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South Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department's District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province's 11 districts ( p  < 0.001). Statistically significant differences were observed in the HIV testing rate and in the HIV positivity rate over the period ( p  < 0.001). Results from multiple regression analysis showed that the HIV testing rate per 100 000 population was the strongest predictor of the HIV positivity rate. HIV positivity among clients correlated negatively with the number of HIV tests conducted per 100 000 population (r = -0.823; p  < 0.001) and the HIV testing rate (r = -0.324; p  < 0.01). This study has found that HIV testing could have an impact on reducing the positivity rate of HIV in the province and is therefore an effective strategy in curbing the HIV epidemic. The KwaZulu-Natal Department of Health should ensure that strategies for implementing and maintaining HIV testing and treating services should continue at an accelerated rate in order to achieve the first 95 of the UNAIDS 2025 SDG target.

Background:  The breast cancer burden on the South African healthcare system is severe, with rural South African women often diagnosed at an advanced stage of the disease. South Africa's rural areas are classified as low-resource settings with limited medical services and infrastructure. The impact of breast cancer on rural communities in South Africa requires ongoing research to better understand the severity of this disease among one of the most vulnerable populations., Objectives:  This study aimed to explore the barriers and enablers of breast cancer screening among rural South African women., Method:  An exploratory qualitative study was utilised. A semi-structured interview was conducted with 22 rural South African women. Data were analysed using thematic analysis. This study utilised the care-seeking behaviour theory as its theoretical framework., Results:  Participants identified many barriers to breast cancer screening, including individual affordability, transportation, rural services, infrastructure, health professional behaviour, and the lack of educational materials. Several factors are suggested to enable the screening of breast cancer in rural South Africa, including breast cancer campaigns, health education, the involvement of key stakeholders, and promotional materials., Conclusion:  Despite the many barriers to breast cancer screening among rural South African women, there is still hope in implementing the various promotional tools outlined in this study and ensuring that breast self-examination is an alternative, affordable screening method.Contribution: The purpose of this article is to contribute to the attainment of the Sustainable Development Goal (SDG) 3, which focusses reducing premature mortality from non-communicable diseases, including cancer.

Background: Health crises have been linked with the exacerbation of pre-existing difficulties and the emergence of unique challenges, as evidenced by the impact of coronavirus disease 2019 (COVID-19) on health caregivers worldwide. Baseline data allow for reflection and preparation for any future health emergencies therefore giving impetus to phenomenological enquiries among the experiencers., Aim: This study aimed to explore the lived experiences of the eThekwini district frontline radiology caregivers during the COVID-19 pandemic., Setting: The study was conducted in public and private radiology departments in the eThekwini district of KwaZulu-Natal, South Africa., Methods: A qualitative, interpretative phenomenological analysis methodology was adopted in a multi-method data-collection context comprising semi-structured interviews and focus group discussions (FGDs) among 24 radiologists, radiographers, and radiology nurses obtained by non-probability sampling. Data were transcribed verbatim and analysed using an interpretative phenomenological approach., Results: Three superordinate themes emerged, namely: (1) duties and roles during the COVID-19 pandemic, (2) work-related challenges, (3) personal challenges., Conclusion: Frontline radiology caregivers experienced increased workload, staff shortages, salary cuts, personal protective equipment (PPE) shortages, non-recognition, poor managerial support, disrupted social relations, and poor work-life balance. This necessitates the need for the radiology departments to address staffing, infection prevention and control deficits, and invest in support interventions to assist frontline radiology caregivers during health crises., Contribution: The findings comprise baseline information that can be used for reflection and guiding radiology departments in preparing for any future health crises., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Background: There is a paucity of literature on perspectives of referring doctors about the quality of medical imaging services and this study closes this gap in literature., Aim: This quality assurance (QA) study aimed to explore the perspectives of doctors on the quality of medical imaging services in selected regional hospitals within eThekwini District of KwaZulu-Natal., Setting: The study was conducted in four public regional hospitals., Methods: An exploratory descriptive qualitative research design involving 30 min-45 min of in-depth individual interviews was used. A purposive sampling technique was used to select research participants and hospitals to ensure adequate responses to the research questions. The sample involved nine participants and was guided by data saturation. Responses were recorded through notes and voice recordings and thematic analysis was used to analyse data., Results: Three main themes (timeliness of examinations, communication and radiology reports and image quality) and eight subthemes (waiting times, shortage of radiographers, workload, communication between doctors and radiographers, requisition forms, unavailability of radiology reports, clarity of images and image acquisition protocols) emerged from the data. Challenges experienced were exacerbated by high workload and shortage of radiologists and radiographers. Doctors in the data collection sites were mainly dissatisfied with services provided by the medical imaging departments., Conclusion: Regular engagements between medical imaging departments and doctors are important in enhancing the provision of quality care to patients. In-service training of radiographers and employment of additional radiographers and finding solutions to mitigate shortage of radiologists are recommended., Contribution: This quality assurance (QA) study focused on experiences of doctors while many other medical imaging QA studies in South Africa are equipment based. In-service training of radiographers is recommended to improve image quality and communication skills., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Background: A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM., Aim: This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province., Setting: This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province., Methods: An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted., Results: Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes., Conclusion: Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded., Contribution: The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Introduction: HIV self-testing (HIVST) is where individuals collect their specimens and perform the HIV test privately. HIVST has improved testing uptake and coverage, especially among vulnerable groups of sub-Saharan Africa (SSA). Vulnerable groups include key populations such as men who have sex with men, sex workers, people who inject drugs, lesbian, gay, bisexual and transgender persons and young women. However, little is known about the determinants and acceptability of HIVST among these groups in SSA. Therefore, this scoping review aims to explore the determinants and acceptability of HIVST among vulnerable groups in SSA., Methods: A scoping review will be conducted using the Arksey and O'Malley framework and further refined by Levac framework. The review will follow a six-step approach: (1) identifying the research question, (2) identifying relevant studies, (3) study selection eligibility, (4) charting the data, (5) collating, summarising and reporting the results and (6) consultation. A comprehensive search strategy will be developed, and the following electronic databases will be searched: MEDLINE, Embase, Global Health and the Cochrane Library. Grey literature will also be searched, including conference abstracts and reports. Eligibility criteria will include studies conducted in SSA, published between 2010 and 2023, focusing on vulnerable groups and exploring the determinants and acceptability of HIVST. Two independent reviewers will screen identified studies' titles, abstracts and full texts. Any disagreements will be resolved through discussion or consultation with a third reviewer. Data extraction will be conducted using a standardised form., Ethics and Dissemination: This review, not requiring ethical approval, aims to inform policy and intervention design to boost HIV testing adoption within vulnerable communities. We plan to disseminate our findings via a peer-reviewed journal, policy briefs, conference presentations and stakeholder engagement., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Emergency medical technicians (EMT) are at high risk of workplace violence as they often care for patients in uncontrolled and often hostile emergency settings. Gauteng Province, the most populous province in South Africa, caters for 75% of the total population which is dependant on state funded health care. Public sector EMTs' have been robbed with aggravated circumstances, assaulted with intent to do grievous bodily harm, raped and even murdered whilst on duty. Despite this, comprehensive studies investigating the factors that predispose public sector EMTs' to workplace violence in Gauteng Province are lacking. Thus, the aim of this study was to investigate the factors that predispose public service EMTs' to workplace violence in Gauteng Province. Data were collected using questionnaires. A total of 413 questionnaires were returned by community members of Gauteng who met the inclusion criteria. Descriptive statistics and binomial tests were used to analyze data. The results of this study revealed that workplace violence toward public service EMTs' in Gauteng is attributed to the high rates of crime, the widening gap of inequality, economic deprivation of basic rights to previously disadvantaged communities by government, vulnerability of EMTs' when responding to the ill and injured within low- and middle-income communities and a lack of consequence for disorderly behavior within the communities. An understanding of the community factors that predispose EMTs' to workplace violence may improve the understanding of the phenomenon of workplace violence and developing prevention programs within the communities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Traditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients' willingness to disclose TM use., Methods: This qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories., Results: The data revealed four major categories: 'providing a suitable atmosphere for disclosure,' 'encouraging patients to disclose TM usage to AMPs,' 'patient autonomy,' and 'AMP training'. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM., Conclusion: This study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure., (© 2023. The Author(s).)

