After action review of the COVID-19 pandemic response in North West province, South Africa

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

Knowledge of final year undergraduate nursing students about HIV and AIDS in Eswatini

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

Knowledge, attitudes and practices of contraceptive methods among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa

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

Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Background: Clinical guidelines are systematically developed statements that assist practitioners and patients to make healthcare decisions for specific clinical circumstances. Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care; resulting in poor clinical outcomes. Aim: To investigate adherence of doctors in rural district hospitals to clinical guidelines using the South African Hypertension Guideline 2006 as an example.Setting: Four district hospitals in Bojanala district of North-West Province; South Africa.Methods:A cross-sectional study determined adherence practices of doctors from records of patients with established hypertension seen at the four district hospitals.Results: Of the 490 total records documented by 29 doctors; screening for co-morbidity or associated factors was carried out as follows: diabetes mellitus 99.2%; obesity 6.1%; smoking 53.5%; dyslipidaemia 36.9%; abdominal circumference 3.3%; organ damage: eye 0; kidney 82%; heart 43.5%; chronic kidney disease 38.2%; stroke/transient ischaemic attack 15.9%; heart failure 23.5%; advanced retinopathy 0.2%; coronary heart disease 23.7%; peripheral arterial disease 13.9%. Critical tests/measurements were documented in the following proportions: blood pressure 99.8%; weight 85.3%; height 65.7%; body mass index 3.1%; urinalysis 74.5%; lipogram 76.1%; urea/creatinine 80.4%; electrocardiogram 42.9%; blood glucose 100%; risk determination and grading: diagnosis by hypertension severity 19%; low added risk 57.1%; moderate added risk 64.7%; high added risk 89.6%; very high added risk 89.2%. Adherence to therapies was as follows: first-line guideline drugs 69.4%; second line 84.7%; third line 87.8% and fourth-line 89.6%.Conclusion: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience; and differed with regard to various aspects of the guidelines

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However; not all patients seek this clarity. Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods: This was a qualitative arm of a larger study; titled 'Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa'; conducted in 2010. Of the 264 inpatients who participated in the larger study; we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners; but that they had nonetheless not sought clarity.Data were analysed thematically. Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be 'too busy'; aloof; non-communicators and sometimes uncertain about patients' conditions. Some inpatients had unquestioning trust in healthcare practitioners;whilst others had experiences of bad treatment. Inpatients had poor self-esteem; incapacitating clinical conditions; fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion: The reasons for not seeking clarity were based on patients' experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners

Nurses' Monitoring of the Road to Health Chart at Primary Healthcare Level in Makhado; Limpopo Province

Background: The Road to Health Chart (RTHC) is a record chart carried by the caregiver that combines essential information on the growth monitoring of a child; immunisation; vitamin A supplementation; deworming medicine and other illnesses. It provides useful information to the parent and healthcare professional. This study sought to determine the challenges faced by professional nurses in monitoring the RTHC during consultation; the degree of implementation of the RTHC programme; and the most utilised aspect of the RTHC at Louis Trichardt Memorial Hospital and surrounding primary healthcare (PHC) clinics. Method: A cross-sectional study was conducted among 128 registered professional nurses. A self-administered questionnaire was used. Results: Ninety-six questionnaires were completed. Most of the respondents were female and aged 40-49 years. The majority of the PHC professional nurses stated that the challenges faced in monitoring the RTHC were staff shortages; lack of equipment; a work overload and unequal distribution of professional nurses on duty per shift. There was poor knowledge on how to identify malnutrition. The majority of PHC professional nurses had not completed their basic courses. Conclusion: PHC professional nurses voiced their concern that challenges encountered during consultations were direct reasons for their poor monitoring of the RTHC. The degree of implementation of the RTHC programme fell short of the norms and standards of the Department of Health and Social Development concerning child health care in South Africa. The most utilised aspect of the RTHC was the expanded programme on immunisation; vitamin A supplementation and deworming medicine

Knowledge and Attitudes about and Practices of Condom Use for Reducing HIV Infection among Goma University Students in the Democratic Republic of Congo

