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Maseko L, Adams F, Myezwa H. Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district. BMC Health Serv Res 2024; 24:501. [PMID: 38649859 PMCID: PMC11035128 DOI: 10.1186/s12913-024-10965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Primary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals. METHODS A retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies. RESULTS The findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30-49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use. CONCLUSION This study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.
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Affiliation(s)
- Lebogang Maseko
- Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Fasloen Adams
- Department of Health and Rehabilitation Sciences, Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hellen Myezwa
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Makukule A, Modjadji P, Thovhogi N, Mokgalaboni K, Kengne AP. Uncontrolled Hypertension, Treatment, and Predictors among Hypertensive Out-Patients Attending Primary Health Facilities in Johannesburg, South Africa. Healthcare (Basel) 2023; 11:2783. [PMID: 37893857 PMCID: PMC10606846 DOI: 10.3390/healthcare11202783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.
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Affiliation(s)
- Amaziah Makukule
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Ntevhe Thovhogi
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Goodman O, Adejoh S, Adeniran A, Emechebe A, Kuyinu Y. We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria. J Family Med Prim Care 2022; 11:215-223. [PMID: 35309609 PMCID: PMC8930113 DOI: 10.4103/jfmpc.jfmpc_1302_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center. Objective: To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria. Method: A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months. Result: Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers. Conclusion: Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.
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Nxumalo CT, Mchunu GG. A qualitative study to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e11. [PMID: 34879694 PMCID: PMC8661111 DOI: 10.4102/phcfm.v13i1.3084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) is a novel virus that has rapidly spread across countries globally, and has been declared a pandemic by the World Health Organization (WHO). In South Africa, more that 1 million cases have been confirmed since case zero was detected in March 2020. South Africa is currently leading in the sub-Saharan African region in terms of COVID-19-related mortality and morbidity rates. AIM The aim of this study was to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa. SETTING The study was conducted at two selected primary health care facilities (a community health centre and satellite clinic) within a low-income rural context in KwaZulu-Natal, South Africa. METHODS A qualitative study was conducted to explore and describe perceptions and understanding of primary health care practitioners regarding the COVID-19 pandemic in KwaZulu-Natal (KZN), South Africa. Data were collected from a purposive sample of 15 participants at two different clinics situated in rural KZN, South Africa. Participants comprised of nurses, physiotherapists, pharmacists, community care givers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. An audiotape was used to collect data, which were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis. RESULTS Participants reported pre-pandemic and pandemic perceptions of fear, denial, expectancy and a perceived poor preparation for the COVID-19 outbreak. The findings also revealed participants' misperceptions regarding the nature of the COVID-19 pandemic and unrealistic expectations of occupational compensations for working during the outbreak. CONCLUSION The findings of this study suggest that primary health care practitioners generally have negative perceptions and understanding regarding the pandemic because of misinformation obtained from social media. Interventions to support health care practitioners are necessary to mitigate the potentially negative implications of health practitioners' misconceptions on service delivery and their mental health.
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Affiliation(s)
- Celenkosini T Nxumalo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Matshabane OP, Campbell MM, Faure MC, Appelbaum PS, Marshall PA, Stein DJ, de Vries J. The role of causal knowledge in stigma considerations in African genomics research: Views of South African Xhosa people. Soc Sci Med 2021; 277:113902. [PMID: 33865094 DOI: 10.1016/j.socscimed.2021.113902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Advances in genomics research have raised several ethical concerns. One concern is the potential impact of genomics research on stigma experienced by people affected by a disease. Studies have found that the type of illness as well as disease causal beliefs impact on the relation between genetic attribution and stigma. This study explored the potential impact of genetic attribution of disease on stigma among Xhosa people with Rheumatic Heart Disease (RHD). METHODS Study participants were 46 Xhosa people with RHD living in the Western Cape Province of South Africa. Using video vignettes in 7 focus group discussions we explored whether and how genetic attribution may impact on disease-stigma. Vignettes introduced participants to non-genetic and genetic causal explanations and were followed-up with a series of open-ended questions eliciting their perceptions of non-genetic disease causes as well as genetic causation and its impact on internalised stigma. RESULTS This study found that Xhosa people with RHD have a general understanding of genetics and genetic attribution for disease. Additionally, and not withstanding their genetic knowledge, these participants hold multiple disease causal beliefs including genetic, infectious disease, psychosocial, behavioural and cultural explanations. While there was evidence of internalised stigma experiences among participants, these appeared not to be related to a genetic attribution to the disease. DISCUSSION The findings of this study provide clues as to why it is unlikely that a genetic conceptualisation of disease impacts internalised stigma experiences of Xhosa people. The causal explanations provided by participants reflect their cultural understandings and their context, namely, living in low-income and poverty-stricken environments. Divergence in these findings from much of the evidence from high-income countries emphasises that context matters when considering the impact of genetic attribution on stigma and caution against generalising findings from one part of the globe to another.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Psychology, Rhodes University, Grahamstown, South Africa.
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, United States; New York State Psychiatric Institute, New York, United States.
| | - Patricia A Marshall
- Department of Anthropology, Case Western Reserve University, Cleveland, United States.
| | - Dan J Stein
- Department of Psychiatry & Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Sharma JR, Mabhida SE, Myers B, Apalata T, Nicol E, Benjeddou M, Muller C, Johnson R. Prevalence of Hypertension and Its Associated Risk Factors in a Rural Black Population of Mthatha Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1215. [PMID: 33572921 PMCID: PMC7908535 DOI: 10.3390/ijerph18031215] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022]
Abstract
Background: The occurrence of hypertension has been increasing alarmingly in both low and middle-income countries. Despite acknowledging hypertension as the most common life-threatening risk factor for cardiovascular disease (CVD), a dearth of data is available on the prevalence, awareness, and determinants of hypertension in rural parts of South Africa. The principal aim of the current study is to determine the prevalence and associated risk factors of hypertension among a black rural African population from the Mtatha town of Eastern Cape Province. Methods: This was a cross-sectional study, and individuals over 18 years of age were randomly screened using a World Health Organization stepwise questionnaire. Sociodemographic information, anthropometric measurements, fasting blood glucose levels, and three independent blood pressure (BP) readings were measured. Blood pressure measurements were classified according to the American Heart Association guidelines. Univariate and multivariate analyses were performed to determine the significant predictors of hypertension. Results: Of the total participants (n = 556), 71% of individuals had BP scores in the hypertensive range. In univariate analysis, age, westernized diet, education, income, and diabetic status, as well as overweight/obese status were positively associated with the prevalence of hypertension. However, in a multivariate logistic regression analysis only, age, body mass index (BMI), diabetic status, and westernized diet were significantly associated with a higher risk of developing hypertension. Gender, age, and BMI were potential factors having a significant association with the treatment of hypertension. Individuals who did not consider the importance of medicine had higher chances of having their hypertension being untreated. Conclusions: Prevalence of hypertension was high among the black rural African population of Mthatha town. Gender, age, westernized diet, education level, income status, diabetic as well as overweight/obese status were the most significant predictors of hypertension.
