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Abstract Objective This study investigates the prevalent issues of healthcare access and the impact of antiseizure treatments among people with epilepsy (PWE) in rural Limpopo and Mpumalanga, South Africa, where healthcare facilities and affordable treatments are often inadequate. Methods Using a cross‐sectional survey, 162 PWE were selected using multistage sampling across the provinces. Data were collected via a structured questionnaire and analyzed descriptively using SPSS v27. Results Most of the participants experienced seizures intermittently, with 70.6% in Limpopo and 53.3% in Mpumalanga reporting occasional episodes, whereas a significant minority in both regions—20.6% and 40%, respectively—suffered from frequent seizures. A notable portion of PWE also reported recurring side effects from antiseizure drugs, which led to consequential life disruptions, including educational dropout and unemployment. Significance The findings underscore an urgent need for enhanced educational programs and increased awareness to improve the understanding and management of epilepsy in these underserved areas. Optimizing care for PWE requires a multifaceted approach, including evaluating healthcare accessibility, affordability, and societal beliefs influencing treatment adherence. The study advocates for government and policy interventions to mitigate the quality of life deterioration caused by epilepsy and its treatment in rural communities. Plain Language Summary In Limpopo and Mpumalanga, many individuals with epilepsy experience seizures occasionally, while a significant minority have them frequently. Numerous people also suffer recurring side effects from antiseizure medications, impacting their lives severely by causing school dropouts and job losses. This underscores the urgent need for improved education and awareness programs to manage epilepsy in these provinces effectively. The study urges government action and policy reforms to enhance care and support for people with epilepsy in rural areas, aiming to improve their quality of life.

IntroductionIn South Africa, approximately half a million individuals live with epilepsy. This means that half a million families and caregivers are impacted by epilepsy, with a limited number of healthcare providers responsible for treating people living with the condition, as well as their families and caregivers.MethodsThis study explored the knowledge-based care and support healthcare providers give families and caregivers. Fifteen participants were purposefully selected from Limpopo and Mpumalanga provinces to participate in the study. Data were collected via an open-ended interview guide divided into two sections: Section A comprised sociodemographic questions, and Section B had questions on epilepsy care and support. Four of the participants were male, and 11 were female, seven were community health workers, five were nurse practitioners, and three were auxiliary nurses. Seven had a grade 12 qualification or lower, and only six had a degree. The data collected was analyzed using thematic analysis, coded by the researcher and co-coded by an independent expert. Two themes emerged from the raw data: epilepsy knowledge and epilepsy support and counselling. From these two themes, three subthemes were identified: psychosocial impact of epilepsy, epilepsy-related training, and counselling and support.ResultsThe study revealed a gap in professional capacity building and highlighted the need for intentional knowledge sharing and equipping of healthcare providers.DiscussionThe findings suggest that equipping community health workers, in particular, may be a better and more efficient way to increase the quality of life for families and caregivers and people living with epilepsy in South Africa.

Most strategies are implemented; however, South Africa needs to evaluate and develop trauma interventions. The study aims to develop, test and validate childhood trauma exposure intervention in the Vhembe district, Limpopo province. Donabedian's structure-process-outcome model will guide the study. The study will employ multiphase mixed methods with five phases. Phase 1 will be a thorough systematic evaluation of literature on childhood trauma and exposure to violence interventions to describe existing interventions. Phase 2, stage 1: Will explore the experiences of children exposed to trauma and violence regarding their experiences of the treatment they received, using semi-structured qualitative interviews. Non-probability purposeful sampling techniques will be used to select participants. The Thoyondou Victim Empowerment's database will select participants. The researchers will conduct semi-structured and unstructured interviews with youngsters exposed to violence and trauma. Stage 2 will be a qualitative study of trauma centre managers and personnel sampled from the contact record. IPA will analyze data. Phase 3 will conceptualize Phase 1 and the empirical phase into Donabedian's SPO framework for Phase 4. Phase 4 develops the intervention using Phase 3′s conceptual framework and tests and validates it.

Abstract Background Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). Aim To explore and describe the nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. Methods Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. Results Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. Conclusion Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs Contributions Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations.

Background Health information is the bedrock of decision-making in primary health care and across health care system building blocks, and it is essential for health care systems’ policy development and governance, human resources development, implementation and regulation, health research, health education and training, service delivery, and financing. This research revealed how Nigeria has attempted to make the health information system and research and development more effective in its primary health care services by developing new health policy The aim of this study was to evaluate the impact of the health information system and research and development on primary health care service delivery in Nigeria. Method A mixed method (qualitative and quantitative) approach guided this study. This approach was adopted because of its ability to provide strengths that offset the weaknesses of both quantitative and qualitative methodological approaches. Results Out of 300 respondents recruited for the quantitative aspect of the study, 294 (98%) perceived that health information systems had an impact on primary health care service delivery. The qualitative aspect of the study established that most participants opined that health information systems were of great importance to primary health care service delivery. Since the two findings were the same, it showed that there was no doubt about the value of such systems in the respondents’ and the participants’ responses. Conclusion This study shows that most health professionals need better research knowledge. The study, therefore, recommends that the Nigerian government focus more on research training for health professionals and recruit more professionals into the health information system, research, and development departments to achieve the goals set by the policymakers.

Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.

Epilepsy is a common neurological condition affecting primary school learners, often leading to misconceptions, stigma, and limited social inclusion. These misconceptions transpire because of a lack of knowledge regarding the condition and may lead to high school dropouts. This systematic review aimed to evaluate the effectiveness of epilepsy education programs on epilepsy-related knowledge and understanding, values and attitudes, and skills among primary school learners. A thorough search of electronic databases was conducted to identify relevant studies published between January 2000 and September 2023. Studies that satisfied the eligibility criteria were chosen, and two reviewers conducted data extraction independently. A narrative synthesis approach was utilised to analyse the findings. The review included 10 studies that satisfied the inclusion requirements. The epilepsy education interventions varied in content, duration, and delivery method. Findings indicated that diverse delivery methods, such as classroom-based programs, hospital-based programs, and community-centred interventions, effectively enhanced epilepsy-related knowledge and understanding, values and attitudes, and skills among primary school learners. This systematic review provides evidence that epilepsy education programs can effectively enhance epilepsy-related knowledge, understanding, values, attitudes, and skills among primary school learners. These findings support developing and implementing comprehensive guidelines for teaching epilepsy in primary schools, suggesting various delivery methods and integrating cultural values to promote optimal learning outcomes and social inclusion for learners with epilepsy.

Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system.

Background: The mobile health clinics (MHCs) have been instrumental in rolling out Human Immunodeficiency Virus (HIV) care since they are an extension of Primary Health Care (PHC) services. The integration of HIV care into PHC services is reported as a structural facilitative factor for implementing nurse-initiated antiretroviral therapy (NIMART). The success of any health program relies heavily on management and support structure, hence managers’ perspectives on the implementation of NIMART services in MHCs are deemed crucial. Aim: The study aimed to explore and describe the managerial factors influencing the implementation of NIMART services in the MHCs of eThekwini municipality in KwaZulu Natal. Methods: A generic qualitative research approach was used applying Qualitative Exploratory Descriptive (QED) design, on twelve MHC managers who were purposefully selected and managing MHCs operated by local and provincial health authorities. The study was approved by the North-West University Human Research Ethics Committee (NWU 00934–19-A1), provincial (KZ_202002_017) and local health (30/1/1/6/3/1) authorities. Online semi-structured interviews were conducted to collect data and were transcribed. Atlas-TI was used for data analysis while demographic data was descriptively analysed. Results: Three themes and twelve subthemes emerged from the study: theme 1: Challenges in implementing NIMART services in MHCs, theme 2: Positive factors influencing implementation of NIMART services in MHCs, and theme 3: Suggestions to strengthen implementation of NIMART services. Subthemes were shortage of staff, shortage of medical equipment for NIMART services, challenges with infrastructure, lack of budget for NIMART services, nurses are trained in NIMART, continuous meetings, Proper planning, more nurses should be trained on NIMART, employment of more nursing personnel, collaboration with relevant stakeholders, proper infrastructure for NIMART and need for allowances. Conclusion: The involvement of managers is key to the successful implementation of NIMART services in the MHCs and improvement is more desirable.

Ubuntu is an ancient concept and a way of life among most African cultures. It describes the fundamental principles of living for African communities and is rooted in the values of reciprocal sharing. Ubuntu encompasses the whole community in contrast to the Western ideology of individualism and hence the need to sustain and transmit these values from one generation to the next. The study focused on exploring the experiences of high school learners regarding Ubuntu education and training in South Africa. The study was conducted in two selected high schools in the Greater Giyani Municipality of the Limpopo Province. A qualitative research approach and an exploratory, descriptive design were applied. A purposive sampling method was used to identify 15 learners from the two selected high schools for the Boot Camp. Focus group discussions (FGDs) were conducted as a data collection method among the grade 10 and 11 learners. Trustworthiness and ethical consideration were ensured. The findings from the study revealed that learners shared different experiences during the Boot Camp. One of the experiences shared by the learners is the knowledge gained on applying the concept of the theology of the body to Ubuntu values. Internalisation of Ubuntu values forms an essential landmark in the individual’s life, significantly young people growing up within African communities rooted in African culture. Contribution: This study’s findings will help educate young people about Ubuntu’s philosophies and encourage them to disseminate information regarding Ubuntu within their respective schools and communities.

Background The incidence and prevalence of COVID-19 continues to escalate globally, with the consequence to quality of life, the economies of nations and various sectors of society. While there is substantial research on the impact and experiences of the COVID-19 pandemic, little remains known about the perceptions and lived experiences of families living with people diagnosed with COVID-19, particularly within the South African context. Purpose To explore the perceptions and lived experiences of family members living with people diagnosed with COVID-19 in South Africa. Methods A descriptive phenomenological design was used. Data were collected from 15 participants who were family members of people diagnosed with COVID-19 in South Africa. Purposive snowball sampling was used to identify and recruit participants, and data were collected at community level in KwaZulu-Natal, Western Cape and Gauteng, South Africa. Individual in-depth interviews were used to collect the data, and an audio tape was used to record all interviews. Data were transcribed verbatim and analysed using a phenomenological data analysis processes. Ethical approval to conduct the study was obtained from the University of KwaZulu-Natal Research Ethics Committee—reference number: BREC00003228/2021. Results Four super-ordinate themes emerged in relation to the perceptions and lived experiences of family members living with people diagnosed with COVID-19 in South Africa. The superordinate themes were: (1) sources of information about COVID-19, (2) pandemic perceptions and experiences, (3) impact of diagnosis and related burden and (4) aftermath of living with a family member diagnosed with COVID-19. Discussion and conclusion Family members’ perceptions and lived experiences of COVID-19 are largely influenced by media, moreover, the impact of diagnosis has consequences for the physical, mental and emotional well-being of family members. Diagnosis disrupts family dynamics by depleting financial resources due to the caregiver burden experienced. The findings thus imply that provision of psychosocial support is imperative for families living with persons diagnosed with COVID-19.

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian’s structure process outcome model and Miller’s pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes.

Research has shown that barriers and facilitators in psychotherapy exhibit similarities. The authors of this study are of the view that to effectively address the difficulties encountered in psychotherapy for children and adolescents, it is crucial to consider the points of view of professionals who have firsthand encounters with children. The purpose of this study was to effectively explore barriers and facilitators in the treatment of children exposed to trauma and violence. Exploratory and descriptive methods, as components of a qualitative research design, were employed to investigate and articulate the barriers and facilitators involved in managing childhood trauma. An advertisement was used to recruit participants. It was developed and distributed to psychologists and social workers recommended by the Thohoyandou Victim Empowerment Programme. Seventeen professionals were individually interviewed using semi-structured interview schedules. The interviews were recorded, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). The findings of the study indicated a lack of commitment from parents in honouring appointments, financial challenges, a fear of perpetrators associated with the poor reporting of incidences, professional boundaries, and referral route challenges. Familiar facilitators in the management of childhood trauma included continuous training and workshops for all people working with childhood trauma and violence, the employment of more victim advocates, and awareness campaigns. Additionally, the referral pathway for traumatised children presents logistical, psychological, and educational hurdles, underscoring the complex nature of meeting the needs of these vulnerable populations within the healthcare system. In conclusion, even while the currently available research supports the barriers and facilitators for this population, more investigation is required to examine how these factors affect treatment outcomes, particularly in community-based settings.

