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This study explores the experiences and coping strategies of female frontline healthcare workers (HCWs) fighting the COVID-19 pandemic in resource-constrained settings. Female frontline HCWs face an elevated risk of contracting the COVID-19 infection and infecting their loved ones because when they return from work. The study adopted a qualitative approach to explore the experiences of female frontline HCWs working in high-volume departments at Bindura provincial hospital in Zimbabwe. Using purposive sampling, 15 participants were recruited. HCWs were asked to share their views and perspectives on COVID-19 and their work environment. The study focused on HCWs’ experiences of stigma and discrimination once infected; access to treatment; understanding of transmission; and life experiences of living with COVID-19. The findings suggest that female HCWs working in high-volume departments experience a higher risk of exposure to infection, barriers to assessing personal protective equipment (PPE) and stigma, which impact their mental health. However, despite the complex interrelated challenges female frontline HCWs face in Zimbabwe, there are limited interventions to ameliorate this burden, a knowledge gap this research aims to illuminate.

Abstract Background Early childbearing is a major concern especially in developing countries. This study sought to understand student‐parents’ perspectives of early childbearing, describe their individual experiences and identify the types of support required for such young parents. Methods This was an exploratory qualitative study with semi‐structured in‐depth interviews among 20 purposively selected participants. All the participants were young parent‐students at the University of KwaZulu‐Natal in Durban, South Africa. The interviews were conducted in 2018. Results The young parent‐students identified a lack of adequate information and knowledge about safe sex, contraceptive methods and prevention of pregnancies that led to early childbearing. The common misinformation that prevented the adoption of contraception methods were societal beliefs among men promoting early childbearing, coupled with the negative attitudes of healthcare workers in providing adequate information and reproductive health services. Both male and female parents suffered life‐changing consequences after early childbearing leading to financial burdens to support their new‐born and the interruption of their education. Government financial schemes and bursaries helped these young parents to financially support their new‐born, whereas family support in terms of taking care of the new‐born allowed them to continue with education. In addition, most participants identified having a child as a motivation for pursuing higher education. There is a need for Life Orientation programmes to be tailor‐made to provide adequate knowledge and sensitise the youth on appropriate life choices and access to contraceptives. Conclusion Early childbearing resulted from a lack of adequate knowledge on safe sex and contraceptive methods, poor access to contraceptives, the negative attitudes of healthcare workers in proving adequate sexual and reproductive health services to the youth. Schemes to financially support the young parents and support from family members were key to helping the young parents to continue with university education.

Occupational stress is rampant across various professions. The process of murder case investigation culminates in a plethora of challenges, including mental health concerns among murder detectives, which can trigger occupational stress. Stress reduces productivity and is detrimental to a worker’s health and well-being. This study explored trauma contributing to occupational stress among murder detectives in the South African Police Service. The study adopted a case study design and a qualitative approach within the constructivist paradigm. To generate rich and thick data, participants were purposively selected. Data were collected using in-depth interviews with eight (n = 8) murder detectives and two (n = 2) employees from the SAPS’ Employee, Health, and Well-being Services (EHWS) department. Data were analysed using thematic analysis. The sources of stress identified were attributed to the nature of police work, namely long work hours and exposure to traumatic crime scenes. Murder cases involving children and women were among the most emotionally challenging sources of stress. Further, most detectives reported resorting to defensive mechanisms in dealing with trauma. Although most detectives knew EHWS, high workloads were reported to be an insurmountable challenge. The findings have important implications for intervention programmes to improve the mental health and well-being of SAPS murder detectives.

South Africa continues to grapple with water insecurity, especially regarding access to rural household water. Access to water in rural areas is communal, yet its distribution remains uneven. A mixed-methods approach was used to elicit data for this study. Quantitative data were collected from 211 households using the survey method where a questionnaire was administered. Qualitative data were collected using key-informant interviews with 20 participants. Quantitative data were analysed using the SPSS software. Qualitative data were analysed using the thematic content analysis technique. The findings indicate that water resource management is intertwined with water allocation. Evidence from Goboti and Khubvi reflect structural inequities and the lack of equalisation of opportunities, especially considering the absence of socially inclusive policy interventions, including the Water Services Act (No. 108 of 1997), which has arguably failed to address the challenges impeding rural household water provision. Further, findings unveiled the fallacy that rural households have a greater acceptance of communal water. This study reflects on how the mandate for transformation has been ignored, prompting the need to understand the implications of lack of water in resource-constrained rural settings. Thus, it is imperative to focus on representation and inclusion within rural communities. More importantly, a commensurable allotment of water resources in South Africa’s post-apartheid extractive political economy and political power of water management remains necessary if water access must be attained.