The Democratic Republic of Congo (DRC) is experiencing increasing human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in young adults. This is despite the government's widespread campaign on HIV/AIDS awareness. In this study; high-risk university students who engage in casual sex; but who have good literacy skills; were surveyed to ascertain whether the education campaigns in the country influenced their condom use practice. This study sought to determine Goman University students' knowledge and attitudes about and practices of condom use for the purpose of reducing HIV infection. A descriptive cross-sectional quantitative study; using a self-administered questionnaire; was carried out. The ages of the students varied between 18 and 33. Most of them were men: 111 (80); 129 (93) were single; and most participants were Protestants (61; 44) and Roman Catholics (57; 41). The majority of participants (137; 99) knew about condoms; while 132 (96) were aware that condoms were available from and sold by pharmacies. Seventy-two (52 ) understood that condoms helped to prevent HIV; pregnancy and sexually transmitted infections (STIs). Ninety-four (68) said that they knew how to use a condom; while 111 (80) stated that the price of condoms was not a barrier to usage thereof. One hundred and two (74) suggested that the university should supply students with condoms. Ninety-one (66) were sexually active and 98 (71) of participants reported that they had unprotected sex. Condom awareness was high and information was available from varying sources. Condoms were accepted as a means to prevent HIV/AIDS; STIs and pregnancy. Some ethnic groups disapproved of condom use because of religious and cultural beliefs. Consistent use of condoms was low in Goma University students

Factors Associated with Pulmonary Tuberculosis Outcomes among Inmates in Potchefstroom Prison in North West Province

Tuberculosis is the leading cause of death among the world's prison populations. Prisons are reservoirs of tuberculosis and threaten inmates; prison staff; visitors and the surrounding community. This study was carried out to explore the associated factors with pulmonary tuberculosis treatment outcomes at Potchefstroom Prison. A retrospective record review of 202 inmates with tuberculosis; whose treatment outcomes as of March 2010 were known; was conducted. Data on sex; racial group; level of education; weight; smoking habits; existence and type of co-morbidity; diagnostic classification; treatment regimen; initiation date; completion date and outcome; use of directly observed treatment; allergy and hospitalisation were captured. The majority of the inmates (142; 70.3) were aged 21-37 years; while 48 (23.8) were aged 38-53 years. There were 198 (98) male and 4 (2) female inmates. Fifty-five inmates (27.3) had attained Grade 6 and lower; 71 (35.1) grade 7-9; 68 (33.7) Grade 10-12; and 8 (3.9) above grade 12. One hundred and fifty-eight (78.2) received occasional visitors. There were 121 (59.9) smokers. The adverse outcomes for tuberculosis were significantly increased by an age 37 years; human immunodeficiency virus co-infection; smoking; a lack of support and an absence of directly observed treatment. Inmates who received fewer visits and less social support must be supported by community volunteers; counsellors and psychologists in order to motivate them and enhance favourable treatment outcomes. Smokers need to stop smoking. Younger inmates require peer support groups

Health-Seeking Behaviour of People with Sexually Transmitted Infections in the Community of Nkomazi East; Mpumalanga

The control of sexually transmitted infections (STIs) is a priority for the World Health Organization. It is estimated that there are 11 million cases of STIs per year in South Africa. Health-seeking and sexual behaviours are important in the management of STIs. The aim was to assess the health-seeking behaviour of people who had STIs in the community of Nkomazi East; Mpumalanga. The study design was a descriptive cross-sectional survey. Participants included patients who presented with confirmed signs or symptoms of an STI; were 16 years or older; voluntarily agreed to participate in the study and were residents of the community. A total of 332 questionnaires were collected. The majority of the participants were single; literate; unemployed black patients aged from 16-23 years (43.7). Participants were very knowledgeable about STIs. Urethral discharge; painful micturition; vaginal discharge and lower abdominal pain were the most commonly recognised STI symptoms. All the participants (100) sought help when they thought that they had an STI. Their preferred source of help was the public healthcare sector. Traditional healers were also consulted frequently. While compliance to treatment was satisfactory; ongoing unsafe sexual practices were common among participants who had active STIs. The respondents had a good knowledge of STI symptoms and signs and sought help early; usually from public healthcare facilities. STI health-seeking behaviour was influenced by multiple factors. This study suggests that STI control programmes should be designed around public healthcare facilities. However; adequate knowledge of STIs did not deter many respondents from engaging in unprotected sexual activity; sometimes with multiple partners