Background: Women in South Africa are battling the scourge of intimate partner violence (IPV), and men are usually responsible. Despite this, no studies have been carried out to specifically explore and describe Christian women’s IPV first-hand experiences in the Limpopo and Gauteng provinces. Aim: This study explored and described lived experiences with regard to IPV among women attending Pentecostal churches in Limpopo and Gauteng provinces. Setting: The study was conducted in the Makhado Local Municipality, City of Tshwane and Johannesburg metropolitan municipalities. Methods: The study utilised a qualitative research method, using interpretative phenomenological analysis. Sampling was purposeful. Semi-structured individual interviews were conducted to collect data among women attending Pentecostal churches in Limpopo and Gauteng provinces. Data saturation was achieved after 10 survivors were interviewed. Results: Two themes surfaced from the analysis: the experience of various forms of IPV by survivors and the hardships survivors encountered when seeking help after IPV. Conclusion: In spite of the salient role Christian belief played in survivors’ lives, the expected support from family, pastors and law enforcement officers after disclosing IPV was non-existent. The survivors were stranded, frustrated and displayed symptoms of depression and anxiety. Contribution: This study revealed survivors’ need for comprehensive, multidisciplinary, and transdisciplinary collaborative support by strengthening partnerships with church leaders to protect Christian women against IPV.

Rapid changes in health care, innovative technologies, and the emergence of new knowledge globally led to a need for enhancement in Continuing Professional Development (CPD) opportunities for nurses in public hospitals of Limpopo. However, they need to be empowered with updated knowledge and skills to adapt to these changes to enable them to render quality care to patients, resulting in fewer lawsuits. To explore and describe the experiences of professional nurses regarding CPD opportunities in the public hospitals of Limpopo Province. An exploratory-descriptive design was utilized in this study. Individual semi-structured interviews were used for data collection. Participants comprised 35 professional nurses who were purposely selected. Data collected were audio-recorded and transcribed verbatim. Data was analyzed using Tech’s eight-step data coding process, which led to the emergence of themes and sub-themes. Trustworthiness was ensured through credibility, confirmability, dependability, and transferability. Four themes emerged: Professional nurses’ understanding of CPD, Professional nurses’ views about necessary support needed for CPD, Professional nurses’ related to in-service training being offered, and Identified measures to resolve the challenges. Findings highlight that professional nurses value CPD and view it as important in learning new skills and improving standards of patient care and their self-esteem. Findings included challenges such as poor attendance of CPD activities and, lack of understanding of CPD, lack of access to CPD training, shortage of staff, and lack of funding and support by managers. Offering CPD opportunities regularly enhances knowledge and skills personally and professionally. However, more effective strategies are needed to address the identified challenges. Nurse Managers, Human Resources Departments, and the Department of Health need to be informed and updated on what is required in order to create and sustain effective and attainable CPD opportunities in the public hospitals of Limpopo Province.

The attitudes and behaviors towards people living with neurological conditions, such as epilepsy, have major implications for the quality of life of affected individuals and for human progress more broadly. Epilepsy is a common neurological disorder often associated with misconceptions leading to discrimination, stigma, and burden for people living with epilepsy (PLWE) and their families. Addressing these negative factors and improving the quality of life has become a crucial area of research. This conceptual framework paper explores the potential of attitude and behavior change to enhance the quality of life for PLWE and their families. The study was conducted in rural Limpopo and Mpumalanga provinces (South Africa), employing an explanatory sequential mixed method approach. Participants included were PLWE (n = 163), their family members and caregivers (n = 519), healthcare practitioners (n = 102), and community members (n = 4290). The findings revealed significant knowledge, awareness, and behavior disparities among participants, with PLWE showing better consistency. Furthermore, the study highlighted the impact of consistency and balance in knowledge, awareness, and behavior on the overall quality of life for PLWE and their families. It is important to have intentional epilepsy education and accurate information sharing to influence attitudes, positive behavior, and improved quality of life for PLWE and their families. While the primary emphasis of this study lies in epilepsy, its implications may extend to other stigmatized and discrimination-prone illnesses, especially those affecting the brain. This highlights the significance of addressing societal attitudes toward such conditions as a measure of social progress.

Introduction: This systematic review was undertaken based on available data on human immunodeficiency syndrome (HIV) care, management, and support services provided by mobile health clinics (MHCs) in various countries globally, to identify available HIV care and support services, as outlined by PEPFAR’s ‘universal’ framework for MHCs. The review question was “What universal HIV care and support is available at MHCs?” Material and methods: The search yielded 34,954 articles and was conducted within four databases, including EBSCOhost (UKZN library), Google Scholar, PubMed, and CINAHL. The search yielded 25 studies, which met the inclusion criteria, from 2011 to 2020. Results: Seven themes were identified relating to HIV care and support services offered by MHCs. Theme 1: Fragmented or selected universal HIV care and support services available at mobile health clinics, Theme 2: Lack of local support for HIV care and support services from ministries of health. Theme 3: Success relies on multiple stakeholders’ engagement. Theme 4: Excellent platform to reach marginalized population and expanding healthcare access. Theme 5: Possible multi-health program delivery. Theme 6: Implementation of critical viable point-of-care services. Theme 7: Follow-up care leads to successful health outcomes for patients attending MHCs. Conclusions: Intentional and carefully planned HIV services delivered by MHCs ensure that minimum universal HIV care and support is achieved for people living with HIV. Local access to healthcare services is improved and yielding positive impact by reducing HIV-related morbidity and mortality rates in the communities, while at risk-populations are considered.

Background: A conversation about sexuality is most likely to encourage healthy and positive sexual practices while reducing risky sexual behaviour among adolescents. Traditionally, sexuality is discussed in hushed tones in proverbs and is reserved for adults. On the other hand, adolescents require to be well informed about their sexuality to assist them to make informed decisions about their sexual behaviour. Aim: The study determined parents' views regarding challenges of sexual health communication among secondary school learners in Limpopo Province. Method: A qualitative, exploratory-descriptive, and contextual approach was employed for the study. Fifty-six parents were purposively select, resulting in five focus group discussions that had 8-12 members. One central question was asked, and based on the participants' responses, probing questions asked followed. Data were analyzed using thematic analysis. Trustworthiness and ethical considerations were ensured. Results: Three themes, that is communication concerns, role shifting in imparting sexuality education and poor parent-child relationships and eight sub-themes emerged from the data. Conclusion: Study identified that communication concerns influence parent-child dialogue on sexuality education. Therefore, there is a need to address factors hindering communication like cultural barriers, role shifting in imparting sexuality education, poor parent-child relationships. This study suggests that parents be empowered in dealing with children's sexuality.

