobacco products are consumed, they increase the risk of morbidity and mortality for users. This study aims to determine the motivations for using snuff, assess awareness of tips to quit, and determine readiness to quit snuff use in patients at a clinic in a Pretoria township, in South Africa. Methods: A descriptive cross-sectional survey using a piloted, structured, and self-administered questionnaire was given to patients at Ramotse clinic. Results: The mean age of the 402 participants was 49.0 years, with a range of 18–104 years. The majority (83.8%) of the participants were females. Of the participants, 26.6% were 60 years of age or older, 59.7% were unemployed, 57.5% were married, and 41.5% had finished primary school. Socio-cultural practices and behaviour were mentioned by 38.1% as the main reason for snuff usage, while 77.2% were uninformed about tips for quitting snuff, and 63.25% were unwilling to give up snuff. Conclusion: The study found that unemployed, married, mostly female, 40 years of age or older, and had a basic education match with the profile of participants. Socio-cultural practices and behaviour and health benefits influenced the habit. Most participants were unaware of tips to quit habits and unprepared to do so. Contribution: Healthcare professionals need to be aware of the health hazards that their patients may face, make sure they are equipped to address them and offer community-saving tips for improvement.

Background: Initiatives to reduce patient safety incidents (PSI) and support healthcare professionals who may experience psychological trauma as a result are becoming increasingly common. However, little is known about the quality of the support provided by Tshwane District Health Services. Therefore, it is necessary to assess their assistance for the second victims in order to evaluate their effectiveness. Methods: A cross-sectional study was conducted, and 319 healthcare professionals from six primary health care institutions were invited to participate in the study. The sociodemographic information, work experience, emotional support, familiarity with the concept of the ‘second victim’ and involvement with PSIs were collected. Results: The mean age was 39.8 years, ranging from 22 years to 66 years. The majority of participants were females (n = 249; 78.1%), nurses (n = 153; 49.2%), and those with 5–9 years of experience (n = 82; 25.8%). Most participants (n = 168; 52.7%) were aware of the possibilities of emotional support, while less than half (n = 142; 44.5%) were familiar with the term ‘second victim’. The cumulative incidence of adverse events in the institutions was 19.4%, and the majority of second victims (n = 39; 62.9%) emotionally felt the need to speak with someone about it, preferably outside of the workplace. Less than 5% of individuals received support that was initiated by existing structures at their workplace. Conclusion: Frameworks exist to assist second victims, although they are only known to some healthcare professionals. However, their current use in Tshwane health facilities is ineffective. After experiencing PSIs, second victims often rely on psychological assistance outside of the workplace. Contribution: Authorities need to determine the causes behind some healthcare professionals’ lack of awareness regarding the support framework for second victims, as well as their growing tendency to rely on psychologists outside of the workplace, and corrective measures should be implemented.

Background: South Africa faced challenges while implementing coronavirus disease 2019 (COVID-19) measures such as mass vaccination. Some people rejected or were hesitant to receive government-recommended vaccines. This study explored COVID-19 vaccination hesitancy among unvaccinated individuals in a primary care setting in Pretoria, South Africa. Methods: This was an exploratory phenomenological study that included one-on-one interviews with 12 individuals at Temba Community Health Centre in Pretoria, South Africa. Results: The research revealed five themes: perceptions of COVID-19 disease, perceptions of COVID-19 vaccine, factors related to non-vaccination, information sources about the COVID-19 vaccine, and long-term vaccination decisions. There were seven linked sub-themes. Conclusion: Overall, participants had a good understanding of COVID-19 disease, but limited knowledge about the vaccine, causing hesitancy to get vaccinated. Reasons for not getting vaccinated included health-related concerns, safety concerns, personal experiences, and social and political factors. Safety and health-related concerns were prevalent, with adverse vaccine outcomes being the most common concern. Most participants had experienced a historic encounter with a vaccine-related death or illness. Contribution: Vaccine hesitancy should be viewed as a powerful concern from the community, and a key source of worry for the health authorities over any vaccine-related doubt.