The onset of the Coronavirus disease 2019 (COVID-19) pandemic has affected the mental health and well-being of women in vulnerable settings. Currently, there is limited evidence that explores the wellness of elderly women under the associated restrictions. This study explores the lived experiences of elderly women in a vulnerable community in Durban, South Africa. A face-to-face, in-depth qualitative approach was implemented to interview 12 women aged 50 years and over. Thematic analysis was used to analyse the data. The findings suggest that social interactions, the effect of a high death rate, and financial strain predominantly affect stress and anxiety levels. Despite the women being in receipt of pensions and/or other grants, their supplementary income was reduced. This, together with the additional expenses incurred during the lockdown, resulted in anxiety over finances. The lack of social interaction, with limits on visiting family and other loved ones when they were ill, along with the limit on the number of people attending the funerals of loved ones were also stressful. This study also reports on the resulting coping mechanisms, which included using hobbies such as baking and sewing as a means of self-care. Religious beliefs also relieved stress while home remedies were used as preventative measures during the lockdown restrictions due to COVID-19.

The incidence of breast cancer in South Africa is increasing, with rural South African women presenting with advanced stages of the disease. A woman's breasts are a symbol of her womanhood; they also constitute a social definition of her femininity. Women with breast cancer in rural South Africa are heavily stigmatized and suffer from various sociocultural interpretations of the disease. Breast cancer is frequently interpreted in rural South Africa as a symbol of witchcraft, sin, and punishment, and traditionally, it is treated by offering animal sacrifices, consumption of herbs, and prayer to ancestors. Using care-seeking behaviour theory as the theoretical framework, we intend to explore the sociocultural factors influencing breast cancer screening practices among rural South African women. A qualitative exploratory study was conducted using semi-structured interviews with 22 rural South African women selected by purposive sampling. Thematic analysis was used to analyse the data. The study identified four sociocultural factors influencing women's practices of breast cancer screening in rural South Africa, including psychological factors, habits, beliefs, and perceptions of healthcare. Women in rural South African communities have deep-rooted traditional beliefs and practices regarding breast cancer. Consequently, this influences women's preventative health behaviours regarding breast cancer screening. The development of culturally appropriate health education programs involving traditional healers and influential community leaders is essential to increasing the number of women being screened for breast cancer in rural South Africa.

Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales.

The COVID-19 pandemic had a significant impact on the mental health of individuals globally, and primary healthcare (PHC) nurses play a critical role in providing mental healthcare services. However, limited research has explored the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic. This study explored the experiences of PHC nurses in providing mental healthcare services during the pandemic in Durban, South Africa. The aim was to identify the challenges faced by healthcare providers and the potential for innovative approaches to improve access to care. A qualitative, exploratory design guided the study, and data were collected through in-depth interviews with twelve PHC nurses purposively selected. Thematic analysis was used to analyze the data. Findings from interviews with PHC nurses reveal that the pandemic exacerbated existing challenges, including medication adherence issues, fear and uncertainty among patients, vaccine hesitancy, decreased clinic visits, and the mental and emotional toll on both patients and healthcare workers. PHC nurses adapted their services by increasing outreach efforts, prioritizing patient care, and utilizing technology and non-governmental organizations' (NGOs) support. Challenges included reduced patient visits, complexities in healthcare provision, and a lack of adequate support. Positive changes observed include increased mental health awareness among healthcare professionals and younger generations. Recommendations include implementing outreach and awareness campaigns, providing accurate information about COVID-19 and vaccinations, and promoting cultural sensitivity in mental healthcare provision.

For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries, including South Africa, take place outside a health facility and without skilled birth attendants. Therefore, this has made it difficult to achieve the Sustainable Development Goals of global reduction in maternal mortality, which is a key health challenge globally, especially in developing countries and sub-Saharan Africa in particular. The study aimed to explore and describe the views of pregnant women regarding facility-based delivery. Focus group discussions were used to gather information from pregnant women. Information was collected from six groups of pregnant women who had delivered babies at the primary health care facilities in the past 5 years. Results showed several factors associated with the failure to use institutional delivery services, such as the lengthy distance from the health care facility, lack of transport, lack of transport fare, shortages of skilled staff, failure to disclose pregnancy, cultural and religious beliefs, and staff attitudes.

