Post-training and mentorship experiences of KidzAlive-trained healthcare workers at primary healthcare facilities in KwaZulu-Natal, South Africa

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

Prevalence of diabetes mellitus and hypertension in people living with human immunodeficiency virus on antiretroviral therapy in Gweru district, Zimbabwe

Background: While antiretroviral therapy (ART) has markedly increased survival in people living with human immunodeficiency virus (PLHIV), emerging trends of co-existence of non-communicable diseases (NCDs) and HIV could negate the gains already achieved in controlling HIV. Aim: The study aimed to determine the prevalence of hypertension and diabetes mellitus in PLHIV on ART in Gweru district. Setting: Six high-volume ART sites in Gweru district under Midlands province in Zimbabwe. Methods: This was a cross-sectional study. Screening and data collection occurred over a 3-month cycle when all patients were expected to have visited the ART sites for their monthly ART drug supply. The process also allowed the identification of health system challenges regarding data management for HIV-NCD comorbidity. Poisson regression analysis was used to calculate NCD prevalence ratio (PR) in PLHIV. Results: Nearly 18 000 PLHIV registered for ART were identified. Hypertension (19.5%) and diabetes mellitus (8.4%) were the most common NCDs identified with a high proportion of those who did not know their diagnosis (over 50%). The prevalence of hypertension and/or diabetes mellitus among women was 74.9% compared to 25.1% in men (PR 3.22; 95% CI: 3.07­5.51, p = 0.0000). Other factors associated with increased prevalence of hypertension and/or diabetes mellitus were age group of ≥ 60 years (PR 2.5; 95% CI: 1.42­3.22, p = 0.00023), and duration of ≥ 5 years on ART (PR 6.4; 95% CI: 4.70­8.01, p = 0.0011). Separate data collection for NCDs and HIV was a key challenge affecting quantification of magnitude of HIV-NCDs comorbidity and subsequently management of NCDs in PLHIV. Conclusions: Indications of increasing prevalence of NCDs in PLHIV call for integrated electronic data management for HIV, TB and NCDs. This will allow active NCD case finding, and eventually improve prevalence data and treatment for HIV-NCD comorbidity. Future studies should focus on the health experiences and access to treatment in PLHIV diagnosed with NCDs; and to establish the accurate manner in which HIV status, ART and NCDs might be associated, through conducting a case control or cohort study

From malaria control to elimination in South Africa: the researchers' perspectives

Background: Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in eligible countries. However; investigation regarding researchers' perspectives on barriers and facilitating factors to effective implementation of a malaria elimination policy in South Africa (SA) is lacking. Aim: The aim of this study was to investigate the malaria researchers' knowledge, understandings, perceived roles, and their perspectives on the factors influencing implementation of a malaria elimination policy in SA. Setting: Participants were drawn from the researchers who fulfilled the eligibility criteria as per the protocol, and the criteria were not setting-specific. Methods: The study was a descriptive cross-sectional survey conducted through an emailed self-administered semi-structured questionnaire amongst malaria researchers who met the set selection criteria and signed informed consent. Results: Most (92.3%) participants knew about SA's malaria elimination policy; but only 45.8% had fully read it. The majority held a strong view that SA's 2018 elimination target was not realistic; citing that the policy had neither been properly adapted to the country's operational setting nor sufficiently disseminated to all relevant healthcare workers. Key concerns raised were lack of new tools; resources; and capacity to fight malaria; poor cross-border collaborations; overreliance on partners to implement; poor community involvement; and poor surveillance.Conclusion: Malaria elimination is a noble idea; with sharp divisions. However; there is a general agreement that elimination requires: (a) strong cross-border initiatives; (b) deployment of adequate resources; (c) sustainable multistakeholder support and collaboration; (d) good surveillance systems; and (e) availability and use of all effective intervention tools

Knowledge and practices towards malaria amongst residents of Bushbuckridge, Mpumalanga, South Africa

Background: Malaria remains one of the greatest public health challenges worldwide and it is amongst the top killers in sub-Saharan Africa. There is however, a general scepticism about the accuracy of Health Management Information Systems (HMIS) in recording all the episodes of malaria in Africa. Given the importance of community knowledge of malaria, its signs and symptoms, as well as prompt treatment-seeking behaviour, the study assessing adult residents' knowledge and practices in Bushbuckridge provided much needed insights into the Malaria Control Programme (MCP). Objectives: The objectives of this study were to determine the adult residents' knowledge and practices towards malaria in Bushbuckridge, Mpumalanga Province, South Africa. Method: The study was undertaken as a descriptive cross-sectional survey in Bushbuckridge in August 2008. Six hundred and two (602) household heads or their proxies from the randomly selected households in 20 localities were interviewed (one household member per household), using a structured field-piloted questionnaire. Results: Approximately 93% of the respondents had heard about malaria, 84.6% of whom correctly associated it with mosquito bites. The health facility (29.1%) and radio (19.8%) were the main sources of malaria information. Knowledge of signs and symptoms was low, whilst treatment-seeking intention at the health facility was high (99%) with 82% of which would be carried out promptly. Survey data showed an indoor residual spraying (IRS) coverage of approximately 70% and a good understanding of the reasons for spraying. Walls were re-plastered infrequently and no evidence was established linking it to the removal of insecticide marks on the wall. Conclusion: The study revealed not only that householders possessed an adequate knowledge of malaria, but also that they had positive malaria treatment-seeking intentions. Their knowledge of malaria signs and symptoms was inadequate and required attention. Whilst IRS coverage needed some improvements, the reasons for IRS were well known