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This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act. Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022. Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination. Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours. Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency. Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

There is an escalating interest in research capacity building across the globe. Research is an integral part of the continuous improvement process, clinical decision making and health system strengthening and should be embedded into the health system. The South African Family Practice Journal editorial team held a workshop on 19 August 2022 at the 24th National Family Practitioners Congress in Cape Town, with the aim of supporting primary care clinicians in their development from early-career researchers to established clinician-scientists. Small group and plenary discussions yielded valuable insights into the lived experiences of early career researchers and highlighted critical action areas to build the landscape of clinician-led research in the South African context. Contribution: This article contributes to current literature by providing insight into the lived experiences of early-career researchers and explores opportunities for research capacity-building.

Abstract Community health workers (CHWs) have helped improve access to quality primary health care (PHC). However, knowledge gaps exist in designing and implementing CHW-engaged models needed to ensure quality people-centered PHC. In this collection, we call for papers which bridge this knowledge gap, to build sustainable, resilient and equitable CHW programs.

Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.

Background: Patient safety culture (PSC) norms set within an organisation prevent harm during medical care. This study assessed the level of PSC among public healthcare professionals (HCPs) in Pretoria, South Africa. Methods: A multi-centre cross-sectional study conducted in three hospitals and 25 clinics in regions 1 and 2 of Pretoria, using a self-administered questionnaire adapted from the Hospital Survey on Patient Safety Culture. Using the Raosoft online sample size formula, from 1238 public HCPs identified, the sample size was calculated at 294; this expanded to 319 as a result of respondents’ willingness to participate in the study. Results: Of the 319 respondents with a mean age of 39.9 years, the minimum and maximum ages were 22 and 66 years, respectively. The age group of 30–39 years had the highest participation rate (17.6%). Most respondents (41.1%) came from the Odi district hospital and there were more women (78.1%) and nurses (49.2%). Positive attitudes were found for all PSC components, with staff education and training scoring highest (98.7%). Patient safety culture received a satisfactory rating from HCPs from the targeted facilities. Conclusion: This study showed that public HCPs in Pretoria’s regions 1 and 2 have a good PSC, particularly among nurses, professionals with more experience, and at primary care level. Contribution: To maintain or increase awareness of this concept among HCPs, the study advocates a PSC programme as well as ongoing education that can be supported by district and facility managers.

Background: Mental healthcare providers have a negative attitude towards the integration of traditional health medicine (THM) into the mental health system. The attitude is based on their lack of trust in traditional practices, which are not supported by substantial evidence-based medical research. The study was conducted to determine mental healthcare providers views on the integration of traditional health medicine into the mental healthcare system. Methods: The study was conducted at a psychiatric hospital in the Tshwane district, Gauteng province, South Africa. A cross-sectional, descriptive research design was conducted on 85 respondents who consented to participate. Data were collected using a survey questionnaire from 23 psychiatrists and 62 psychiatric nurses. Data were analysed using descriptive statistics and presented in the form of graphs, frequencies and percentages. Results: Mental healthcare providers displayed a negative attitude towards integrating THM in psychiatric hospitals. The results showed no significant difference between psychiatrists and psychiatric nurses in their preference for modern mental healthcare practices (p = 0.25). Conclusion: There is still doubt among the mental healthcare providers on whether to support integration of the THM into mental health system or not. The doubt is based on the two-health system isolated from each other especially in South Africa. Contribution: This study contributed by showing the need and importance of understanding a patients’ cultural background, which supports the integration of a traditional health system into the mental healthcare system, which in turn will lead to the appropriate management of mental illnesses.

Early rapid access to the vascular system is essential in emergencies and is lifesaving. In this article, we will provide information on the common sites used, the equipment that is required, the indications and contraindications for intraosseous line insertion, how to correctly and safely do the procedure, medication that can be administered, post insertion line management and possible complications. This is a lifesaving procedure and primary healthcare physicians should acquire this skill.

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Background: In 2014, the South African National Department of Health introduced a new addition to the long-acting reversible contraceptive (LARC) options available in the country. This was a single rod subdermal progestogen implant (Implanon®NXT) which provided 3 years of effective contraception cover. However, the new contraceptive device uptake and general acceptance amongst women quickly diminished, with a slew of requests for its removal. The aim of this study was to explore the reasons given by women for discontinuing the use of their progestogen implants at Koster Hospital, North West province, South Africa. Methods: A qualitative study was conducted using semistructured interviews. Thirteen women were purposively selected and interviewed at Koster Hospital Family Planning Unit. The transcriptions of the audio-taped interviews were analysed thematically. Results: The following themes emerged from the interviews as reasons the women discontinued their progestogen implants: side effects such as menstrual problems, arm discomfort and weight gain. Other themes were family or social factors and the desire to conceive. Conclusion: The reasons for discontinuation of Implanon by women at Koster Hospital were the undesirable side effects they experienced whilst using the contraceptive device. These side effects were mainly menstrual problems, arm discomfort and weight gain. Family and other social dynamics also influenced some of the participants’ decision to discontinue their contraceptive implants.