In Eswatini (formerly Swaziland), the increasing number of orphans and vulnerable children due to HIV/AIDS has spurred demand for psychosocial support services. When the Ministry of Education and Training assumed responsibility for delivering psychosocial support, educators were burdened with the additional role of looking after orphans and vulnerable learners. This exploratory, sequential, mixed-methods study was employed to analyse factors that enhance the provision of psychosocial support services and the perceptions of educators towards psychosocial support delivery. The qualitative study phase entailed 16 in-depth interviews with multi-sectoral psychosocial support specialists and seven focus group discussions with orphans and vulnerable learners. In the quantitative study phase, 296 educators were surveyed. Thematic analysis was used for the qualitative data, and the quantitative data was analysed using Statistical Package for the Social Sciences version 25 software. The findings reveal problems associated with psychosocial support service delivery at strategy, policy and operational levels. The results indicate that orphans and vulnerable children are offered material support (e.g. food and sanitary pads) and spiritual support, but were rarely referred for social and psychological needs. There were no proper counselling facilities and not all teachers received relevant training in children's psychosocial needs. Training of educators in specific psychosocial support areas was considered significant to enhance service delivery and the psychosocial well-being of the learners. Overall, accountability was difficult to establish because the administration of psychosocial support is split among the Ministry of Education and Training, the Deputy Prime Minister's office and Tinkhundla administration. There is unequal distribution of qualified early childhood development teachers to cater for early childhood educational needs.

The enforcement of the coronavirus disease 2019 (COVID-19) pandemic restrictions disrupted the traditional face-to-face qualitative data collection in public health. The pandemic forced qualitative researchers to transition to remote methods of data collection such as digital storytelling. Currently, there is a limited understanding of ethical and methodological challenges in digital storytelling. We, therefore, reflect on the challenges and solutions for implementing a digital storytelling project on self-care at a South African university during the COVID-19 pandemic. Guided by Salmon's Qualitative e-Research Framework, reflective journals were used in a digital storytelling project between March and June 2022. We documented the challenges of online recruitment, obtaining informed consent virtually, and collecting data using digital storytelling as well as the efforts of overcoming the challenges. Our reflections identified major challenges, namely online recruitment and informed consent compromised by asynchronous communication; participants' limited research knowledge; participants' privacy and confidentiality concerns; poor internet connectivity; quality of digital stories; devices with a shortage of storage space; participants' limited technological skills; and time commitment required to create digital stories. Strategies adopted to address these challenges included an ongoing informed consent process; flexible timelines for the creation of digital stories; one-on-one guidance on creating digital stories; and multiple online platforms to share digital stories. Our critical reflection offers practical guidance for the ethical conduct of digital storytelling in public health research and makes a significant contribution to methodological considerations for use in future pandemics. These ethical and methodological challenges should be recognized as features of the context of the research setting including restrictions imposed by the COVID-19 pandemic than disadvantages of digital storytelling., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Gumede, Sibiya. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Adopting change is something that is often resisted, as is often the case in the adoption of electronic health records (EHRs) in healthcare organizations. Embracing this will require computer knowledge to handle the system for the management of patients and their care. This study aims to determine the computer skills required for the uptake of electronic health records (EHR) by healthcare workers in an annex of the state teaching hospital, Okela Health Centre (OHC) Ado-Ekiti. The study uses a cross-sectional research design with a structured questionnaire distributed to 30 healthcare workers across seven disciplines working in the hospital. Descriptive statistics of frequency tables and percentages were used to ascertain the relationship between computer skill usage and the adoption of EHR. The majority of respondents were only efficient in Microsoft Word (MW), email, and WhatsApp, with efficiency rates of 63.4%, 76.6%, and 73.3%, respectively. The majority were not efficient in Microsoft Excel (ME) and Microsoft Access (MA), at 56.7% and 70%, respectively. Computer appreciation is an important basis for the adoption of EHR in hospitals.

In this paper, we use data generated through one-on-one interviews with 12 purposively sampled Child and Youth Care Workers to examine their narratives of work and life-related vulnerabilities and agency during the peak of the COVID-19 global pandemic in KwaZulu-Natal, South Africa. Our findings show that Child and Youth Care Workers were vulnerable to poor mental health. Indeed, working and socialising during the height of COVID-19 posed a mental toll on the Child and Youth Care Workers in this study, who experienced fear, uncertainty, anxiety and stress. Moreover, these workers faced challenges with working under the so-called new normal, which was instituted as part of a non-pharmaceutical response to slow and curb the spread of COVID-19. Finally, our findings show that Child and Youth Care Workers actively identified and applied specific emotionally-focused and physically-focused coping mechanisms to deal with the burden brought on by the pandemic. The study has implications for CYCWs working during crisis periods.

Background: The shortage of staff in Kwa-Zulu Natal (KZN) public hospitals is evident and poses a challenge to retain radiographers. Therefore, there is need to identify the factors that influence resignations of radiographers., Objective: The aim of this study was to explore the factors that influence resignations of radiographers employed by tertiary hospitals in KZN province., Methods: The study was guided by a descriptive quantitative research method. The data was collected in the form of questionnaires. A letter of information describing the details of the study was provided to the participants. All consenting participants were requested to provide a written consent prior to completing the questionnaire. The questionnaire was completed, collected and analysed. The statistical analysis test was conducted using SPSS statistic V25., Result: A response rate of 66.35% was received with 78.3% (n=108) female and 21.7% (n=30) male. The result suggested that participants unanimously agree that resignation of radiographers is precipitated by factors such as poor working conditions, unhygienic working environment and uncompetitive salaries. The result also suggested that moving from their current career in radiography to another career is precipitated by factors such as high stress level and long working hours., Conclusion: The factors identified were further analysed and results showed that the participant's personal reasons for moving from their jobs are co-related with environmental reasons. The most influential factor was stress and remuneration., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2023 Pillay M et al.)