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Affiliation(s)
- Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
| | - Sihle E. Mabhida
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
| | - Bronwyn Myers
- Division of Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa;
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Teke Apalata
- Division of Medical Microbiology, Department of Pathology and Laboratory-Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa;
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa;
- Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
| | - Christo Muller
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
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Han KT, Kim SJ. Regional factors associated with the prevalence of metabolic syndrome: Focusing on the role of healthcare providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:104-112. [PMID: 32716123 DOI: 10.1111/hsc.13073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease, which is gradually becoming more prevalent due to changes in dietary habits and lifestyle. The aim of this study was to evaluate the association between regional factors and the prevalence of MetS, with a particular focus on access to healthcare providers. STUDY DESIGN Observational study. METHODS We used data from the annual Korea National Health and Nutrition Examination Survey (2013-2017), which included 24,695 eligible participants. Regional factors that were related to access to care and could affect the prevalence of MetS were evaluated. A generalised estimating equation model was utilised to identify variables associated with the prevalence of MetS. MAIN FINDING In this study, the prevalence of MetS was 25.9% (n = 7,100). Results of the generalised estimating equation model indicated that a higher density of physicians was significantly associated with a lower prevalence of MetS (odds ratio: 0.864, 95% confidence interval: 0.758-0.984). The density of community health nurses was not significantly associated with the prevalence of MetS; however, the subgroup analysis revealed that higher densities of physicians and community health nurses were significantly associated with a low prevalence of MetS in regions with a high proportion of community health centres. CONCLUSIONS AND IMPLICATION Regional factors related to access to care were associated with the prevalence of MetS. Higher physician density and community health centre utilisation rates were associated with a decreased prevalence of MetS. Regional differences in access to care should be addressed to reduce the health gap between regions and prevent the development of MetS.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Management Policy, National Cancer Center, Goyang, Republic of Korea
| | - Seung Ju Kim
- Department of Nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea
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Boro B, Saikia N. A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam. PLoS One 2020; 15:e0240096. [PMID: 33031431 PMCID: PMC7544062 DOI: 10.1371/journal.pone.0240096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aim to explore the barriers to accessing modern healthcare services in two tribal populations in Assam. METHODS In March 2018, we conducted qualitative research through 60 in-depth interviews with men and women aged 15 to 50 from Bodo and Rabha tribes in Udalguri and Baksa districts of Assam. We interviewed a group of health-service providers from public health facilities to understand the demand-supply balance in those facilities. FINDINGS On the demand side, direct and indirect financial obstacles, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, and lack of infrastructure were the main barriers to utilizing healthcare facilities. On the supply side, doctors and nurses in government health facilities were overburdened by demand due to a lack of human resources. CONCLUSIONS Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the patient's socio-economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that these programs have not been successful in enhancing the rural healthcare system in the study area.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
| | - Nandita Saikia
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
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Sivanandan A, Kumar SG, Krishnamoorthy Y. Awareness and preference in utilizing primary health-care services from rural health center as first point-of-care: A community-based cross-sectional study in South India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:85. [PMID: 32509893 PMCID: PMC7271905 DOI: 10.4103/jehp.jehp_593_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/15/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND First point-of-care (FPC) at the primary health care (PHC) level is an important public health issue at the global level. Patients directly come to tertiary health centers without a referral. AIMS AND OBJECTIVES Hence, the current study was done to assess the proportion of individuals availing health-care services from rural health center (RHC) as FPC and reasons for not availing it. METHODS A community-based cross-sectional study was conducted in Puducherry, coastal South India, among 367 households with 1510 individuals. Sociodemographic details, recent FPC during the past 6 months, morbidity profile, and reasons for not seeking were collected from all the individuals. RESULTS About 44.5% (672/1510) of individuals used any health facilities, of which 70.4% (473/672) used RHC as the FPC. About 33.2% of individuals had a respiratory illness, 22.3% had general signs and symptoms. About 24.6% (32/130) mentioned the reasons for not seeking care as lack of appropriate health facilities. CONCLUSION More than one-fourth of the study population not utilized services at PHC level. Improving the health facilities may help to increase these services.
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Affiliation(s)
| | - S. Ganesh Kumar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
- Address for correspondence: Dr. S. Ganesh Kumar, JIPMER, Puducherry, India. E-mail:
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Boersema G, Van Wyk N, Louw E. Adaptation and validation of a self‐report measure of youth‐friendly primary healthcare services. Int Nurs Rev 2019; 66:269-279. [DOI: 10.1111/inr.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G.C. Boersema
- Department of Nursing Science University of Pretoria South Africa
| | - N.C. Van Wyk
- Department of Nursing Science University of Pretoria South Africa
| | - E.M. Louw
- Department of Statistics University of Pretoria South Africa
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Nagel DA, Keeping-Burke L, Pyrke RJL, Pyrke CLB, Goudreau A, Luke A, Wilbur KA, Waycott L, Hamilton C. Frameworks for evaluation of community health centers' services and outcomes: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:451-460. [PMID: 30451712 DOI: 10.11124/jbisrir-2017-003843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this scoping review is to identify and map the frameworks used to evaluate services and outcomes of community health centers within the broader context of primary health care.The primary question for this scoping review is: what are the frameworks used to evaluate services and outcomes of community health centers?Secondary questions for this review are.
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Affiliation(s)
- Daniel A Nagel
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Ryan J L Pyrke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Courtney L B Pyrke
- Saint John Free Public Library, New Brunswick Public Library Service, Saint John, Canada
| | - Alex Goudreau
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
- University of New Brunswick Libraries, University of New Brunswick, Saint John, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Kimberly A Wilbur
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Loretta Waycott
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Catherine Hamilton
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
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Naidoo U, Ennion L. Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa. Prosthet Orthot Int 2019; 43:95-103. [PMID: 30044179 DOI: 10.1177/0309364618789457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. OBJECTIVE: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. STUDY DESIGN: A qualitative descriptive approach was used to collect and analyse data. METHODS: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. RESULTS: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant's utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant's utilisation of rehabilitation. CONCLUSION: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. CLINICAL RELEVANCE Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.