Background: Quality has increasingly become a critical part of life in every aspect. Patients are today continuously looking for good quality services from health professionals. Professional nurses are expected to render quality care to fulfil the patients’ healthcare needs. Poor nursing care has led to several litigations and the loss of patients’ lives. It is essential to explore professional nurses’ viewpoints regarding quality nursing care. Objectives: To explore and describe the understanding of professional nurses regarding quality care rendered to patients in the selected hospitals of Limpopo Province. Method: This study utilised a qualitative, exploratory-descriptive design. Individual semi-structured interviews were conducted for data collection. Participants comprised 35 professional nurses who were purposely selected. Data collected were audio-recorded and transcribed verbatim. Data were analysed using Tech’s eight-step data coding process, which led to the emergence of themes and sub-themes. Trustworthiness was ensured through credibility, confirmability, dependability, and transferability. Results: Three themes emerged: professional nurses’ descriptions, meanings, and expectations of quality nursing care. The findings highlight that quality nursing care means meeting patients’ needs through advocacy, empathy, fulfilment of patients’ needs, good interpersonal relationships and teamwork. Challenges experienced included the lack of resources and staff shortage. Conclusion: Hospital management needs to develop effective ways to support professional nurses in delivering quality nursing care. In discussion with the Department of Health (DoH), hospitals should be fully equipped with resources to render quality care to patients. Evaluation of service quality and patient satisfaction should be ongoing for improving the quality of patient care. Contribution: The study reveals that professional nurses perceive quality nursing care differently. Moreover, it emphasises the importance of maintaining and promoting quality nursing care as the cornerstone of healthcare.

Several crimes in South Africa cause physical, economic, and mental problems. Xenophobic attacks, mob justice, and other violent conduct directly traumatise children. Service delivery riots and physical and sexual abuse are examples. This evaluation evaluates childhood trauma and exposure to violence interventions. The review describes the therapeutic methods for traumatised children exposed to violence, the healthcare professionals administering them, and the strategies used to tailor the interventions. The researcher systematically searched PsycINFO, Google Scholar, PubMed, Science Direct, and EBSCOhost. Literature from 2011 to 31 July 2023 was searched, and 19 papers were chosen for further review after the systematic search. The authors conducted an eligibility evaluation according to PRISMA guidelines. A thorough review of article texts identified 19 papers that met eligibility standards. Only nineteen studies have validated trauma and violence therapies for children. An effective multi-phased intervention that is feasible and adaptable to varied socioeconomic backgrounds is needed. Further studies on the mental health benefits of brief trauma intervention treatment are needed.

Plain English language Health service providers play a significant role in crafting and implementing health policies and programs that manage adolescent sexual health-related matters. Different strategies have been implemented in different country settings to improve adolescents sexual health-related outcomes. The role played by health service providers is not adequately documented to aid decision making in policy formulation and implementation. This work explores and documents the roles that modern health systems play through the specified health service provider in managing adolescent sexual health issues. The study also examines the potential for integrating modern health systems with indigenous health systems to improve adolescent sexual health matters. The study further presents ways of overcoming challenges that could derail the possible integration of the two mentioned health systems in the management of adolescent sexual health-related matters.

In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.

Background: There is a high prevalence of occupational exposure among health care practitioners (HCPs) around the globe. One of the risk factors of HIV infection among HCPs is occupational exposure to human immunodeficiency virus (HIV) infection through blood or fluid from HIV-infected individual. Therefore, because of this prevalence, there is a need to have sufficient knowledge and information regarding post-exposure prophylaxis (PEP). Sufficient PEP knowledge assists individuals in utilising PEP in case of exposure to HIV. Aim: This study aims to assess the level of knowledge, attitude and adherence to PEP in HCPs in Southern Africa. Setting: The systematic review included studies conducted in Southern Africa. Methods: A systematic review was conducted. Search engines employed in this study included Google Scholar, Science Direct, PubMed, Ebscohost and JSTOR. From these, 3572 articles emerged after removing duplications, and article screening was guided by inclusion and exclusion criteria and outlined on a PRISMA flow chart. Ultimately, the study included 13 articles. A critical appraisal skills programme was applied for the quality assessment of the eligible studies. Results: Studies included in this review revealed that most participants have adequate knowledge regarding PEP (n = 6). However, it was revealed that poor adherence occured because most HCPs did not complete PEP. Conclusion: Health care practitioners have adequate knowledge of PEP with varying levels of adherence to PEP. Therefore, more awareness illustrating the importance of adhering to PEP is needed. Contribution: There is an adequate level of knowledge regarding PEP found in the included studies although not satisfactory in Southern Africa given the participants are HCPs, and marked inappropriate practices affect adherence.

Covid-19 has disrupted normal working conditions as people were not allowed to assemble in one place. There is a limit that is placed on the number of people congregating in public areas, and these measures also affect the education system worldwide. The purpose of the study was to explore nursing students’ experiences in a historically disadvantaged rural-based university on the impact of Covid-19 on teaching and learning. The study employed an exploratory-descriptive qualitative design among nursing students who were purposively sampled to participate in the study. A qualitative self-administered open-ended online google form was used to collect data. Thematic analysis was employed for this study. All ethical measures were respected during this study. Interviews were conducted with 68 participants, including 12 undergraduate second-year students, 7 third-year students, and 49 fourth-year students. A total of 51 females and 17 males participated in this study. The study yielded several themes, including participants’ expression of their experiences related to teaching and learning during the national lockdown, participants’ views on the impact of COVID-19 on teaching and learning/research, and Participants suggested sustainable strategies to promote teaching and learning during the national lockdown. In conclusion, the role of preceptors in all clinical areas should be strengthened to improve clinical teaching and learning. The researchers recommend strengthening collaboration among university lecturers for sharing ideas and finding innovative solutions appropriate for handling any pandemic that threatens teaching and learning processes.