Introduction: Despite the potential role of Traditional Birth Attendants (TBAs) and Traditional Healers (THs), little is known about their knowledge of tuberculosis (TB) management and referral practices in Nigeria., Objective: To determine knowledge and self-reported practices of traditional birth attendants and traditional healers in managing TB in Lagos, Nigeria., Methods: A cross-sectional study of 120 THs and TBAs in three high TB burden Local Government Areas (LGAs) in Lagos, Nigeria. Data were collected between April 2018 to September 2018 through interviewer-administered questionnaires. We used Statistical Package for Social Sciences software for data analyses. Independent predictors of being TBA or TH were determined using logistic regression at the statistical significance of P<0.05 and 95% confidence interval., Results: TB knowledge increased from 52.7% pre-test to 61.7% post-test and did not differ between TBAs and THs. Of the 120 Traditional Medical Practitioners studied, 70% (84) never treated TB; 57.3 % (69) ever referred chronic cough patients to a health facility; 90% (108) were willing to collaborate with National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), 85% (102) attached monetary and token incentive as a condition for the collaboration. THs had decreased odds of ever referring TB patient to the hospital (AOR: 0.3, 95% CI:0.14-0.64, P=0.002); currently referring TB patients (AOR: 0.06, 95% CI:0.02-0.17, P<0.0001) and consulting <40 patients in a year (AOR: 0.22,95% CI:0.09-0.53, P<0.0001)., Conclusion: Majority of the THs and TBAs were willing to collaborate with NTBLCP in the identification and referral of Presumptive TB patients. We suggest that NTBLCP empowers the TBAs and THs to help with an early referral of TB patients., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

Background: Globally, the COVID-19 pandemic has had a negative impact on individuals, education, and the economy. During its peak, the pandemic forced school closures. Although there is currently no cure for corona virus, non-pharmaceutical measures can help prevent its spread. Among these preventive measures are regular handwashing with soap and water or the use of hand sanitizers, avoiding touching the mouth, nose, and eyes, social distancing, and the use of face masks. As a result, this study investigated COVID-19 prevention practices among Durban University of Technology staff and students in South Africa. Methods: Using a cross-sectional study design, data were gathered online via self-administered, structured questionnaires from 5849 university students and staff members between May 2020 and March 2021. Utilizing descriptive statistics, the characteristics of the study sample were reported. Using logistic regression models, the relationship between demographic characteristics and the overall level of COVID-19 preventive practices was evaluated. Results: The multivariate logistic regression model showed statistically significantly associations for COVID-19 preventive practices by: male (AOR: 9.815, 95% CI: 1.721-55.959, p = 0.01) compared to female participants, single participants (AOR: 6.012, 95% CI: 2.070-17.461, p = 0.001) compared to other marital categories, and those in the faculty of Health Sciences (AOR: 1.721, 95% CI: 1.023-2.894, p = 0.041) compared to other faculties. Conclusions: Overall, the study's preventive practices were commendable; they were also influenced by socio-demographic factors such as age, gender, marital status, and university faculty. Increasing age was associated with reduced compliance with COVID-19 preventive practices. In addition, men demonstrated greater caution than women.

Background: The negative consequences of disruptive behaviours involving healthcare workers threatens the institution's image, staff morale, finances, and patient safety. While all kinds of health organisations or settings are potentially exposed to disruptive behaviours, some are at higher risk than others because of both environmental and cultural factors. Such risk should be assessed having regard to the specific situation and conditions in which each healthcare organization operates., Aim: The aim of this study was to explore radiography manager's perspectives on the environmental and cultural factors leading to DBs involving radiographers at central hospitals in Harare Metropolitan Province., Methods: An exploratory qualitative study employing in-depth interviews with 11 radiography managers across five departments at three central hospitals selected by criterion purposive sampling was done. The interview data were analysed using Tesch's method of qualitative analysis., Results: The key environmental and cultural factors identified included three themes: power hierarchy, work environment and reporting framework. Power hierarchy comprised categories, superiority, professional boundaries and representation. The work environment incorporated categories, trust in leadership, burnout and fatigue and remuneration. Lastly, reporting framework included categories, lack of protocol and reporting culture., Conclusion: Radiography managers believe that environmental factors play a bigger role in leading to disruptive behaviours that involve radiographers at central hospitals in Harare Metropolitan Province. This underscores the need for hospital and radiography managers to pay particular emphasis on these when formulating policies and procedures to address these behaviours. Addressing DBs ensures that healthy work environments are promoted which in turn ensures that patients receive optimum and safe care., Implications for Practice: The paper provides an insight into the environmental and cultural dynamics that may trigger disruptive behaviours involving radiographers. This information is invaluable in formulating policies and procedures for addressing these unprofessional behaviours., (Copyright © 2022. Published by Elsevier Inc.)

Background: Understanding disruptive behaviours from the perspective of radiographers is important, as this professional group uses hazardous radiation in the execution of their duties, making patient safety of utmost concern., Objective: Determine the disruptive behaviours involving radiographers at central hospitals in Harare Metropolitan Province, Zimbabwe., Methods: A descriptive cross-sectional quantitative study was carried out at central hospitals in Harare Metropolitan Province, Zimbabwe, where 100 radiographers were randomly selected., Results: Overall, 83% of radiographers had been exposed to an incident of DB in the preceding 12 months. Reported types of disruptive behaviour included: Verbal abuse (81%), sexual abuse (21%) and physical abuse (4%). Of the 21 radiographers that suffered sexual abuse, the majority 71 % (n=15) were female while 29% (n=6) were males. Prevalence odds ratio revealed that female radiographers were 1.8 times more likely than their male counterparts to be victims of the workplace sexual abuse (95% C.I.: 0 - 3.04). A significant 69% were abused by patients and their families/escorts, p=.001., Conclusion: More than 8 out of 10 radiographers in this study were exposed to disruptive behaviours, mostly from the patients and patient's family or escorts. A framework to increases awareness and address these behaviours is recommended., Competing Interests: None declared., (© 2022 Chinene B et al.)

Disruptive behaviours (DBs) are not normally in the scope of legal sanctions, notwithstanding their undesirable effects. Hence, many healthcare organizations still have difficulty in dealing with them in an effective manner. Several studies suggest that few organizations have tailor-made policies or procedures for evaluating, proving and mitigating these behaviours. However, evidence shows that mitigating DBs is critical to empowering healthcare workers to focus on providing superior, affordable and safe patient care. The aim of this study was to explore radiography managers' perspectives on the strategies to mitigate DBs involving radiographers. An exploratory qualitative study employing one-on-one semi-structured in-depth interviews was carried out between March and April 2021. Eleven radiography managers at central hospitals in Harare Metropolitan Province were selected by criterion-purposive sampling. The interview data were analyzed using Tesch's method of qualitative analysis. The data were first manually coded and then entered into Nvivo (QSR International Version 11) for further analysis. Three themes emerged from the interview data including awareness of DBs, willingness to address DBs, and conflict resolution. Context-specific strategies to mitigate DBs should be identified and implemented to guarantee a healthy work environment for radiographers so that they focus on providing excellent and safe patient care.