Abstract Background Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model. Methods The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants’ assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method. Results The findings identified the following barriers to child-participation: Primary caregiver limiting the child’s involvement due to fear of traumatising them; HCWs’ limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs’ and PCGs’ fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care. Conclusions This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings.

Abstract Background KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap. Methods We conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research. Results Child-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs’ participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children. Conclusion Child-friendly spaces promote HIV positive children’s right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children’s HIV-related health outcomes.

Background: KidzAlive, a multicomponent, child-centred capacity building model was adopted by South Africa’s National Department of Health to address the challenges of quality of care among HIV+ children. This model involves training and mentoring healthcare workers (HCWs) on a child-centred care approach of communicating with children and their primary caregivers (PCGs). This study explored HCWs’ post-training experiences after a 6-months implementation period. Aim: To evaluate the KidzAlive model as a healthcare approach that seeks to improve the quality of HIV care among children. Setting: The study was conducted in 20 PHC rural and urban facilities across four districts in KwaZulu-Natal. Methods: Interviews were conducted by trained interviewers who followed a structured interview guide. These were audio-recorded, transcribed, and imported into NVivo 10 software for thematic analysis. Thematic analysis was used to develop a coding framework from the participant’s responses. Results: Five themes, namely: (1) increased healthcare worker knowledge, skills and confidence to provide child-friendly HIV services to children; (2) increased involvement of HIV + children in own healthcare journey; (3) the involvement of primary caregivers in children’s healthcare journey; (4) improved health outcomes for HIV + children; and e) transformation of the PHC environment towards being more child-friendly. Conclusion: The findings present preliminary evidence of successful KidzAlive trained HCWs’ buy-in of KidzAlive intervention. KidzAlive has been well integrated into current service delivery processes in PHC facilities. However, more rigorous research is warranted to fully understand the impact of this intervention on children and their primary caregivers.

Introduction. Child-centred care approaches are increasingly gaining traction in healthcare; and are being applied in the delivery of HIV care for children in resource constrained settings. However, very little is known about their potential benefits. Methods. We synthesised literature from primary and secondary publications exploring the philosophical underpinnings of the concept of child-centred care, and its application to HIV service delivery for children in resource constrained settings. We concluded the review by suggesting a conceptual framework for mainstreaming and integrating child-centred care approaches in the management of HIV in resource constrained settings. Results. The philosophical underpinnings of child-centred care stem from human rights (child-rights), holism, the ecological model, and life-cycle approaches. Although there is no standard definition of child-centred care in the context of HIV, the literature review highlighted several phrases used to describe the “child-centredness” of HIV care for children. These phrases include: (i) Respect for child-healthcare rights. (ii) Using the lifecycle approach to accommodate children of different ages. (iii) Provision of age-appropriate HIV services. (iv) Meaningful participation and inclusion of the child in the healthcare consultation process. (v) Using age-appropriate language to increase the child’s understanding during healthcare consultations. (vi) Age-appropriate disclosure. (vii) Primary caregiver (PCG) participation and preparation (equipping the PCGs with information on how to support their children). (viii) Creation of a child-friendly healthcare environment. (ix) Consideration of the child ecological systems to have a holistic understanding of the child. (x) Partnership and collaborative approach between children, PCGs, and healthcare workers (HCWs). Conclusion. Child-centred care approaches can potentially increase child-participation, promote positive health outcomes and resilience in children living with a communicable, highly stigmatised and chronic condition such as HIV. More evidence from controlled studies is required to provide concrete results to support the application of child-centred care approaches in HIV care services.