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.

Tracheal intubation in primary health care is a necessary skill and usually one that is necessary for appropriate emergency management of unstable patients. Primary care practitioners may not have an anaesthetist or critical care doctor available to help them in these emergencies and must manage these patients themselves. Often tracheal intubation may fail because of multiple possible factors and a different course of action may be needed to minimise the potential for harm to the patient. The primary care professional or family physician will have to manage this failed intubation. Primary health care facilities providing obstetric services must have guidelines and appropriate equipment for management of airway problems. This article will explore reasons for the failure of tracheal intubation and how this can be managed.

Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are overwhelming health issues globally. They have caused many devastating and draining health issues, which have escalated a critical need for a well-trained and sustainable healthcare workforce in order to meet the needs of people living with HIV and AIDS (PLWHA). Health science students are the future healthcare providers who will implement proper preventive measures, as well as health educational and promotional sessions to promote information and knowledge among the public regarding HIV and AIDS in Eswatini. Methods: A quantitative cross-sectional study was conducted on 140 final-year undergraduate nursing students in three nursing universities in Eswatini. A questionnaire adapted from Othman and Ali in Malaysia with closed-ended questions was modified and used to collect data. The questionnaire consisted of questions on the virus structure, transmission, prevention and management of HIV and AIDS. Statistical Package for the Social Sciences (SPSS) version 20 was utilised to analyse the data. Results: The level of knowledge about HIV and AIDS was high, as evidenced by a mean score and standard deviation of (91.02 ± 5.00). However, there were low scores on questions related to the transmission of the disease. Conclusion: Across all three universities in Eswatini, there were good nursing education programmes on HIV and AIDS, evidenced by the high knowledge level about HIV and AIDS. However, there are still some knowledge gaps on HIV and AIDS transmission and management that need to be attended to. Contribution: This study contributed by providing knowledge of undergraduate nursing students’ HIV and AIDS training and management of PLWHA.

Background: The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01 January 2020 to 30 June 2020. Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire. Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30–39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12–23 months. From participants’ responses, it seems that Etonogestrel implants may be offered from as early as 15–20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.

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Palpitations are a common, non-specific presenting complaint in primary healthcare and emergency departments. Palpitations are mostly a symptom of benign underlying disease but a sign of life-threatening conditions. Importantly, palpitations are a symptom and not a diagnosis, and cardiac causes are the most concerning aetiology. Clinicians should seek to identify the underlying cause. History and physical examination are important in the assessment of patients with palpitations, and the use of a 12-lead electrographic (ECG) monitor on presentation is the gold standard of diagnosis. If the aetiology cannot be determined, an ambulatory Holter 24–48-h monitor can be used. Treatment and follow-up of patients presenting with palpitations as the main complaint will depend on the aetiology and investigation findings. Patients with palpitations accompanied by dizziness, excessive fatigue, or chest pains should receive adequate acute care aiming to stabilise their condition before referring to a higher level of care.

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Background: Facing the highly transmissible viral infection referred to as the coronavirus disease 2019 (COVID-19) that threatens human life, South African frontline healthcare professionals have faced a major challenge. Being one of the African countries with a higher prevalence of COVID-19 cases, this study aimed to assess the preparedness levels of emergency doctors, nurses and clinical associates in the Tshwane district of South Africa regarding the COVID-19 pandemic. Methods: This was a cross-sectional survey using a developed and piloted online questionnaire. It was conducted in the casualty departments (emergency medical units) of seven hospitals in the Tshwane district of South Africa. Only emergency doctors, nurses and clinical associates took part. Results: Of the 87 respondents, the mean age was 33.9 years and the minimum and maximum ages were 22 and 62 years, respectively; 37 (42.5%) were aged 26–30 years, 54 (62.1%) were females, 46 (52.9%) were single persons, 35 (40.2%) were medical officers, 42 (48.3%) were healthcare professionals with 0–5 years of experience and 21 (24.1%) were from a provincial tertiary hospital. Of the healthcare professionals, 63 (72.4%) were assessed as being prepared regarding the COVID-19 pandemic. Conclusion: The current online survey demonstrated a good preparedness level regarding the COVID-19 pandemic management amongst frontline healthcare professionals working in seven hospitals of the Tshwane district. An educational training programme on disaster management or the COVID-19 pandemic should be implemented to ensure that all frontline healthcare professionals are adequately prepared for current and future outbreaks.