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Affiliation(s)
- Ugendrie Naidoo
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Liezel Ennion
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Ramma L, Nhokwara PT, Rogers C. Statistical factors associated with utilisation of ototoxicity monitoring services for multi-drug-resistant tuberculosis patients in the Western Cape. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2019; 66:e1-e6. [PMID: 30843411 PMCID: PMC6407470 DOI: 10.4102/sajcd.v66i1.596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 09/21/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background South Africa is a high-burden multi-drug-resistant tuberculosis (MDR-TB) country. Previously, standard MDR-TB treatment regimen in South Africa included kanamycin, an aminoglycoside, which can cause permanent hearing loss in patients. South African National Tuberculosis Control programme’s guidelines for the management of patients with MDR-TB were revised in 2011 to support outpatient-based models. This, in turn, required reorganisation of ototoxicity monitoring services to support these new models of service delivery. Objectives The aim of this study was to determine factors associated with the utilisation of ototoxicity monitoring services for patients with MDR-TB who accessed treatment as outpatients. Method A retrospective review of medical records of patients who attended ototoxicity monitoring clinic at a central TB hospital in Cape Town during 2012–2013 was conducted. A total of 801 medical folders were reviewed: 415 (51.8%) males and 386 (48.2%) females, median age 37 (range 7–85) years. Results Ten per cent of patients attended all the recommended six-monthly appointments. Patients who presented with hearing loss at baseline or developed hearing loss after treatment initiation were more likely to attend their appointments. Patients were also more likely to attend their appointments if a baseline audiometric assessment was conducted within 1 month of MDR-TB treatment initiation. Conclusion This study revealed that outpatient-based ototoxicity monitoring services were largely underutilised by patients. Development of hearing loss and prompt determination of a baseline audiogram were associated with a higher likelihood of attendance of ototoxicity monitoring appointments. Therefore, utilisation of outpatient-based ototoxicity monitoring services is likely to be improved by identifying patients early and monitoring them closely.
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Affiliation(s)
- Lebogang Ramma
- Department of Health and Rehabilitation Sciences, University of Cape Town.
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Mak D, Sengayi M, Chen WC, Babb de Villiers C, Singh E, Kramvis A. Liver cancer mortality trends in South Africa: 1999-2015. BMC Cancer 2018; 18:798. [PMID: 30086727 PMCID: PMC6081797 DOI: 10.1186/s12885-018-4695-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background In South Africa (SA), liver cancer (LC) is a public health problem and information is limited. Methods Joinpoint regression analysis was computed for the most recent LC mortality data from Statistics South Africa (StatsSA), by age group, sex and population group. The mortality-to-incidence ratios (MIRs) were calculated as the age-adjusted mortality rate divided by the age-adjusted incidence rate. Results From 1999 to 2015, the overall LC mortality significantly decreased in men (− 4.9%) and women (− 2.7%). Overall a significant decrease was noted in black African men aged 20–29 and 40–49 years, and white women older than 60 years but mortality rates increased among 50–59 and 60–69 year old black African men (from 2010/2009–2015) and women (from 2004/2009–2015). The mortality rates increased with age, and were higher among blacks Africans compared to whites in all age groups - with a peak black African-to-white mortality rate ratio of six in men and three in women at ages 30–39 years. The average MIR for black African men and women was 4 and 3.3 respectively, and 2.2 and 1.8 in their white counterparts. Moreover, decreasing LC mortality rates among younger and the increase in rates in older black Africans suggest that the nadir of the disease may be near or may have passed. Conclusions Findings of population-age subgroup variations in LC mortality and the number of underdiagnosed cases can inform surveillance efforts, while more extensive investigations of the aetiological risk factors are needed. Impact: There was a large race, sex and age differences in trends of LC mortality in SA. These findings should inform more extensive evaluation of the aetiology and risk factors of LC in the country in order to guide control efforts.
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Affiliation(s)
- Daniel Mak
- Hepatitis Virus Diversity Research Unit (HVDRU), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mazvita Sengayi
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong C Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa. .,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit (HVDRU), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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Geographic assessment of access to health care in patients with cardiovascular disease in South Africa. BMC Health Serv Res 2018; 18:197. [PMID: 29566692 PMCID: PMC5863828 DOI: 10.1186/s12913-018-3006-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) including cardiovascular diseases (CVDs), diabetes, cancer and chronic lung disease are increasingly emerging as major contributors to morbidity and mortality in developing countries. For example, in South Africa, 195 people died per day between 1997 and 2004 from CVDs related causes. Access to efficient and effective health facility and care is an important contributing factor to overall population health and addressing prognosis, care and management CVD disease burden. This study aimed to spatially evaluate geographic health care access of people diagnosed with CVD to health facilities and to evaluate the density of the existing health facility network in South Africa. Methods Data was obtained from the National Income Dynamics Study (NIDS) conducted in 4 waves (phases) between 2008 and 2014. The participants who responded as having heart problems that were diagnosed by a health practitioner were extracted for use in this study. Network analyst in ArcGIS ® was used to generate a least-cost path, which refers to the best path that one can travel. The residential locations of participants diagnosed with heart problems were put into the network analysis model as origins and the location of health facilities were destinations. District averages were used to protect the identity of studied participants. Results There were a total of 51, 42, 43, 43 health districts out the 52 that had recorded subjects with a heart condition in the 2008, 2010–2011, 2012 and 2014–2015 waves, respectively. The mean distance from a case household to a health facility per wave was 2, 2.3, 2.1 and 2.1 km in 2008, 2010–2011 and 2014–2015 respectively. The maximum individual distances travelled per wave were 41.4 km, 40,5 km, 44,2 km and 39.6 km for the 2008, 2010–2011, 2012 and 2014–2015 waves respectively. For district level analysis, participants with CVD residing in the districts found to be among the poorest in the country travelled the longest distances. These were located in the provinces of Limpopo and KwaZulu Natal. It was also found that districts with large proportions of their population living in rural settings had among the lowest densities of health facilities. Significant percentages of study participants were exposed to numerous CVD risk factors, the commonly reported one being high blood pressure. A lack of regular exercise was also commonly reported in each of the waves. Conclusion A lack of accessible healthcare in already impoverished municipalities could result in an increase lack of timely diagnosis, CVD case management. This could result in increased CVD-related morbidity and mortality. GIS methods have the potential to assist national health programs to develop policies that target issues such as areas or populations being underserved by health facilities and populations that must travel long distances to receive healthcare. These policies will be key in preventing and controlling the emerging CVD burden through an accessible primary healthcare system for early detection and case management. Electronic supplementary material The online version of this article (10.1186/s12913-018-3006-0) contains supplementary material, which is available to authorized users.