Background: The elements of job satisfaction can be categorized into intrinsic and extrinsic factors. The presence of a higher level of intrinsic factors will result in increased motivation amongst employees, whilst extrinsic factors will result in job dissatisfaction. Decreased job satisfaction levels amongst healthcare professionals are known to create an intent to leave. Hence the need to explore these factors amongst radiographers employed by tertiary hospitals in the Gauteng province of South Africa., Objective: To determine the influence of intrinsic and extrinsic factors of job satisfaction on intent to leave amongst radiographers employed by public tertiary hospitals in the Gauteng province., Methods: A quantitative cross-sectional survey guided the study, and a self-administered questionnaire was used to collect data. The sampling technique used for this study was disproportional stratified sampling., Results: The study had a response rate of 62%. A significant number of the participants (50%) were between the ages of 21-33 years. Also, worth noting that 51% of the participants were newly qualified, 28% were employed for a period of 10-20 years and only 20% were employed for a period greater than 20 years. Diagnostic radiography had the most number of participants at 55%, followed by radiation therapist at 24%, nuclear medicine radiographers at 13%, mammography radiographers at 5% and only 3% were sonographers. Pearson's correlation showed a significant negative correlation with the following extrinsic factors: supervision, r= -.344, p=.000; satisfaction with PMDS, r=-.302, p=.000; human resources processes, r=-.249, p=.001; infrastructure, r=-.236, p=.001; the OSD policy, r=-.233, p=.002; satisfaction with remuneration, r=-.202, p=.006; satisfaction with CPD activities, r=-.201, p=.007; and satisfaction with equipment, r=-.163, p=.029., Conclusion: Both intrinsic and extrinsic factors are associated with an intent to leave amongst radiographers employed by public tertiary hospitals in the Gauteng province., (© 2022 Sibiya MN et al.)

Introduction: Although disruptive behaviours (DBs) are universal in healthcare, each healthcare setting, profession or department presents unique DBs antecedents. Gaining better insights into the antecedents of DBs is crucial in order to put together a tailor-made program designed to raise awareness, establish accountability, and provide resources to mitigate their impact. There are, however, a few studies exploring antecedents of DBs involving radiographers, more so in low resource settings like Africa. The aim of the study was to determine the antecedents of DBs involving radiographers employed by central hospitals in Harare Metropolitan Province, Zimbabwe., Methods: A descriptive cross-sectional survey was carried out from January to March 2021 at central hospitals in Harare Metropolitan Province, Zimbabwe. A self-administered questionnaire was used to capture the views of 100 randomly selected radiographers., Results: There was a significant agreement that the following are antecedents of DBs: frustration due to poor working conditions (Mean = 3.93.p < .0005); long waiting times for patients (Mean = 3.91.p < .0005); a sense of privilege and status for those at the top (Mean = 3.87.p < .0005); burnout or fatigue (Mean = 3.79.p < .0005); narcissism (Mean = 3.79.p < .0005); differences in communication styles (Mean = 3.68.p < .0005); divergence of opinions or thoughts (Mean = 3.59.p < .0005); personal conflicts or family problems (Mean = 3.57.p < .0005); self-protection against feelings of inadequacy (Mean = 3.42.p < .0005); dysfunctional organizational culture (Mean = 3.38.p < .0005) and cultural, generational or gender bias (Mean = 3.32.p < .0005)., Conclusion: This study identifies the antecedents of DBs involving radiographers at central hospitals in Harare Metropolitan Province. It is crucial that any attempts at finding solutions to address the behaviours should be based on evidence of the antecedents in the setting concerned., Implications for Practice: This will help in the understanding of the antecedents of DBs involving radiographers so that context specific interventions to address these behaviours are formulated., Competing Interests: Conflict of interest statement None., (Copyright © 2022 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Introduction: Emotional Intelligence (EI) is an important skill within the various health care professions, and a higher level of EI is associated with better patient care, communication, empathy and teamwork. Within the Republic of South Africa, there is limited literature on EI within the health care sector, and specifically within radiography., Methods: The Trait EI Questionnaire Short Form (TEIQue-SF) was used to record the EI scores of 247 BHSc Radiography students in all four disciplines over the four years of study at the selected University of Technology (UoT) in Kwazulu-Natal (KZN), South Africa. The TEIQue-SF yields a Global EI score and the four factors of EI., Results: The study benchmarked the TEI scores of the radiography cohort. The male participants scored significantly higher in Global EI (p = 0.020 and 0.029) and the Self-control factor (p = 0.000) of EI compared to the female participants. The younger participants scored significantly higher in three of the five factors of TEI, namely: Global EI (p = 0.003), Well-being (p = 0.003) and Self-control (p = 0.010), which was an unexpected finding and against the norm. Racially (0.010 and 0.009) and culturally (P = 0.022 and 0.026), the Black participants and the Zulu participants scored significantly higher in the Self-control factor of TEI., Conclusion: This study benchmarked the TEI scores of radiography students within KZN and compared these TEI scores to the demographic variances of the students with interesting results. This study has highlighted the TEI level of the students at a selected UoT, which can be used to ensure that better prepared, well-rounded and employable graduates enter the workplace. This can be achieved by the implementation of the recommendations, which includes the levels of EI to be developed and relevant EI training required. Further research is required within the field of TEI and Radiography in the South African context to strengthen this study's findings., Implication for Practice: This study has highlighted the EI scores of a cohort of radiography students. The results of this study have made the institution more aware of the students' TEI which will allow the institution to ensure students are better prepared and are employable graduates within their chosen profession by including EI training within the health faculty curriculum., (Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: Back pain is not uncommon in pregnant women, but it is often under-reported and can be disabling. International studies report a high prevalence of back pain, especially in the last trimester. Little is known about the prevalence of back pain in South African pregnant women., Aim: To determine the prevalence and risk factors of back pain in a cohort of pregnant women., Setting: Public primary healthcare clinics and the eThekwini municipality of KwaZulu-Natal (KZN), South Africa., Methods: A descriptive cohort design was used to survey pregnant women ( n = 303) over the course of their pregnancy. Data were collected at the first antenatal visit and again in the third trimester. Participants gave consent and ethical clearance was obtained from an institutional research ethics committee, from the eThekwini Health District and KZN Provincial Department of Health., Results: The respondents were young Black African women (mean age of 25.8 (± 6.0), who were mostly unemployed (70.7%), and resided in a resource poor setting. Back pain prevalence at the first antenatal visit and the third trimester was 12.4% ( n = 35) and 10.9% ( n = 5), respectively. This condition was associated with carrying water and residing in a hostel or an employee's property. Being single was associated with less risk for developing back pain., Conclusion: The prevalence of back pain was low in this cohort of women, yet it resulted in a negative impact on the women's ability to cope with daily life., Contribution: This is one of the first studies to describe back pain in a South African pregnant population., Competing Interests: The authors declare no competing interests, financial or personal relationship that may have inappropriately influenced them in writing this manuscript., (© 2021. The Authors.)