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In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

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Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague symptomatology and difficult correlation to specific organ pathology obscures clinical findings leading to incorrect diagnoses. Although most presentations of abdominal pain are benign, a significant number of patients have life-threatening conditions that require a meticulous approach to management in order to prevent morbidity and mortality. The skill in assessing patients presenting with abdominal pain is fundamental for all primary care doctors. This review will discuss an approach to the assessment and diagnosis of abdominal pain in the primary care setting.

The ongoing coronavirus disease 2019 (COVID-19) pandemic presented a huge challenge to the health systems across the world. When the virus hit South Africa, and the state of national disaster was announced by the president, the healthcare system had to work on its COVID-19 response preparedness. Initially, a few hospitals were then designated facilities for managing COVID-19 patients. Kalafong Hospital, which was not amongst a list of designated facilities for COVID-19 was forced to evaluate its level of preparedness after an intern doctor tested positive. The objectives of this report are to illustrate the hospital’s response around the management of the index case to share our facility’s general response to the pandemic.

Background: Despite the provision of the policy for Ward-based Primary Healthcare Outreach Teams, which requires home-based care workers to be supported by different categories of health professionals, home-based care workers continue to experience challenges during service provision in the communities. Home-based care workers form an integral part of the Ward-based Primary Healthcare Outreach Teams that form part of the streams of primary healthcare re-engineering. The aim of the study was to explore and describe the experiences of home-based care workers (HBCWs) when rendering services in the communities of Northern Tshwane district in Gauteng province and Madibeng district in the North West province. Methods: The study design was qualitative, exploratory and descriptive. Purposive sampling was used from the population of HBCWs in Gauteng and North West. Focus group interviews were conducted. Tesch’s data analysis method was used. Themes and subthemes were identified by the researcher and co-coder, and these were summarised into subjects that were interrelated. Results: Diverse experiences of participants emerged. These experiences included lack of human and material resources, poor funding, lack of knowledge, lack of support and respect and the need for psychological support. Conclusion: There is a need for a collaborative approach amongst the National Department of Health, non-governmental organisations (NGOs) and HBCWs in patient care. Policies and support structures should be strengthened or reformed to promote comprehensive and integrated care to sustain HBCWs.

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Background: Empowering women to have a full control over the size of their family is not only an issue of human rights but also a sustainable development goal.1 This study sought to determine the factors influencing the use of contraception amongst female patients aged 18–49 years attending Odi District Hospital, Tshwane district. Methods: A cross-sectional survey was carried out from September 2018 to February 2019 at Odi District Hospital. A representative sample size of 400 female patients was recruited by systematic random sampling. Logistic regression model was used to determine the most influential predictors. Results: The mean age in the studied population was 30.65 (±7.57) years. Contraceptive prevalence was estimated to be 55.3%. Dual protection (condom) was used as additional method by up to 72.3% of respondents. Injectables remained the most used contraceptive method, while more permanent methods, such as Bilateral Tubal Ligation (BTL), were less utilised. The source of family planning information, past exposure to contraceptive methods and woman’s number of living children (parity) determined the use of contraception amongst Odi district females. Conclusion: This study revealed a discrepancy within the maternal health delivery system regarding the supply and demand chain prompting the need for more insights. The results suggest evidence-based reengineering programme that incorporates contraceptive uptake determinants into the maternal health delivery system.

Background: It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors’ misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions. Methods: A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty. Results: The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary health- care and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors’ level of surgical ability. Based on individual interviews, 11 themes were extracted and a ‘wheel’ model was created, depicting the core values of the FM discipline. Conclusion: The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills.

No abstract available.