The Prevention-of-Mother-To-Child Transmission (PMTCT) program was introduced to prevent vertical transmission of HIV from a mother to her infant through pregnancy, labor, and breastfeeding. Therefore, it is critical for the program to be accessible in primary health care facilities across the globe to increase treatment uptake and to eliminate child and maternal mortality rates caused by HIV infections. However, barriers are still being experienced by some nurses while implementing PMTCT around Moretele sub-district in the North West Province (NWP). Hence, this qualitative study explored and described the factors influencing the implementation of PMTCT. A qualitative, exploratory-descriptive design was followed. Ten participants were selected purposively, and each participant was interviewed individually using WhatsApp video calling. All participants were made aware of their voices being recorded; data saturation was reached on the eighth participant as no new information evolved. Data were analyzed using Tesch’s method of qualitative data analysis. The findings revealed that factors that influenced PMTCT implementation were due to patient, management, and staff-related factors. Moreover, these factors impacted the provision of effective patient care. The findings of this study show that much still needs to be done to achieve and sustain the PMTCT implementation goal. Therefore, the training of nurses should be of paramount importance. They should be provided and equipped with the necessary resources, support, and encouragement to offer and ensure quality health care. Furthermore, the government should ensure that policies and guidelines are regularly monitored and evaluated.

Abstract Background Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses’ adherence to TB/HIV treatment guidelines. Methods The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. Results The singular theme of factors facilitating NIMART trained nurses’ adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. Conclusion Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.

Occupational exposure to human immunodeficiency virus (HIV) among nurses had been reported to be a major challenge in South African and broader African context. There seems to be an increase in the level of exposure and uptake of post-exposure prophylaxis (PEP) in Africa. This had warranted the need to establish a systematic review on the level of knowledge among nurses regarding PEP in the African continent. The search engines used included: EBSco Host (North-West University [NWU] library), Sabinet, Google Scholar, ScienceDirect, and PubMed. The search was limited to the current decade (2008-2018), including articles that are in English. Keywords used were: ‘knowledge’, ‘post-exposure prophylaxis/PEP’, ‘HIV’, and ‘nurs*’. Thematic evaluation to pick out commonalities of the applications covered in this review have been achieved. The themes identified from the review were: poor knowledge regarding PEP, receiving training on PEP for HIV, immediate steps to take after exposure to infected blood, exposure to HIV, and not taking PEP. There is a strong need to increase the awareness and knowledge regarding PEP as well as to implement training programs to train nurses on the process of PEP in healthcare settings, to increase knowledge on PEP, and thereby decrease seroconversion of HIV. y.

Abstract Background Zimbabwe has the highest teenage pregnancy rate in Sub Saharan Africa. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence which is estimated at 12% (18 and 13.6% respectively) in Zimbabwe. Indigenous Health Systems (IHSs) and Modern Health Systems (MHSs) in Zimbabwe run parallel thereby introducing challenges in the management of adolescent sexual health due to conflicts. This study seeks to develop strategies that will facilitate the integration of IHSs and MHS in Mberengwa and Umguza districts. Methods This research will be conducted in two phases. The first phase would utilise a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches would be merged through a comparison of findings side by side. The second phase would focus on the development and validation of strategies that would facilitate the integration of IHSs and MHSs. The Strength, Weakness, Opportunity and Threat (SWOT) analysis would be applied on interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore and Minimise (BOEM) models would then be used to develop strategies based on the SWOT findings. The developed strategies would be validated through the application of Delphi technique and administration of checklist to selected key stakeholders through organised workshops. Discussion There have been no known studies found in the literature that explores the possibility and developed strategies of integrating IHSs and MHSs so as to promote safe sexual practices in adolescents. Most programs on sexual health have ignored the role of IHSs and MHSs in influencing safe sexual practices leading to them failing to attain desired goals. A lot of emphases has been targeted at minimising the spread of Sexually Transmitted Infections (STIs) through advocating for utilisation MHSs rather than focussing on an integrating systems that are meant to manage Adolescent Sexual Health (ASH) related issues. The study protocol was approved by the University of Venda Ethics Committee Registration (SHS/19/PH/17/2608) on the 26th of August 2019.

Epilepsy is a disorder in which nerve cell activity in the brain is disturbed, causing seizures. It may result from a genetic condition and occurs mainly in children, especially at a primary level. Most people living with Epilepsy suffer from stigma and discrimination because of a lack of knowledge regarding Epilepsy. This study aims to develop life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces to educate learners about Epilepsy, thus decreasing stigma and discrimination. A multimethod research approach will be used in this study to fulfil its purpose. Both stages 1 and 2 of the empirical phase (phase 1) will employ an exploratory-descriptive study design focusing on the primary school teachers, life skills educational advisors and learners to obtain their perceptions or views regarding the need to include Epilepsy in life skills education. Data will be collected using individual interviews for life skill educational advisors and focus group discussions for teachers and learners at the sampled primary schools in Limpopo and Mpumalanga provinces. Phase two will conceptualise the phase 1 findings into the conceptual framework, and phase 3 will develop and validate the life skills guideline. This study will adhere to both internal and external ethical considerations. Recommendations will be made based on the findings of the study.

Although epilepsy is a common non-communicable neurological disease, lack of knowledge, awareness, and negative attitudes of it abound. This study aimed to explore public awareness, knowledge, and attitudes towards epilepsy and people living with epilepsy (PLWE). RaoSoft software was used to calculate the sample size, and 4290 respondents were included. The researchers employed a non-experimental quantitative survey method. Data were collected using a questionnaire, and descriptive and regression analyses were performed. Most respondents had a secondary education without grade 12 (45.2%); 79.6% were unemployed in Limpopo and 70.5% in Mpumalanga. This study had a 95.3% response rate. Both provinces displayed low knowledge of epilepsy (48.2%; mean = 5.99; SD = 2.38). Only 41% demonstrated awareness, and 56.7% had a positive attitude towards epilepsy (mean= 4.67; SD = 1.90). The findings revealed positive correlations between demographic factors and overall knowledge, awareness, and attitude. In addition, demographic factors, such as level of education and employment status, may be associated with an individual’s knowledge, awareness, and attitudes towards epilepsy. This study concluded that, despite individuals’ awareness of epilepsy, their levels of knowledge were low, and many (43.3%) had a negative attitude regarding the disease. In the two provinces investigated, the study highlighted the need for epilepsy education to empower the public and improve the quality of life of PLWE and their families.