Background: Cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) is crucial for the continuity of care in the treatment of patients with cancer. However, scant information exists on how to co-ordinate cooperation between these health practitioners without interrupting the treatment of the patients., Aim: The study aimed to explore the practices of THPs and ROs in cancer treatment and ultimately derive a workable practice framework between these health practitioners in the KwaZulu-Natal (KZN) province., Setting: The study was conducted in selected districts, namely eThekwini, uThukela, Amajuba, uMkhanyakude, iLembe, uMzinyathi and uMgungundlovu, in KZN., Methods: A qualitative study by using a descriptive phenomenological approach was conducted to collect data from 28 THPs involved in the treatment of cancer and four ROs from public oncology hospitals. Focus groups and one-on-one semi-structured interviews by using open-ended questions were conducted to collect data from THPs and ROs, respectively. Framework analysis was used for data analysis to identify themes., Results: The study found that in KZN, THPs and ROs are working in parallel and that there are problems when patients seek cancer treatment from both health practitioners. Furthermore, the THPs and ROs work in an environment where there is no relationship, respect and trust, open communication and referral of patients by ROs to THPs. Both teams indicated that patients consult both traditional medicine (TM) and allopathic medicine (AM) by moving between the two health practitioners, resulting in interruptions in treatment. In addition, the study found that cooperation between THPs and ROs is understood as the provision of continuity care, where the parties work independently but share certain information of the patient on treatment, or as already being treated by each of them. The focus was on the type of relationship, enablers and common grounds for cooperation., Conclusion: The workable cooperative practice framework could be an inclusive health system where the parties work in parallel, with the patient being the main actor in the collaboration., Competing Interests: The authors have declared that no competing interests exist., (© 2021. The Authors.)

Background: Worldwide, gender inequality has been a dominating factor in the training of student accoucheurs in most maternal healthcare institutions. This poses challenges for the maternal healthcare institutions where student accoucheurs are placed for clinical practice as most women become reluctant or refuse to accept their services. Gender inequality has a negative impact on the training of student accoucheurs as most of them become demotivated which could lead to a high attrition rate., Objectives: This study explored and described the perceptions of student accoucheurs regarding gender inequality in midwifery training at the Free State maternal healthcare institutions., Method: An explorative and descriptive qualitative research design was undertaken. There were 40 student accoucheurs that formed 10 focus group discussions. Each focus group discussion had four participants. Tesch's eight-steps of data analysis was used to analyse data., Results: Three major themes emerged during data analysis: meeting the training requirements in midwifery, women's autonomy in a choice of healthcare provider versus student accoucheurs' autonomy to be trained in midwifery and staff establishment to render maternal healthcare., Conclusion: The participants perceived prejudice, rejection and resistance by women in maternity units as a contributing factor to gender inequality, which has a negative impact on their training in midwifery. The study recommends that health directorates, nurse managers and training institutions should consider revising maternal healthcare policies regarding the recruitment and placement of willing accoucheurs in maternity units in order to address gender inequality.

Purpose: The quality of maternal healthcare training is the most optimal degree of health in the delivery of effective, efficient and quality healthcare in midwifery discipline. Student accoucheurs studying at the Free State School of Nursing are faced with resistance, discrimination, rejection and unacceptability by pregnant women during their clinical placement at the Free State maternal healthcare institutions. This results in poor quality of training of student accoucheurs in maternal healthcare. Considerable studies have been conducted on males in midwifery nursing, but no guidelines have been developed to facilitate student accoucheurs' acceptance and improvement of the quality of training in maternal healthcare, hence the purpose of this study., Design/methodology/approach: A descriptive, explorative qualitative design was used in this study. Qualitative focused group discussions ( n  = 32) were conducted through purposeful sampling method. Data was analysed thematically., Findings: Three main categories emerged: student accoucheurs' related factors with social interactions and relations as a theme; maternal healthcare users' related factors with transcultural diversity and socio-economic status as themes; nurse training institutions and maternal healthcare institutions service providers-related factors with gender inequality in the work place as a theme. Ultimately, the guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in maternal healthcare institutions were developed and recommended for implementation., Originality/value: The paper developed guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in Free State maternal healthcare institutions., (© Siphiwe Themba Madlala, Maureen Nokuthula Sibiya and Thembelihle Sylvia Patience Ngxongo.)

Introduction: The World Health Organization seeks to address the maldistribution of healthcare professionals which results in inequitable services to underserved communities (World Health Organization (WHO), 2015). In South Africa, the underserved areas are the public sector hospitals and the rural areas. Radiographers, like other healthcare professionals, are also unequally distributed between the public and private sector hospitals, and between the rural and urban areas. Since one of the perceived factors for maldistribution is job satisfaction, it is essential to explore factors that contribute to job satisfaction/dissatisfaction amongst radiographers to develop a model to attract and retain radiographers in the public sector., Methods: The study used exploratory sequential mixed methods approach to explore job satisfaction amongst radiographers, employed by public tertiary hospitals in the Gauteng province, South Africa. In phase one of the study (qualitative), individual and focus group interviews were used to collect data, and in phase two (quantitative), a self-developed questionnaire was used. The data collected was analyzed in sequential order, where thematic analysis was performed for phase one of the study, and SPSS version 23 was used in phase two., Results: In phase one, five themes emerged, namely the influence of government policies on job satisfaction, lack of career pathing, poor remuneration, working conditions, and the role of the human resources department. In phase two, the Pearson's correlation test was performed which showed that there was a significant correlation of intent to leave, p = .005 with the following factors: government policy on Occupational Specific Dispensation (OSD) and Performance Management Development System (PMDS), working conditions, supervision, equipment and infrastructure, and poor remuneration., Conclusion: Government policies, working conditions, and poor remuneration play a significant role in job satisfaction amongst radiographers employed by public tertiary hospitals in the Gauteng province., Implications for Practice: The proposed model could enhance job satisfaction for radiographers employed by the public sector hospitals and ultimately increase attraction and retention rates of radiographers for this sector., Competing Interests: Conflict of interest statement None., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010-2016 in Lagos, Nigeria., Methods: Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval., Results: A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014-2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level., Conclusion: Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome., Competing Interests: The authors have declared that no competing interests exist.