The viral haemorrhagic fevers are infectious diseases that often cause life-threatening illnesses. These diseases are common in the tropical areas of the world, and travel history to an endemic area together with recognising signs and symptoms is essential to aid diagnosis. Treatment is often supportive, and infection control measures need to be instituted early at the point of entry. In this article, we will provide an approach to a patient with viral haemorrhagic fevers in a primary healthcare setting.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent public health crisis threatening the current world health establishment. The SARS-Co-2 was first identified in Wuhan, Hubei Province, China, in December 2019. There have been about 6.5 million reported cases of coronavirus disease 2019 (COVID-19) and about 350 000 reported deaths throughout the world within the last 6 months from the onset of the epidemic. The virus is primarily transmitted by inhalation or contact with infected droplets. The COVID-19 patient usually presents with fever, cough, sore throat and breathlessness. Currently, available data indicate that the majority of people with the disease have mild symptoms, while about 20% present with moderate-to-severe disease. About 5% of these may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction. To date, there is no recommended medical treatment, and supportive measures are a crucial part of management. The case fatality rate of SARS-CoV-2 is lower than that of its two coronavirus predecessors, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The full impact of this new pandemic on health, social and economic well-being of humankind is yet to be ascertained.

Background: Under-five mortality and morbidity could be reduced through increased implementation of the Integrated Management of Childhood Illness (IMCI) strategy. The aim of the study was to determine challenges facing IMCI-trained professional nurses on implementing this strategy when managing children less than 5 years of age. Methods: A quantitative descriptive survey method was used. The target populations were IMCI-trained professional nurses with the sample of 208 respondents. Data were collected through self-report questionnaires and analysed using statistical analysis system software. Results: The implementation of the IMCI strategy by IMCI-trained professional nurses in Vhembe primary health care (PHC) clinics continues to face challenges, making it difficult for professional nurses to follow guidelines. These challenges range from staff barriers, management barriers, poor management process and poor infrastructure. All these challenges lead to poor-quality under-five patient care. Conclusion: Regardless of the IMCI strategy being implemented since its inception in 1999, the under-five mortality remains not reduced. This is related to the identified challenges facing the IMCI-trained professional nurses implementing the strategy.

Abstract Background Evidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also contextually defined. The South African family medicine discipline has agreed on six roles. These roles were incorporated into a family physician impact assessment tool, previously validated in the Western Cape Province. Methods A cross-sectional study design was used to assess the perceived impact of family physicians across seven South African provinces. All FPs working in the district health system (DHS) of these seven provinces were invited to participate. Sixteen respondents (including the FP) per enrolled FP were asked to complete the validated 360-degree assessment tool. Results A total number of 52 FPs enrolled for the survey (a response rate of 56.5%) with a total number of 542 respondents. The mean number of respondents per FP was 10.4 (SD = 3.9). The perceived impact made by FPs was high for five of the six roles. Co-workers rated their FP’s impact across all six roles as higher, compared to the other doctors at the same facility. The perceived beneficial impact was experienced equally across the whole study setting, with no significant differences when comparing location (rural vs. metropolitan), facility type or training model (graduation before and ≥ 2011). Conclusions The findings support the need to increase the deployment of family physicians in the DHS and to increase the number being trained as per the national position paper.

Background: Various reasons have been cited in studies conducted in South Africa on why women legally terminate their pregnancies. We sought to determine the reasons for women to terminate their pregnancies legally and their contraceptive practices. This study was conducted at Soshanguve 3 Community Health Centre (CHC), located in a semi-rural zone in the north-west of Pretoria, Gauteng province of South Africa. Method: A cross-sectional study design was adopted in this study. Results: Of the 250 respondents, high participation (23.2%) was noted amongst women aged 18–20 years. Eighty-three (33.2%) respondents did not have children, 108 (43.2%) had completed their secondary school education and 226 (90.4%) were Christian. Of the participants, 80% were single and 62.8% were unemployed. About 85.6% (214) of respondents had not had a previous abortion. A total of 24% of respondents requested abortion because they wanted to focus on their education, while 23.1% were not ready to be parents and 21.7% experienced financial difficulties. With regard to practice, all respondents had already used contraception and the most used contraceptive was the male condom (43.5%), followed by an injectable contraceptive (7.1%). Conclusion: While academic reasons, not being ready to be a parent and financial difficulties were named as the main reasons for terminating a pregnancy legally, the selected pregnant women at Soshanguve 3 CHC demonstrated an unsatisfactory practice of contraceptive measures.