Background: Strategies to improve sexual health outcomes have evolved over the years due to technology’s evolution to ensure that they are relevant. Challenges have been noticed in different systems that run parallel, particularly in Low-Income Countries where the majority utilise Indigenous Health Systems. Optimisation of resources and minimisation of conflicts could be realised through integrated health systems in the management of adolescents’ sexual health issues. This study sought to develop strategies to facilitate Indigenous Health System and Modern Health System integration to improve the management of Adolescent Sexual Health issues, leveraging results from 3 papers. Methods: A multi-stage approach was utilised, with Phase 1 focussing on a preliminary assessment through merging findings from the 4 papers. The Strengths, Weaknesses, Opportunities, and Threats analyses were then used, followed by the Basic Logic Model to identify critical aspects that needed to be considered in building the strategies. The second phase used the Build, Overcome, Eliminate and Minimise framework to build the strategies. Results: A total of 5 strategies were proposed to facilitate this integration, and these included revival of committees that were inclusive of all stakeholders; allocating Indigenous Health System space in clinics to work in; establishing adolescent-friendly clinics; intensifying information dissemination on sexual health-related issues, and developing clear Terms of Reference and procedures to govern this integration and ensure it is a success. Conclusions: Implementing these strategies could facilitate this integration and ensure that programs are planned and implemented in a complementary manner, thereby reducing conflicts between the 2 systems and ensuring collaborative efforts towards shared goals that would transform to better Sexual Health Outcomes for adolescents.

Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) caregiving has created a foundation for stress and burnout amongst nurses as they are burdened by the increased workload of HIV and AIDS care. Objectives: This study aimed to develop a support model for nurses caring for people living with HIV and AIDS (PLWH). Method: The study employed concept analysis and the identified concept of interest within the caring context of HIV and AIDS was conceptualised using six elements of practice-oriented theory, namely, the context, agent, recipient, dynamic, procedure and purpose. Results: The framework consisted of six components: health service and legislative (context); nursing service managers (agents); nurses (recipients); decreasing power imbalance, participative and transformational leadership and trust (dynamics); initiation of support process through teamwork and mutual goal-setting, implementation and sustenance through reflections, monitoring and evaluation (process) and empowered nurses (outcome). Conclusion: Poor organisational support deteriorates the quality of nurses’ lives on a personal level and imposes a direct economic cost on the employer by decreasing overall nursing workforce productivity. The conceptual framework could be a guide to support nurses in healthcare services regarding the management of HIV and AIDS in the workplace.

This systematic review was conducted based on the available data on antiretroviral therapy adherence among human immunodeficiency virus (HIV)-infected individuals in South Africa and identified factors that were outlined by different studies. In order to identify said factors, the review question was: “What are the factors influencing non-adherence to antiretroviral therapy (ART) in South Africa?”. The search was conducted on four databases: PubMed (9), Google Scholar (5340), EBSCOhost (9), and South African national EDT (10) using the keywords: “non-adherence”/”non-compliance”, “anti- retroviral therapy”, “HAART”, “ARVs”, and “South Africa”. The search yielded seven studies that met the inclusion criteria. From the results, six themes and 14 sub-themes emerged of factors influencing non-adherence to antiretroviral therapy in South Africa, inclusive of: patient-related factors, economic factors, social factors, health system and health team factors, therapy-related factors, and cultural and belief factors. It is believed that from the information provided in this review, interventions can be drawn which will help patients achieve the benefits of ART, while at the same time helping South Africa to achieve its aim of reducing high mortality and morbidity rates.

Background: The preceptorship model has been widely used as a method of choice for clinical learning in nursing education institutions worldwide, including South Africa. The aim of the study was to determine factors influencing preceptorship in clinical learning in an undergraduate nursing programme in nursing education institutions in the North West Province of South Africa. Methods: A cross sectional design was conducted among preceptors (n = 9), preceptees (n = 177) and unit managers (n = 38) using total population sampling technique. Data about factors influencing preceptorship were collected and analysed using descriptive statistics and the Statistical Package for Social Sciences (SPSS version 23). Results: The following factors influenced preceptorship positively: course expectations discussed at the beginning of placement, preceptors and unit managers with adequate knowledge to meet the preceptees’ learning outcomes, hospital units were good clinical learning environments and good inter-professional relationships in the clinical areas. The factors that influenced preceptorship negatively included: the preceptors’ perceived insufficient knowledge and skills to meet the preceptees’ learning outcomes; and nurses in the units who did not support student supervision. Conclusion: Good interpersonal and inter-professional relationships between stakeholders are important to influence preceptorship positively as do preceptors and unit managers with adequate knowledge to meet preceptees’ learning outcomes. Preceptorship could be enhanced by increasing the time spent in the clinical learning environment to meet expected preceptees’ learning outcomes. Keywords: Preceptorship model, Clinical learning, Undergraduate nursing programme, Clinical learning environment

Different stakeholders play varying roles in shaping up adolescent sexual behaviours that, in turn, influence their sexual experiences. In Zimbabwe, it has been reported that adolescents from cultural districts exhibit poor sexual health outcomes as compared to other districts. Therefore, this study sought to explore the role of different key community stakeholders in the indigenous health system and how it impacts on adolescent sexual health issues. The study further explored how the indigenous health system could be integrated into the modern health system. A qualitative cross-sectional survey was conducted on purposively and snowballed respondents in Umguza and Mberengwa districts. Interviews and focus group discussions were used to gather and record data from participants. The recorded data were transcribed verbatim, translated to English, coded and thematically analysed on MAXQDA Analytics Pro 2020. Four superordinate and 12 subordinate themes emerged from the data during analysis. Stakeholders play varied roles in adolescents’ upbringing and support though there are contradicting teachings from the indigenous health system and modern health system. It is possible to integrate these two systems though there were foreseen logistical challenges and clashes in the values and belief systems. Participants made suggestions on how these challenges could be overcome. There is a window of opportunity to pursue the suggested ways of integrating indigenous health systems and modern health systems for improved adolescent sexual health outcomes.

Background: The increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy (ART) prompted the Department of Health to adopt World Health Organization’s task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern. Aim: The aim of this study was to explore and describe the challenges influencing NIMART training and implementation amongst PNs and programme managers. Setting: The study was conducted from the PHC facilities, in the rural districts of the North West province. Methods: An exploratory programme evaluation and contextual research design was used in the study. Purposive sampling was used. Focus group discussion (n = 28) and individual interviews were used to collect data. Data was analysed using ATLAS.ti software. Results: The results revealed two themes: inadequacy in NIMART training and the healthcare system challenges that influence NIMART training and implementation. Theme 1 included among others the lack of standardised curriculum and model or conceptual framework to strengthen NIMART training. And theme 2 included patient and district healthcare structural system. Conclusion: There a need to improve NIMART training and implementation through the standardisation of NIMART curriculum, introduction of pre-service NIMART training in institutions of higher learning, addressing staff shortages and negative attitude of PNs providing ART.