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Kigozi G, Engelbrecht M, Heunis C, Janse van Rensburg A. Household contact non-attendance of clinical evaluation for tuberculosis: a pilot study in a high burden district in South Africa. BMC Infect Dis 2018; 18:106. [PMID: 29506488 PMCID: PMC5838997 DOI: 10.1186/s12879-018-3010-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background In 2012, the World Health Organization launched guidelines for systematically investigating contacts of persons with infectious tuberculosis (TB) in low- and middle-income countries. As such, it is necessary to understand factors that would influence successful scale-up. This study targeted household contacts of newly-diagnosed infectious TB patients in the Mangaung Metropolitan district to explore factors associated with non-attendance of clinical evaluation. Method In September–October 2016, a pilot study of household contacts was conducted. At each of the 40 primary health care (PHC) facilities in the district, at least one out of four types of TB index cases were purposefully selected. These included children <5 years, smear-positive cases, HIV co-infected cases, and multidrug-resistant TB (MDR-TB) cases. Trained fieldworkers administered questionnaires and screened contacts for TB symptoms. Those with TB symptoms as well as children <5 years were referred for clinical evaluation at the nearest PHC facility. Contacts’ socio-demographic and clinical characteristics, TB knowledge and perception about TB-related discrimination are described. Logistic regression analysis was used to investigate factors associated with non-attendance of clinical evaluation. Results Out of the 259 participants, approximately three in every five (59.5%) were female. The median age was 20 (interquartile range: 8–41) years. While the large majority (87.3%) of adult contacts correctly described TB aetiology, almost three in every five (59.9%) thought that it was hereditary, and almost two-thirds (65.5%) believed that it could be cured by herbal medicine. About one-fifth (22.9%) of contacts believed that TB patients were subjected to discrimination. Two in every five (39.4%) contacts were referred for clinical evaluation of whom more than half (52.9%) did not attend the clinic. Non-attendance was significantly associated with inter alia male gender (AOR: 3.4; CI: 1.11–10.24), prior TB diagnosis (AOR: 5.6; CI: 1.13–27.90) and sharing of a bedroom with the index case (AOR: 3.4: CI: 1.07–10.59). Conclusion The pilot study identified gaps in household contacts’ knowledge of TB. Further research on important individual, clinical and structural factors that can influence and should be considered in the planning, implementation and scale-up of household contact TB investigation is warranted.
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Affiliation(s)
- Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P. O. Box 339, Bloemfontein, 9300, South Africa.
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, P. O. Box 339, Bloemfontein, 9300, South Africa
| | - Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P. O. Box 339, Bloemfontein, 9300, South Africa
| | - André Janse van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, P. O. Box 339, Bloemfontein, 9300, South Africa
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Kagabo DM, Kirk CM, Bakundukize B, Hedt-Gauthier BL, Gupta N, Hirschhorn LR, Ingabire WC, Rouleau D, Nkikabahizi F, Mugeni C, Sayinzoga F, Amoroso CL. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda. PLoS One 2018; 13:e0190739. [PMID: 29320556 PMCID: PMC5761861 DOI: 10.1371/journal.pone.0190739] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/11/2017] [Indexed: 02/03/2023] Open
Abstract
Background Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child’s death, and identifies factors associated with care-seeking for these children in rural Rwanda. Methods Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child’s birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher’s exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. Results Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. Conclusion Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care.
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Affiliation(s)
- Daniel M. Kagabo
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- * E-mail:
| | | | | | - Bethany L. Hedt-Gauthier
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Neil Gupta
- Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | | | - Felix Sayinzoga
- Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
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Myers B, Joska JA, Lund C, Levitt NS, Butler CC, Naledi T, Milligan P, Stein DJ, Sorsdahl K. Patient preferences for the integration of mental health counseling and chronic disease care in South Africa. Patient Prefer Adherence 2018; 12:1797-1803. [PMID: 30271123 PMCID: PMC6154740 DOI: 10.2147/ppa.s176356] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To describe patient perceptions of the acceptability of integrating mental health counseling within primary care facilities in the Western Cape province of South Africa and their preferences for the way in which this care is delivered. PATIENTS AND METHODS Qualitative interviews with 30 purposively selected patients receiving treatment for HIV or diabetes within primary care facilities who screened positive for depression using the Center for Epidemiological Studies Depression Scale or hazardous alcohol use through the Alcohol Use Disorders Identification Test. RESULTS Participants articulated high levels of unmet need for mental health services and strong associations between poor mental health and the challenges of living with a chronic disease. Consequently, they considered it acceptable to offer screening and mental health counseling within the context of chronic disease care. They thought counseling would be highly relevant if it helped patients develop adaptive strategies for coping with stress and negative emotions. Irrespective of chronic disease, patients indicated a preference for lay counselors rather than existing clinicians as potential delivery agents, supporting a task-shared approach to mental health counseling delivery in primary care settings. Some expressed concern about the feasibility of using lay counselors already present in facilities to deliver this service, suggesting that additional counselors might be needed. CONCLUSION Findings demonstrate a need for mental health counseling within the context of chronic disease care in South Africa. Task-shared approaches, using lay counselors, seem acceptable to patients - provided counselors are selected to ensure they possess the qualities associated with effective counselors. Findings have informed the design of a task-shared mental health program that is responsive to the preferences of patients with chronic diseases.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa,
- Division of Addiction Psychiatry, Psychiatry and Mental Health,
| | - John A Joska
- HIV and Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi S Levitt
- Division for Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Services, Oxford University, Oxford, UK
| | - Tracey Naledi
- Western Cape Department of Health, Cape Town, South Africa
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Milligan
- KwaZulu-Natal Department of Health, KwaZulu-Natal, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SAMRC Unit on Anxiety and Stress Disorders, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Kapwata T, Morris N, Campbell A, Mthiyane T, Mpangase P, Nelson KN, Allana S, Brust JCM, Moodley P, Mlisana K, Gandhi NR, Shah NS. Spatial distribution of extensively drug-resistant tuberculosis (XDR TB) patients in KwaZulu-Natal, South Africa. PLoS One 2017; 12:e0181797. [PMID: 29028800 PMCID: PMC5640212 DOI: 10.1371/journal.pone.0181797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background KwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal. Methods We recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants’ home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital. Results During 2011–2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8–4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4–23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from <10 km (n = 143, 36%) to >50 km (n = 109, 27%), with a mean of 69 km. The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area. Conclusions XDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB epidemic.