Background: South Africa is moving towards National Health Insurance (NHI), which aims to provide access to universal health coverage for all South Africans. The NHI will only accredit and contract eligible health facilities that meet nationally approved quality standards in the public and private sector. Detailed tools for measuring compliance with the National Core Standards (NCS) and Batho Pele principles have been developed and implemented in the public sector. To date and since its implementation in the public sector, very little is known about the national audit tool and the method used to evaluate quality and patient safety standards in private hospitals in eThekwini district., Objective: The aim of the study was to develop an audit tool for relicensing inspection of private hospitals in eThekwini district based on the clinical domains of the NCS and Batho Pele principles., Methodology: An exploratory sequential mixed method research design was used with a qualitative first phase involving 24 nurse managers through purposive sampling. This was followed by a quantitative phase in which a structured questionnaire was administered to 270 nurses who were randomly sampled for the study from 4 hospitals., Results: The results revealed that the NCS and the Batho Pele principles are not fully implemented or evaluated in the selected hospitals in eThekwini district., Conclusion: These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district., (© 2020 Chellan J et al.)

Background: South Africa is one of the countries in Africa adversely affected by rabies, a notifiable disease which can be fatal. Fatalities can be prevented if health care is sought timeously and people are educated about the disease. The Province of Kwa-Zulu-Natal, in particular, has had rabies outbreaks in the past which have led to loss of many lives and devastation of entire families., Objective: The aim of the study was to explore the experiences of people affected by rabies in the eThekwini district of Kwa-Zulu-Natal, South Africa., Methods: The study was guided by a qualitative, exploratory, descriptive design. The sample was purposively selected, and a semi-structured interview was used to collect data from people affected by rabies in the eThekwini district. Data saturation was reached after 12 participants were interviewed. Data was analysed by using Tesch's eight steps of thematic analysis., Results: The themes included family stability and support structures, exposure to risk factors and risky practices, factors that hindered participants from seeking health care assistance, limited knowledge about rabies and the effects of rabies., Conclusion: It was evident that participants experienced many challenges during their rabies exposure. Individuals, who were directly affected by rabies through contact with rabid animals, were expected to take responsibility for their own lives., (© 2020 Hadebe JM et al.)

Background: Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child., Aim: The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women ( N = 100) in early pregnancy (up to 24 weeks gestation)., Setting: The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa., Methods: This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy., Results: Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category., Conclusion: Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome., Competing Interests: The authors have declared that no competing interests exist., (© 2019. The Authors.)

Background: The public health sector in South Africa has been facing severe financial cutbacks and financial constraints in recent times. The nurse manager (NM) is faced with the task of managing and reducing expenditure in the nursing sector without compromising the quality care. This requires skills and understanding of financial management., Aim: This study aimed to explore the financial management roles of NMs and to identify financial management development needs necessary for NMs' practice., Setting: The study was conducted in KwaZulu-Natal. A total of eight hospitals from the five health districts were included., Methods: The study used the naturalistic paradigm with a constructivist grounded theory approach. Interviews were used to initially gather data from six NMs who were purposively selected. Theoretical sampling was used to further recruit financial managers, chief executive officers, assistant nurse managers and operational managers. The final sample consisted of 18 participants., Results: Financial management of the hospitals is the primary function of the financial managers and the chief executive officers. However, the role of NMs extends to the performance and participation in various activities relating to the financial functioning of the hospital. These include financial planning, financial monitoring, financial decision-making and financial control., Conclusion: Nurse managers have a financial management function in public health care organisations but lack the necessary skills, knowledge and competencies to function in this role and require additional training. Recommendations included that a competency framework be developed to improve the financial management competencies of NMs.

Background: Since the publication of the White Paper for the Transformation of the Health System in South Africa in 1997, which included Policy on Integration of Mental Health Care into primary health care (PHC), there has been an emphasis on the promotion of health as well as the re-engineering of PHC to include the integration of mental health care into PHC. Although South Africa has made significant advances at the level of health-related policy development and legislation in trying to bring the country in line with international trends, there have been challenges with regard to implementation of policies, including that of integration of mental health care into PHC., Objectives: The aim of this study was to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KwaZulu-Natal (KZN) province of South Africa and to seek possible solutions., Method: A qualitative exploratory descriptive design was used to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. The sample consisted of 42 participants of whom 4 were PHC managers, 6 were operational managers and 22 were professional nurses who were directly involved in implementing the policy at the operational level., Results: The challenges identified included lack of training in mental healthcare services for staff working in PHC, unavailability of mental health policies, inadequate resources, poor communication between management and staff, lack of skills among PHC nurses in identifying signs of mental illness and misdiagnosis of patients., Conclusion: Considering the challenges pertaining to PHC nurses' abilities and skills to implement the Policy on Integration of Mental Health Care into PHC, PHC-trained nurses should engage in lifelong learning and be encouraged to develop their knowledge, skills and competence throughout their professional lives.

Background: Anecdotal evidence suggests that student accoucheurs studying at the Free State School of Nursing in South Africa are faced with resistance, discrimination, rejection and unacceptability by pregnant women during their clinical placement at the Free State maternal health care institutions., Objective: The aim of the study was to explore and describe the challenges faced by student accoucheurs regarding the maternal health care services they render to women., Methods: An explorative, descriptive, and qualitative research design was employed to conduct the study. Purposive sampling was used to select student accoucheurs who met the inclusion criteria. Focus group discussion was used to collect data from the selected student accoucheurs. Data were analysed thematically, and the findings were triangulated with the integration of Peplau's Theory of Interpersonal Relations as a theoretical framework that guided the study., Results: The findings in relation to the research question were synthesised under four themes: transcultural diversity, socio-economic factors, social interactions and relations, and gender inequality in the work place., Conclusion: The study is a contribution to the emerging education and training of student accoucheurs body of knowledge in the Free State Province and to the global existing body of knowledge regarding the phenomena., (© 2019 Sibiya et al.)

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women., Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes)., Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks' gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant., Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy., Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies., (© 2019 Ogunlola et al.)