Background: The implementation of nurse-initiated management of antiretroviral therapy (NIMART) management training is a challenge in the primary health care (PHC). It is evident from the literature reviewed and the data obtained from the North West province that gaps still exist. There is no conceptual framework providing guidance to NIMART training and implementation. Aim: Therefore, the aim of this study was to develop a conceptual framework to strengthen NIMART training and implementation in the North West province to improve patients and human immunodeficiency virus (HIV) programme outcomes. Setting: The study was conducted in the North West Province, South Africa. Methods: A pragmatic, explanatory, sequential, mixed-methods research design was followed. A descriptive and explorative programme evaluation design was used. Data were collected from two sources: antiretroviral therapy (ART) statistics from District Health Information System (DHIS) Tier.net of 10 PHC facilities to evaluate and determine the impact of NIMART on the HIV programme and five focus group discussions conducted amongst 28 NIMART nurses and three HIV programme managers to describe challenges influencing NIMART training and implementation. Results: The study revealed that there was low ART initiation compared to the number of clients who tested HIV-positive. There was poor monitoring of patients on ART, which was evident in the low viral load collection and suppression, high loss to follow-up and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including human resource ratios, training and mentoring and the entire absence of a conceptual framework or model that guides training and implementation. Conclusion: The study findings were conceptualised to describe and develop a framework needed to facilitate and influence NIMART training and implementation to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach’s practice-oriented theory and Donabedian’s structure process outcomes model provided a starting point in the ultimate development of the framework. Although the study was limited to the North West province’s PHC clinics and community health centres and did not include hospitals, it is of high significance as there is no such conceptual framework in the province or in even South Africa.

The challenges of caring for people living with HIV (PLWH) in a low-resource setting has had a negative impact on the nursing profession, resulting in a shortage of skilled nurses. In response to this shortage and perceived negative impact, we conducted a descriptive, cross-sectional study to describe the level of knowledge and psychosocial wellbeing of nurses caring for PLWH at a regional hospital in Limpopo Province, South Africa. A total of 233 nurses, the majority being female, participated and were stratified into professional nurses (n = 108), enrolled nurses (n = 58) and enrolled nursing auxiliaries (n = 66). Data were collected using HIV/AIDS knowledge questionnaire, Maslach Burnout Inventory; AIDS Impact Scale and Beck's Depression Inventory. The total knowledge score obtained by all the participants ranged from 2 to 16, with an average of 12.93 (SD = 1.92) on HIV/AIDS knowledge. Depersonalization (D) (83.7%) and emotional exhaustion (EE) (53.2%) were reported among participating nurses caring for PLWH. Burnout was higher among professional nurses as compared to both enrolled nurses and enrolled nursing auxiliaries. There was a moderate negative significant correlation between HIV knowledge with the nurses' emotional exhaustion (r = −0.592), depression (r = −0.584) and stigma and discrimination (r = −0.637). A moderate to high level of burnout was evident among all levels of nurses. These findings lead to the recommendations for support of nurses caring for PLWH that include structured nursing educational support, organisational support with respect to employee wellness programmes that address depression and work burnout, as well as social support. The provision of these support mechanisms has the potential of creating a positive practice environment for nurses in the Vhembe District of the Limpopo Province in particular, and South Africa in general, and in improved care for PLWH.

INTRODUCTION: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. METHODS: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. RESULTS: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. CONCLUSION: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.

Background: The main objective of the Integrated Management of Childhood Illnesses (IMCI) strategy was to reduce child mortality and morbidity, which are associated with major childhood illnesses. IMCI offers a comprehensive health programme that is directed at the development needs of children under five years of age. This strategy also focuses on good nutrition, health promotion, immunization and preventive measures, provides counselling services to mothers or care givers, and engenders an appropriate referral system for seriously ill children. Purpose: The purpose of this study was to explore and describe factors inhibiting implementation of IMCI in primary health care (PHC) facilities in selected sub-district of North West Province, South Africa. Methods: A qualitative, exploratory, descriptive-contextual framework was used. The target population of this study was professional nurses (PNs) working in community health centres (CHC) and primary health care (PHC) facilities. The sample size of the study included 15 participants as determined by data saturation reached by the 12th participant. The study included professional nurses trained in IMCI. Data was collected through in-depth individual semi-structured interviews, using an audio tape recorder and field notes, with data transcribed verbatim. Data was analysed using Atlas TI. Results: Participants were professional nurses aged between 25 and 50 years. Themes emerging from the data included organizational and structural factors inhibiting IMCI implementation; education, training and awareness; the behaviour and attitude of nurses towards IMCI implementation; and caregiver related factors affecting IMCI implementation. Conclusion: The study revealed that professional nurses need effective support, mentoring and supervision throughout IMCI implementation by the Mother, Child and Women Health (MCWH) coordinators. Caregivers and mothers need to know the importance of providing a comprehensive child history to professional nurses and therefore they need to be encouraged to disclose all relevant information during the IMCI process. Keywords: Implementation, Caregivers, PHC, WHO and IMCI

Background: The purpose of NIMART training is to upscale the capacity of PNs with knowledge, skills, confidence and competencies to provide comprehensive and quality health care services to PLWH and thereby improve the performance of the HIV programme. Therefore, this study evaluates the impact of NIMART training on the implementation of the HIV programme to identify gaps and extend best practices. Objectives: The objective of the study is to determine and evaluate the impact of NIMART training on HIV programme in order to make recommendations leading to effective training and implementation. Methods: A quantitative descriptive design for programme evaluation was used to examine the impact of NIMART training on the implementation of the HIV programme. The study was conducted in rural districts of the North West province. A stratified simple random sampling method was used to select n = 10 PHC fixed clinics and community health centres that met the inclusion criteria. Five sub-districts were selected to participate in the study to allow a greater degree of representativeness. The statistics of ART indicators were collected from the DHIS from January 2012 to December 2016. These ART indicators have been measured against the number of PNs trained on NIMART. Descriptive statistics were used to analyse data. Results: The study results revealed ineffectiveness in the implementation of NIMART training programme and inefficiency in the management of HIV as there is no steady increase of new ART initiation in adults, children, and ANC pregnant women and below 90%, despite 99% of PHC selected facilities having 75% on PNs trained on NIMART, 42.8% were not certificated for competence and only 23% not trained, including the changes in eligibility criteria for treatment, introduction of PMTCT policy and universal test and treat (UTT) in September 2016. Sustainability of patient on ART is poor as the study results revealed fluctuation in both adults and children TROA and high LTFU at an average of 14%. Again, of Viral load collection (54%) & Viral load suppression (56%) rate at 12 months after ART initiation is far below the 90% target and had negative impact on patient treatment outcomes including decanting of stable patients out of the overcrowded facilities. However, adult patient death after 12 months of starting treatment declined. Conclusion and Recommendations: There is a significant impact of NIMART training on HIV management with regard to increased access to PHC facilities. However, challenges still exist that reveal poor quality of HIV management, non-compliance to guidelines and monitoring of treatment effectiveness despite PNs trained on NIMART. Challenges or barriers that lead to the identified gaps need to be investigated in order to make recommendations that strengthen NIMART training and implementation. Keywords: NIMART- Nurse initiated management of anti-retroviral therapy training, HIV programme, Impact, PHC facilities, Professional nurses