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Affiliation(s)
- Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
| | - Natashia Morris
- Biostatistics Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Angela Campbell
- Departments of Epidemiology and Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Thuli Mthiyane
- Departments of Medical Microbiology and Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Primrose Mpangase
- Departments of Medical Microbiology and Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Kristin N. Nelson
- Departments of Epidemiology and Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Salim Allana
- Departments of Epidemiology and Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - James C. M. Brust
- Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States of America
| | - Pravi Moodley
- Departments of Medical Microbiology and Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Koleka Mlisana
- Departments of Medical Microbiology and Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Neel R. Gandhi
- Departments of Epidemiology and Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
| | - N. Sarita Shah
- Departments of Epidemiology and Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Global Tuberculosis Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Getahun B, Wubie M, Dejenu G, Manyazewal T. Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis. Infect Dis Poverty 2016; 5:93. [PMID: 27799063 PMCID: PMC5088676 DOI: 10.1186/s40249-016-0187-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. METHODS A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. RESULTS Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). CONCLUSION Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.
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Affiliation(s)
- Belete Getahun
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Moges Wubie
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Wu J, Zhang S, Chen H, Lin Y, Dong X, Yin X, Lu Z, Cao S. Patient Satisfaction with Community Health Service Centers as Gatekeepers and the Influencing Factors: A Cross-Sectional Study in Shenzhen, China. PLoS One 2016; 11:e0161683. [PMID: 27552228 PMCID: PMC4994937 DOI: 10.1371/journal.pone.0161683] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Shenzhen is the first pilot city in China implementing the gatekeeper policy, with community health service (CHS) centers as the gatekeepers. We aim to investigate patient satisfaction with this policy and its influencing factors in Shenzhen. METHODS 3,848 patients visiting eight CHS centers in Shenzhen of China between May 1 and July 28, 2013 were recruited. We interviewed them using a structured questionnaire to investigate their satisfaction with the gatekeeper policy of CHS. Multivariable logistic regression models were used to identify influencing factors. RESULTS Of the respondents, 28.17%, 47.27% and 24.56% were satisfied with, neutral to, and not satisfied with the gatekeeper policy respectively. Patient satisfaction with this policy was found to be associated with education level, familiarity with the policy, referral experience, satisfaction with convenience of seeing a doctor, satisfaction with waiting time, satisfaction with medical facility, satisfaction with general medical practitioners' professional skill, and proportion of expense reimbursed. CONCLUSIONS Our investigation shows that patient satisfaction with the gatekeeper policy was low. To improve patient satisfaction, efforts should be made to increase the convenience of seeing a doctor in community, shorten waiting time, improve general medical practitioners' professional skill, and increase proportion of expense reimbursement.
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Affiliation(s)
- Jiang Wu
- Baoan Central Hospital of Shenzhen, Shenzhen, China
| | | | - Huiqing Chen
- Baoan Central Hospital of Shenzhen, Shenzhen, China
| | - Yingyu Lin
- Baoan Central Hospital of Shenzhen, Shenzhen, China
| | - Xiaoxin Dong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxu Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (SC); (ZL)
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (SC); (ZL)
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Adeniyi OV, Yogeswaran P, Longo-Mbenza B, Ter Goon D, Ajayi AI. Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa. BMJ Open 2016; 6:e010875. [PMID: 27473948 PMCID: PMC4986079 DOI: 10.1136/bmjopen-2015-010875] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. DESIGN A cross-sectional analytical study. SETTING Primary healthcare setting in OR Tambo district, South Africa. PARTICIPANTS Patients treated for T2DM for 1 or more years (n=327). PRIMARY OUTCOME MEASURE Prevalence of uncontrolled T2DM. SECONDARY OUTCOME MEASURE Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). RESULTS Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. CONCLUSIONS We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Faculty of Health Sciences, Department of Family Medicine, Walter Sisulu University, East London, South Africa
| | - Parimalaranie Yogeswaran
- Faculty of Health Sciences, Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Benjamin Longo-Mbenza
- Faculty of Health Sciences, Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Daniel Ter Goon
- Department of Nursing Science, School of Health Sciences, University of Fort Hare, East London, South Africa
| | - Anthony Idowu Ajayi
- Faculty of Social Sciences & Humanities, Department of Sociology, University of Fort Hare, East London, South Africa
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Karim RM, Abdullah MS, Rahman AM, Alam AM. Identifying role of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context. BMC Health Serv Res 2016; 16:204. [PMID: 27341806 PMCID: PMC4921026 DOI: 10.1186/s12913-016-1461-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients’ perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. Methods This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. Results About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach’s α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach’s α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic’s services utilization. Conclusions Besides parental education and income, client’s perception and satisfaction played significant role in community clinic service utilization. Provider’s perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers’ and patients’ ideas of community clinic service quality.
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Affiliation(s)
- Rizwanul M Karim
- Department of community Medicine, Abdul Malek Ukil Medical College (AMUMC), Begumgonj, Noakhali, 3820, Bangladesh.
| | - Mamun S Abdullah
- Filaria Control Program, CDC, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, 1212, Bangladesh
| | - Anisur M Rahman
- Department of Epidemiology, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, 1212, Bangladesh
| | - Ashraful M Alam
- Department of Maternal and Child Health, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, 1212, Bangladesh
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Nemutandani SM, Hendricks SJ, Mulaudzi MF. Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-8. [PMID: 27380856 PMCID: PMC4926717 DOI: 10.4102/phcfm.v8i2.1007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/13/2022] Open
Abstract
Background The indigenous health system was perceived to be a threat to the allopathic health system. It was associated with ‘witchcraft’, and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Methods Qualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo’s Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department’s Research Committee. Results Dominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities. Conclusion Allopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required.
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Adeniyi OV, Yogeswaran P, Longo-Mbenza B, Goon DT. Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa. PLoS One 2016; 11:e0150033. [PMID: 26930050 PMCID: PMC4773066 DOI: 10.1371/journal.pone.0150033] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/08/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Paucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa. METHODS This cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140 mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension. RESULTS Of the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p<0.0001), excessive alcohol intake (p = 0.005) and consumption of western-type diet (p<0.0001) were positively associated with uncontrolled hypertension. In multivariate logistic regression (LR method) analysis, unemployed status (p<0.0001), excessive alcohol intake (p = 0.007) and consumption of western-type diet (p<0.0001) were independently and significantly associated with uncontrolled hypertension. There is significant association between increasing number and classes of anti-hypertensive drugs and uncontrolled hypertension (p = 0.05 and 0.02, respectively). CONCLUSION Prevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and T2DM in the study population. Male sex, aging, clinic inertia, unemployed status and nutritional transitions are the most important determinants of uncontrolled hypertension in T2DM in Mthatha, South Africa. Treatment to blood pressure targets, though feasible in our setting, would require concerted efforts by addressing these determinants and clinic inertia.