Purpose: The purpose of this paper is to share insights, research findings and discuss key issues related to graduate experiences with transnational nursing education (TNE)., Design/methodology/approach: The authors used a qualitative approach and sampled national and international nurse graduates to identify challenges and best operating practices in cross-border nursing program facilitation., Findings: This research paper has provided a platform for graduates to lend their voices to the promotion of effective cross-border nursing education delivery and suggests that although international collaborations endeavor to maintain high academic standards in TNE, there is still a need to re-engineer, revise and adapt curricular content, learning, teaching and assessment practices to aid the nursing student., Research Limitations/implications: Identified challenges affecting the facilitation and delivery of cross-border nursing education programs can act as levers to improving service quality of present and future cross-border programs to the nursing student. This will assist future nursing students to recognize culture shock and embrace their decision to pursue nursing., Practical Implications: The experience of being involved in TNE for nursing students may not be that much different than students of other disciplines. While not able to be generalized to the entire population, the reports by the nursing students in this sample appear to be valuable and worthwhile to continue supporting and encouraging other TNE opportunities., Originality/value: This paper explores cross-border nursing education experiences from national and international perspectives. The authors were able to explore inherent TNE challenges from diverse population and cultural backgrounds.

Background:  Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy., Aim:  This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN)., Setting:  The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu., Methods:  A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN., Results:  This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases., Conclusion:  The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.

Purpose: The purpose of this paper is to share insights, research findings and discuss key issues relating to quality practices and quality assurance in cross-border nursing education program development and implementation., Design/methodology/approach: The authors used a qualitative, multiple case-study approach, by sampling local, national and international nursing education institutions, academia and nurse graduates to identify challenges and best operating practices in implementing and facilitating cross-border education., Findings: The authors reveal that quality assurance affects cross-border nursing education program design, delivery and implementation., Research Limitations/implications: Quality assurance plays an important role in cross-border nursing education, by enhancing the reputation and recognizing the effectiveness and capacity of the educational institution. These findings of this study can offer valuable insight to forthcoming as well as existing nursing education curriculum developers who plan to engage in national or international educational partnerships., Practical Implications: Quality assurance plays an important role in cross-border nursing education, by enhancing the reputation and recognizing the educational institution's effectiveness and capacity. The findings offer valuable insight into forthcoming and existing nursing education for curriculum developers who plan to engage in national or international educational partnerships., Originality/value: This paper explores inherent challenges in cross-border nursing education and maximized data collection opportunities by sampling participants from both national and international settings.

Progress in promoting knowledge of HIV status has been made globally, but half of all people living with HIV are still unaware of their HIV status. It is argued the new innovative HIV self-testing strategy could increase the uptake of HIV testing among the people. The aim of the study was to assess outpatients' health care user's knowledge, attitudes and perceptions towards HIV self-testing (HIVST) at selected Gateway clinics at eThekwini District, KwaZulu-Natal Province, South Africa. The objectives of the study were to determine health care users' knowledge of HIVST, assess health care users' attitudes and perceptions towards HIVST and establish if there is any relationship between knowledge, attitudes and perceptions of health care users towards HIVST. A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three purposefully selected Addington, R. K. Khan and Prince Mshiyeni Memorial Hospital Gateway clinics at eThekwini Health District. A convenience sampling of 442 respondents were sampled from the three study sites. Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they could use it if it can be made freely available to the public and be properly regulated. Generally, health care users indicated positive attitudes towards HIV self-testing. Nevertheless, issues of lack of pre and post-test counselling, false negative results and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated in South Africa.

Background:  Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated., Objectives:  The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme., Method:  Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch's method was used to analyse the data., Results:  Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students' performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions., Conclusion:  It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students.

Background:  Malnutrition is a major public health challenge in developing countries. It has been identified as an important cause of child mortality and morbidity and leads to inadequate physical and cognitive development in children. The South African government implemented a strategy for malnutrition assessment in children under 5 years by community caregivers (CCGs), who would then refer children at risk or those having developed malnutrition to primary health care clinics. Irrespective of this strategy, children still present at clinics with severe malnutrition., Aim:  The aim of the study was to explore and describe the experiences of community caregivers with the assessment of malnutrition in children under 5 years old., Setting:  The study was conducted in North Area six of eThekwini district in the province of KwaZulu-Natal., Methods:  A qualitative, exploratory descriptive approach was used to collect data from 13 purposively selected CCGs. Content analysis was used to analyse data., Results:  The majority of participants were dissatisfied with the training, as it was conducted in a language in which they were not proficient. They reported a lack of support and supervision in their performance such that mid-upper arm circumference was non-prioritised. They were dissatisfied with work overload not matched by remuneration and they worked under unsafe conditions., Conclusion:  Effective training of CCGs needs to be conducted in the language that they understand to combat malnutrition in children under 5 years. CCGs have multiple roles and may need to prioritise their work; this is not easy and requires specific guidance from skilled health professionals.

Background:  Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms., Objectives:  The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District., Method:  This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics., Results:  Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2-3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%)., Conclusion:  The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2-3 times.

Background: Teenage pregnancy is a socio-economic challenge and a serious public health problem for communities in South Africa. It is, therefore, imperative that effective interventions and programmes be implemented to address this problem. A number of research studies have been conducted on teenage pregnancy in South Africa, but their focus was mainly on teenage girls excluding young men's involvement in teenage pregnancy., Aim: The aim of the study was to determine the perceptions of young men between the ages of 18 and 23 years towards teenage pregnancy., Methods: A qualitative, explorative semi-structured interview descriptive design was used toconduct the study. The study was guided by the Johnson's Behavioral System Model. Purposive sampling was used to select 10 participants with whom semi-structured interviews were conducted. Thematic analysis of data were performed., Setting: The study was conducted in Free State School of Nursing's two main campuses., Results: The findings of this study revealed that young men were not involved in reproductive health programmes aiming to prevent teenage pregnancies. Father and son's poor communication on issues related to sex and teenage pregnancy contributes to unprotected sexual intercourse resulting in teenage pregnancy. Cultural and traditional practices such as the withdrawal method, not using contraceptives, and misleading teachings at the initiation schools contribute to risk factors of teenage pregnancy., Conclusion: There is still a gap in reproductive health that needs to be filled by involving young men to reduce teenage pregnancies. Involving young men in reproductive health programmes could lead to a decreased number of teenage pregnancies. Factors, such as cultural and traditional practices, and father and son sexual health education, need to be taken into consideration to prevent teenage pregnancies.