Arthritis is a common condition seen frequently by family practitioners, and there are many types of arthritis. Management of arthritis depends largely on the specific type of arthritis that the patient suffers from. In this article, we will provide the primary care doctor with practical information for managing arthritis, focussing on the management of osteoarthritis and rheumatoid arthritis.

Background: In this study, stress is conceptualised as a psychological syndrome in response to stressors. Stress and inappropriate coping mechanisms constitute a serious problem in police profession. Organisational causes of stress, such as lack of support from management, are additional stressors. The ability to cope with this stress is influenced by marital status, gender, rank, age and years of service. In managing stress, police officers may use adaptive or maladaptive coping mechanisms. Aim: To investigate stress and the coping mechanisms used by police officers. Setting: The study was set in Tzaneen, Limpopo province, South Africa. Methods: This cross-sectional study used a self-administered questionnaire based on the Police Stress Inventory (PSI) and Coping Orientation to Problems Experienced (COPE) tools. Results: Of the 104 participants, female police officers had significantly higher stress intensity scores, while constables and captains had statistically significant lower stress scores. The highest ranked stressors were killing someone in the line of duty, a fellow officer killed in the line of duty, and knowledge of and experiencing the death of a fellow officer in the line of duty. The five most frequently occurring stressors were organisational in nature. Respondents were more likely to use coping strategies that were problem-focused. Conclusion: Organisational stressors were common, suggesting that the South African Police Services (SAPS) management should provide interventions that reduce the effects of work-related stressors. The majority of respondents used problem-focused coping strategies, indicating that most handle stressors in a positive manner.

Introduction. There is an alarmingly high rate of women in South Africa, who are of childbearing age, who still opt for abortions or Voluntary Termination of Pregnancy (VTOP). Despite the availability of free contraceptive methods and health education in all health facilities across the country, to reduce and prevent unwanted pregnancies and VTOP there is still an alarming increase in the rate of VTOP. This study sought to determine the knowledge, attitudes and practices of contraceptive methods among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa. Methods. A across-sectional survey using a piloted, structured and self- administered questionnaire. Convenience sampling was applied and the sample size was 126. Result. The mean age of the 126 participants was 26.1 years. Findings obtained after analysis of participants’ data were grouped following the university categorisation. Below 50% referred as “poor” outcome, from 50 to 74% was referred as “satisfactory” outcome and beyond 74% was considered as “excellent” outcome. Knowledge was poor for 28 (22.2%) of women. It was satisfactory for 91 (72.2%) women and excellent for 7 (5.5%) women. Looking at the attitude: 124 (98.4%) approved the use of contraception, 1 (0.79%) disapproved and 1 (0,79%) abstained due to religious beliefs. Regarding the practice of contraception: 92 (73.0%) have already used contraceptive methods while 34 (27.0%) have not. Conclusion: In summary, the study showed a satisfactory knowledge of contraceptive methods, a positive attitude towards contraception and a huge number of participants who have already used contraceptive methods, among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa.

No abstract available.

Background: Sport has the capability to unite a country. To achieve winning teams, athletes have to rely on each other and often have close physical contact. Disclosure of a positive human immunodeficiency virus (HIV) status may be problematic for athletes in contact sports as they may suffer discrimination and stigmatisation which may impact their relationship behaviours. This may impact frontline nursing and medical staff dealing with on-field ‘blood’ injuries. Objectives: The purpose of this study was to determine if individuals who participate in football and rugby are aware of the risk of HIV infection in contact sports and their perceptions and reported behaviour towards HIV-positive athletes. Method: A cross-sectional survey design with a qualitative element. Quantitative data were analysed using descriptive statistics, while thematic content analysis was used to analyse qualitative data. Non-proportional quota sampling was used for male rugby (n = 23) and football (30) players registered at the University of Limpopo (Turfloop campus). Results: The results supported previous research in that there are gaps in HIV knowledge. For instance, not knowing that anal sex may cause HIV infection and believing that saliva can transmit HIV and that blood transfusions are unsafe. Conclusion: Problematic findings were that a portion of the sample believed that having sex with a virgin could cure HIV and the majority of the sample believed that being ‘bewitched’ could cause HIV and acquired immunodeficiency syndrome (AIDS).