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Gonani A, Muula AS. The importance of Leadership towards universal health coverage in Low Income Countries. Malawi Med J 2015; 27:34-7. [PMID: 26137197 DOI: 10.4314/mmj.v27i1.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Universal health coverage--defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection--was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.
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Affiliation(s)
- A Gonani
- Hospital Director, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - A S Muula
- Department of Public Health, School of Public Health, University of Malawi, College of Medicine, Blantyre, Malawi
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Lopes Ibanez-Gonzalez D, Tollman SM. Clinics and churches: lifeworlds and health-seeking practices of older women with noncommunicable disease in rural South Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:12. [PMID: 26017870 PMCID: PMC4445983 DOI: 10.1186/s12914-015-0051-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
Abstract
Background In this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa. The purpose of the study was to generate key concepts of health care access and the management of NCDs in a rural South African context. Methods The study employed a qualitative methodology with serial semistructured interviews. We used a content analytical approach to analyse key themes and patterns in participants’ narratives of NCDs and health care access. Results The findings are reported by theme and include analyses of narrative sequences related to 1) family environment, 2) experiences of NCDs, 3) understandings of the causes of NCDs, 4) accessibility of formal health care services, 5) experiences of formal health care services, 6) treating NCDs, and 7) experiences of informal health care services. The findings suggest that participation in the routines prescribed by formal health care services and reinforced by families and faith-based communities normalises the experience of NCDs to the extent that narratives of NCDs form the background, rather than the focus of broader illness narratives. Such narratives rather tend to focus on significant life events and relationships. The key features of the narratives include connections between social or autobiographical and biological understandings of NCDs, the appropriation of modern concepts of disease in illness narratives, and reflexive commentary on the modern features of NCDs. In the context of such narrative expertise formal health care services have a high level of acceptability in this rural area. Conclusion Lifeworld analysis of health care access based on the theory of communicative action places consensual understandings of NCDs and their treatment as central to the health care experience. Our findings suggest that such analyses can facilitate potential feedback processes between health care users and professionals which generate consensus as well as institutional reform within formal health care services.
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Affiliation(s)
- Daniel Lopes Ibanez-Gonzalez
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
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Uzodike N, Ross A, Harbor O. Adherence by a primary healthcare clinic in KwaZulu-Natal to the national HIV guidelines. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.976945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Adeniyi OV, Longo-Mbenza B, Ter Goon D. Female sex, poverty and globalization as determinants of obesity among rural South African type 2 diabetics: a cross-sectional study. BMC Public Health 2015; 15:298. [PMID: 25880927 PMCID: PMC4380244 DOI: 10.1186/s12889-015-1622-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
Background Countries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas. Despite their growing influence on population health in the region, there is a paucity of epidemiological studies on the twin epidemic of obesity and T2DM, particularly in the rural communities in South Africa. We investigated the prevalence and the determinants of overall obesity among patients with T2DM in rural and semi-urban areas surrounding the town of Mthatha, South Africa. Methods This hospital-based cross-sectional study was conducted among patients with T2DM attending the outpatient department at Mthatha General Hospital, Eastern Cape Province, South Africa. Data were obtained from 327 participants using standardized questionnaires that included items on sex, age, level of education, type of residence, employment status, smoking status, physical activity, diet and alcohol intake. After taking measurements of height and weight, participants were defined as obese if their body mass index exceeded 30 kg/m2. Univariate and multivariate logistic regression analyses were performed to identify the determinants of obesity in our sample population. Results We found that 60.2% of our sample population were defined as obese. In our univariate analyses, female sex (p < 0.001), age ≥50 years (p = 0.023), rural residence (p < 0.001), excessive alcohol intake (p = 0.002), current cigarette smoking (p < 0.001), level of education (p < 0.001), regular consumption of soft drinks (p < 0.001) and unemployment (p = 0.043) were found to be positively and significantly associated with obesity. In the multivariate logistic regression analysis, female sex (p < 0.001), unemployment (p = 0.012) and level of education (p < 0.001) were found to be independent determinants of obesity. Conclusion We found that female sex, educational attainment, unemployment and current cigarette smoking were positively associated with obesity among the study participants. Lifestyle changes, poverty reduction and public education are urgently needed to address the growing obesity epidemic in rural areas of South Africa.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine, Senior Specialist, Faculty of Health Sciences, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, Private Bag X 9047, Mdantsane, East London, South Africa, 5200.
| | - Benjamin Longo-Mbenza
- Department of Community Medicine, Research Champion Professor, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha, South Africa, 5117.
| | - Daniel Ter Goon
- Department of Nursing Science, Senior Researcher, School of Health Sciences, University of Fort Hare, Private Bag X9083, East London, South Africa, 5201.
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Faleye A. Knowledge of HIV and benefits of male medical circumcision amongst clients in an urban area. Afr J Prim Health Care Fam Med 2014; 6:E1-5. [PMID: 26245426 PMCID: PMC4564906 DOI: 10.4102/phcfm.v6i1.722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/28/2014] [Accepted: 08/14/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Male medical circumcision (MMC) has been shown to reduce the risk of HIV transmission in circumcised men by up to 60%. Following recommendations from the World Health Organization, South Africa adopted MMC as a preventative strategy against HIV in 2010 and set up circumcision camps across the country. Concerns have been raised about condom avoidance following MMC because of a mistaken belief about the benefits of MMC.Aim and setting: The aim of this study was to describe the profile and knowledge about HIV and circumcision amongst men presenting for MMC in an urban area in KwaZulu-Natal. METHODS This was a cross-sectional descriptive study of 394 clients over the age of 18 years who presented to two MMC sites in Durban between November 2012 and March 2013. A validated questionnaire was used to collect data. RESULTS The mean age of clients presenting for MMC was 28 years. Most clients were black, single, unemployed and sexually active. The majority presented for MMC because they believed that MMC would reduce their risk of acquiring HIV infection. Knowledge about HIV transmission was very good and 86.3% of clients were aware that risky sexual behaviour such as condom avoidance could reverse the benefits of MMC. CONCLUSION The knowledge of HIV and benefits of MMC was very good amongst those presenting for MMC. However as MMC is primarily a preventative strategy, innovative methods to promote MMC prior to first sexual encounter need to be explored. Further research is needed to determine whether the benefits of MMC on the reduction of HIV transmission are sustained in routine practice.