Background: Nurses, as front-line care providers in the South Africa’s health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored. Purpose: To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces. Design: This study employed a qualitative exploratory descriptive design. Methods: Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software. Findings: During data analysis, two themes emerged: (1) NIMART trained nurses’ distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses’ adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors. Conclusion: This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses’ barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

Background: The purpose of the performance management system (PMS) is planning, monitoring, evaluation and development of employees to meet the organisational goals and objectives and transform of service delivery to excellence of the organisation. However, public services are deteriorating and implementation of PMS stimulated different views among professional nurses (PNs) in the Mopani district clinics, which warrants exploration and documentation of the findings. Objective: The objective of this study was to explore and describe the PNs’ perceptions towards PMS. Methods: A qualitative, phenomenological research was conducted to explore and describe the nurses’ lived experiences regarding PMS. A purposive sampling method was used. Data collection was done using focus group interviews. Three focus group discussion sessions were conducted, inclusive of six to nine participants in each session. Results: Twenty-two PNs were interviewed. The findings revealed the following themes: PNs’ uncertainty regarding the implementation of PMS, poor implementation of PMS and its process, lack of knowledge and understanding of PMS implementation and its process, and negative attitudes towards the implementation of PMS. Conclusion: PNs perceived PMS negatively. There is a need to improve leadership and management behaviour by enhancing productivity, job satisfaction and organisational commitment. Constructive feedback, training and capacity development, including standardisation and stabilisation of performance instrument, might improve the process.

Background: Nurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis. Objectives: To determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH. Method: A cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data. Results: A total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622). Conclusion: The study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses. Keywords: Post-Exposure Prophylaxis; Nurses; HIV, Occupational Exposure; PLWH

Background: Gender-based violence is a challenge in South Africa, despite available interventions. Caring for the survivors of both forms of violence is critical for ensuring their speedy recovery. Objectives: To compare the effects of trauma on female survivors of sexual assault versus those experienced by survivors of physical assault by their intimate partners. Method: A quantitative cross-sectional comparative study design was used to compare 30 sexually-assaulted women and 30 physically-assaulted women regarding depressive symptoms, posttraumatic stress disorder and coping styles three months after the incident. Semi-structured interviews were conducted with the survivors of both types of assault and the Beck Depression Inventory posttraumatic stress disorder checklist and Brief COPE Inventory were administered in order to obtain quantitative data. Both parametric and non-parametric statistics were employed. Ethical measures were adhered to throughout the research process. Results: A significantly-higher proportion of sexually-assaulted women disclosed the incident to family (p = 0.021). The majority of sexually- (90%) and physically- (86%) assaulted women were likely to recall the incident. Sexually-assaulted women had a significantly-higher mean for avoidance/numbness (p < 0.001) and physical-assaulted women in arousal (p > 0.051). About 41% of sexually-assaulted participants reported severe depression. Findings confirmed that sexual assault is more personal whilst physical assault is more interpersonal. If physically-assaulted women were removed from the perpetrators they recovered faster than sexually-assaulted women. Their stay with the perpetrators may perpetuate the violence. Conclusion: The need for counselling and support for the survivors of both traumas was recommended. All stakeholders should be educated to provide support to survivors of both traumas. Agtergrond: Ten spyte daarvan dat daar intervensies beskikbaar is, bly geslagsgebaseerde geweld ‘n uitdaging in Suid-Afrika. Die versorging van die oorlewendes geweld is van kritieke belang om die oorlewendes se spoedige herstel te verseker. Doelwitte: Die doel was om die gevolge van trauma op die vroulike slagoffers van seksuele aanranding te vergelyk met die trauma wat die oorlewendes van fisiese aanranding ervaar het. Metode: ‘n Kwantitatiewe dwarssnit ontwerp is gebruik om 30 seksueel aangerande vroue en 30 fisiek aangerande vroue te vergelyk sover dit depressiesimptome, posttroumatiese stresversteuring en coping styl betref drie maande na die voorval plaasgevind het. Semi-gestruktureerde onderhoude is gevoer met die oorlewendes van beide soorte aanvalle, terwyl die Beck depressie-inventaris, die kontrolelys vir posttroumatiese stresversteuring en die bondige COPE-inventaris afgeneem is om kwantitatiewe data te bekom. Sowel parametriese as nie-parametriese statistiek is gebruik. Etiese vereistes is regdeur die navorsingsproses nagekom. Resultate: ‘n Aansienlik hoër persentasie seksueel aangerande vrouens het hulle gesin oor die voorval ingelig (p = 0.021). Die meeste seksueel (90%) en fisiek (86%) aangerande vrouens het die voorval onthou. Seksueel aangerande vrouens toon ‘n aansienlik hoër gemiddelde vir vermyding of gevoelloosheid (p < 0.001) en fisiese aangerande vrouens het ‘n hoër gemiddelde vir opwekking (p > 0.051). Sowat 41% van die seksueel aangerande deelnemers meld erge depressie. Die studie bevestig dat seksuele aanranding persoonliker is, terwyl fisieke aanranding meer interpersoonlik is. As fisiek aangerand vroue van die oortreders verwyder word, herstel hulle vinniger as die seksueel aangerande vroue. As hulle by die oortreders bly, kan die geweld voortduur. Gevolgtrekking: Die noodsaak aan berading en ondersteuning vir beide groepe oorlewendes word aanbeveel. Alle belanghebbendes moet opgevoed word om ondersteuning aan oorlewendes te bied.