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Affiliation(s)
- Abidemi Faleye
- Department of Family Medicine, University of KwaZulu-Natal, Durban.
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Dickens C, Joffe M, Jacobson J, Venter F, Schüz J, Cubasch H, McCormack V. Stage at breast cancer diagnosis and distance from diagnostic hospital in a periurban setting: a South African public hospital case series of over 1,000 women. Int J Cancer 2014; 135:2173-82. [PMID: 24658866 PMCID: PMC4134722 DOI: 10.1002/ijc.28861] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/21/2014] [Accepted: 03/11/2014] [Indexed: 01/28/2023]
Abstract
Advanced stage at diagnosis contributes to low breast cancer survival rates in sub-Saharan Africa. Living far from health services is known to delay presentation, but the effect of residential distance to hospital, the radius at which this effect sets in and the women most affected have not been quantified. In a periurban South African setting, we examined the effect of a geographic information system (GIS)-measured straight-line distance, from a patient's residence to diagnostic hospital, on stage at diagnosis in 1,071 public-sector breast cancer patients diagnosed during 2006-2012. Generalized linear models were used to estimate risk ratios for late stage (stage III/IV vs. stage I/II) associated with distance, adjusting for year of diagnosis, age, race and socioeconomic indicators. Mean age of patients was 55 years, 90% were black African and diagnoses were at stages I (5%), II (41%), III (46%) and IV (8%). Sixty-two percent of patients with distances >20 km (n = 338) had a late stage at diagnosis compared to 50% with distances <20 km (n = 713, p = 0.02). Risk of late stage at diagnosis was 1.25-fold higher (95% CI: 1.09, 1.42) per 30 km. Effects were pronounced in an underrepresented group of patients over age 70. This positive stage-distance association held to 40 km, and plateaued or slightly reversed in patients (9%) living beyond this distance. Studies of woman and the societal and healthcare-level influences on these delays and on the late stage at diagnosis distribution are needed to inform interventions to improve diagnostic stage and breast cancer survival in this and similar settings.
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Affiliation(s)
- Caroline Dickens
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa
| | - Maureen Joffe
- Wits Health Consortium, MRC/Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of Witwatersrand
| | - Judith Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Francois Venter
- Information Management Directorate, Gauteng Provincial Department of Health, 37 Sauer Street, Bank of Lisbon, Marshall Town, Johannesburg, 2000, South Africa
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa
- Chris Hani Baragwanath Hospital Breast Clinic, Old Potch Road, Soweto, South Africa
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
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Tsawe M, Susuman AS. Determinants of access to and use of maternal health care services in the Eastern Cape, South Africa: a quantitative and qualitative investigation. BMC Res Notes 2014; 7:723. [PMID: 25315012 PMCID: PMC4203863 DOI: 10.1186/1756-0500-7-723] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/02/2014] [Indexed: 11/26/2022] Open
Abstract
Background The main aim of the study is to examine whether women in Mdantsane are accessing and using maternal health care services. Accessibility of maternal health care facilities is important in ensuring that lives are saved through the provision and use of essential maternal services. Therefore, access to these health care services directly translates to use – that is, if women cannot access life-saving maternal health care services, then use of such services will be limited. Findings The study makes use of mixed methods to explore the main factors associated with access to and use of maternal health care services in Mdantsane. For the quantitative approach, we collected data using a structured questionnaire. A sample of 267 participants was selected from health facilities within the Mdantsane area. We analyzed this data using bivariate and multivariate models. For the qualitative approach, we collected data from health care professionals (including nurses, doctors, and maternal health specialists) using one-on-one interviews. The study found that women who were aged 35–39, were not married, had secondary education, were government employees, and who had to travel less than 20 km to get to hospital were more likely to access maternal health services. The qualitative analysis provided the insights of health care professionals regarding the determinants of maternal health care use. Staff shortages, financial problems, and lack of knowledge about maternal health care services as well as about the importance of these services were among the major themes of the qualitative analysis. Conclusion A number of strategies could play a big role in campaigning for better access to and use of maternal health services, especially in rural areas. These strategies could include (a) the inclusion of the media in terms of broadcasting information relating to maternal health services and the importance of such services, (b) educational programs aimed at enhancing the literacy skills of women (especially in rural areas), (c) implementing better policies that are aimed at shaping the livelihoods of women, and (d) implementing better delivery of maternal health care services in rural settings.
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Affiliation(s)
| | - Appunni Sathiya Susuman
- Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa.
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Dong X, Liu L, Cao S, Yang H, Song F, Yang C, Gong Y, Wang Y, Yin X, Xu X, Xie J, Sun Y, Lu Z. Focus on vulnerable populations and promoting equity in health service utilization--an analysis of visitor characteristics and service utilization of the Chinese community health service. BMC Public Health 2014; 14:503. [PMID: 24884542 PMCID: PMC4037411 DOI: 10.1186/1471-2458-14-503] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/12/2014] [Indexed: 11/26/2022] Open
Abstract
Background Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. Results The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. Conclusions The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Okoronkwo IL, Onwujekwe OE, Ani FO. The long walk to universal health coverage: patterns of inequities in the use of primary healthcare services in Enugu, Southeast Nigeria. BMC Health Serv Res 2014; 14:132. [PMID: 24655898 PMCID: PMC3984026 DOI: 10.1186/1472-6963-14-132] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/14/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Knowledge and understanding of health service usage are necessary for health resource allocation, planning and monitoring the achievement of universal coverage (UHC). There is limited information on patterns of utilization among adult users of primary health care (PHC) services. Lack of understanding of current and past utilization patterns of health services often hinders the improvement of future Primary Health Care (PHC) delivery in the remote areas of developing countries. This paper presents new knowledge on the patterns of utilization of PHC services among adults in Enugu metropolis southeast Nigeria. METHODS A cross-sectional study was conducted in 15 PHC facilities of Enugu North Local Government Area (LGA) from June to July 2012. A total of 360 consenting adult users aged 18 years and above were consecutively recruited as they attended the health facilities. An interviewer-administered questionnaire was used to collect data from the respondents. A modified Likert scale questionnaire was used to analyze data on patterns of utilization. Utilization of PHC services was compared by gender, socio-economic status (SES) and level of education. RESULTS Out of the 360 respondents, (46.9%) utilized PHC services regularly. The components of PHC mostly utilized by respondents were immunization with a mean score of 3.05, treatment of common ailments (2.99) and maternal and child health (2.64). The least poor SES group utilized PHC services the most while the very poor and poor SES groups used PHC services least. There were statistically significant relationships between utilization of PHC services and gender (p = 0.0084), level of education (p=0.0366) and income (p =0.0001). CONCLUSIONS Most adult users in this study did not utilize the health facilities regularly and there were gender, educational and SES inequities in the use of PHC services. These inequities will negate the achievement of universal health coverage with PHC services and should be remedied using appropriate interventions.
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Affiliation(s)
- Ijeoma L Okoronkwo
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
- Department of Nursing Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Obinna E Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Francis O Ani
- Department of Nursing Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
- School of Nursing, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
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Ackers ML, Hightower A, Obor D, Ofware P, Ngere L, Kubaje A, Laserson KF. Health care utilization and access to human immunodeficiency virus (HIV) testing and care and treatment services in a rural area with high HIV prevalence, Nyanza Province, Kenya, 2007. Am J Trop Med Hyg 2013; 90:224-33. [PMID: 24323517 DOI: 10.4269/ajtmh.13-0181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We present health and demographic surveillance system data to assess associations with health care utilization and human immunodeficiency virus (HIV) service receipt in a high HIV prevalence area of western Kenya. Eighty-six percent of 15,302 residents indicated a facility/clinician for routine medical services; 60% reported active (within the past year) attendance. Only 34% reported a previous HIV test, and self-reported HIV prevalence was 6%. Active attendees lived only slightly closer to their reported service site (2.8 versus 3.1 km; P < 0.001) compared with inactive attendees. Multivariate analysis showed that younger respondents (< 30 years of age) and active and inactive attendees were more likely to report an HIV test compared with non-attendees; men were less likely to report HIV testing. Despite traveling farther for HIV services (median distance = 4.4 km), 77% of those disclosing HIV infection reported HIV care enrollment. Men and younger respondents were less likely to enroll in HIV care. Socioeconomic status was not associated with HIV service use. Distance did not appear to be the major barrier to service receipt. The health and demographic surveillance system data identified patterns of service use that are useful for future program planning.
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Affiliation(s)
- Marta-Louise Ackers
- Global HIV/AIDS Program and Division of Parasitic Diseases, Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute/Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tum SJ, Maree JE, Clarke M. Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a Community Health Worker: a pilot intervention study. Eur J Cancer Care (Engl) 2012; 22:107-16. [PMID: 22966910 DOI: 10.1111/ecc.12005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In South Africa, cervical cancer is the most common female cancer followed by breast cancer. Despite the high incidence of these cancers, population-based screening is limited to cervical screening available at primary health clinics. Cervical screening uptake is, however, low. In 2009 a new cancer prevention initiative was launched in a specific resource poor community in Tshwane, South Africa. The low cervical screening uptake as well as a potentially low breast screening uptake could have resulted in the failure of this initiative. The purpose of the study was to develop and pilot test an intervention to address this risk. A Community Health Worker was trained and tasked to raise awareness of cervical and breast cancer and motivate women to take up screening. The intervention was assessed in terms of three outcomes: screening uptake, awareness and the value of the Community Health Worker. Despite the fact that the Community Health Worker's role was valued, screening uptake was disappointing and the level of awareness remained low. Unfortunately this intervention failed and once again we are left with the challenge of improving screening uptake.
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Affiliation(s)
- S J Tum
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
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Gopalan SS, Durairaj V. Addressing women's non-maternal healthcare financing in developing countries: what can we learn from the experiences of rural Indian women? PLoS One 2012; 7:e29936. [PMID: 22272262 PMCID: PMC3260165 DOI: 10.1371/journal.pone.0029936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 12/07/2011] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives This paper focuses on the inadequate attention on women's non-maternal healthcare in low- and middle-income countries. The study assessed the purchase of and financial access to non-maternal healthcare. It also scoped for mainstreaming household financial resources in this regard to suggest for alternatives. Methods A household survey through multi-stage stratified sampling in the state of Orissa interviewed rural women above 15 years who were neither pregnant nor had any pregnancy-related outcome six weeks preceding the survey. The questions explored on the processes, determinants and outcomes of health seeking for non-maternal ailments. The outcome measures were healthcare access, cost of care and financial access. The independent variables for bivariate and multivariate analyses were contextual factors, health seeking and financing pattern. Results The survey obtained a response rate of 98.64% and among 800 women, 43.8% had no schooling and 51% were above 60 years. Each woman reported at least one episode of non-maternal ailment; financial constraints prevented 68% from receiving timely and complete care. Distress coping measures (e.g. borrowings) dominated the financing source (67.9%) followed by community–based measures (32.1%). Only 6% had financial risk-protection; financial risk of not obtaining care doubled for women aged over 60 years (OR 2.00, 95% CI 0.84–4.80), seeking outpatient consultation (OR 2.01, 95% CI 0.89–4.81), facing unfavourable household response (OR 2.04, 95% CI 1.09–3.83), and lacking other financial alternatives (OR 2.13, 95% CI 1.11–4.07). When it comes to timely mobilization of funds and healthcare seeking, 90% (714) of the households preferred maternal care to non-maternal healthcare. Conclusion The existing financing options enable sub-optimal purchase of women's non-maternal healthcare. Though dominant, household economy extends inadequate attention in this regard owing to its unfavourable approach towards non-maternal healthcare and limited financial capacity and support from other financial resources.
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Affiliation(s)
- Saji S Gopalan
- Blair East, Silver Spring, Maryland, United States of America.
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Tsuji Y, Hirao T, Fujikawa A, Hoshikawa Y, Yoshioka A, Yoda T, Suzue T. Disease-wide accessibility of the elderly in primary care setting: The relationship between geographic accessibility and utilization of outpatient services in Tokushima prefecture, Japan. Health (London) 2012. [DOI: 10.4236/health.2012.46053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Achieving equitable universal health coverage requires the provision of accessible, necessary services for the entire population without imposing an unaffordable burden on individuals or households. In South Africa, little is known about access barriers to health care for the general population. We explore affordability, availability, and acceptability of services through a nationally representative household survey (n = 4668), covering utilization, health status, reasons for delaying care, perceptions and experiences of services, and health-care expenditure. Socio-economic status, race, insurance status, and urban-rural location were associated with access to care, with black Africans, poor, uninsured and rural respondents, experiencing greatest barriers. Understanding access barriers from the user perspective is important for expanding health-care coverage, both in South Africa and in other low- and middle-income countries.
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MAREE JE, LU X, WRIGHT S. Combining breast and cervical screening in an attempt to increase cervical screening uptake. An intervention study in a South African context. Eur J Cancer Care (Engl) 2011; 21:78-86. [DOI: 10.1111/j.1365-2354.2011.01292.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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