ABSTRACT
Background: The burden of stroke is increasing worldwide. The hierarchical healthcare referral system in South Africa (SA) poses unique challenges to clinicians when caring for people with suspected strokes (PsS). To improve health outcomes, novel strategies are required to provide adequate care, including prognostication, in SA. Aim: To determine the subjective burden of and challenges posed by suspected stroke cases and the potential usefulness of biomarkers in prognostication. Setting: This study was conducted in the uMgungundlovu Health District (UHD), KwaZulu-Natal, SA. Methods: An online questionnaire was distributed to doctors within the UHD. Demographic data and answers to a series of 5-point-Likert-type statements were collected. Results: Seventy-seven responses were analysed. A third of doctors worked in primary healthcare facilities (PHCare) and saw ≥ 2.15 suspected strokes-per-doctor-per-week, compared to ≥ 1.38 seen by doctors working in higher levels of healthcare. Neuroimaging was relied upon by > 85% of doctors, with nearly half of PHCare doctors having to refer patients to facilities 5 km - 20 km away, with resultant delays. Knowledge about prognostic biomarkers in strokes was poor, yet most doctors believed that a biomarker would assist in the prognostication process and they would use it routinely. Conclusion: Doctors in this study faced a significant burden of strokes and rely on neuroimaging to guide their management; however, many challenges exist in obtaining such imaging, especially in the PHCare setting. The need for prognostic biomarkers was clear. Contribution: This research lays the platform for further studies to investigate prognostic biomarkers in stroke in our clinical setting.
ABSTRACT
Background: Following the rollout of several effective vaccines against coronavirus disease 2019 (COVID-19), many countries have introduced vaccination passports or certificates as a means of certifying that an individual has been vaccinated against, is immune to, or is presently uninfected with COVID-19. An extensive ethical debate has ensued. Aim: To determine the perspectives of South African healthcare workers (HCWs) on the implementation of COVID-19 vaccination passports (C19VPs) in South Africa (SA). Setting: Healthcare workers working in various fields and practice settings throughout SA were invited to complete an online questionnaire. Methods: An online questionnaire was distributed using convenience sampling via social media platforms to HCWs over a 1-month period, collecting demographic details and responses to 8 Likert-type items regarding agreement with C19VPs, ethical issues and feasibility. Each item was graded from 1 (strongly disagree) to 5 (strongly agree), with grouping of 4 of the 8 items exploring a common theme of C19VPs being a good idea, constituting a score out of 20. Non-parametric tests were performed to determine differences in responses between groups. Results: One thousand HCWs responded to the survey and fulfilled inclusion criteria. The majority (83.2%) of respondents were medical practitioners (MPs). Overall, most (73.5%) respondents agreed that C19VPs are a good idea. Older respondents agreed more strongly than younger respondents (medians 18 and 17, respectively, p = 0.001), and respondents in private practice agreed more strongly than those in state practice (medians 18 and 16, respectively, p = 0.042). The median response was neutral (3) in response to the ethics of C19VPs considering variations in vaccine access and tending towards disagreement (2.5) in disadvantaging poorer people. Most respondents disagreed that vaccine hesitancy would make C19VPs unethical, and responses from provinces with the highest vaccination proportions disagreed more than others with lower vaccination proportion (median 2 compared with 3, p < 0.001). There was uncertainty about the feasibility of C19VPs in SA, with older HCWs, non-students, senior MPs and those who thought C19VPs are a good idea being more likely to consider them feasible. Conclusion: The perspectives of HCWs, mainly MPs, about C19VPs in SA were obtained. Further research should focus on vaccine hesitancy and its factors in HCWs and the effect of C19VPs on restrictions, reduction in transmission and benefits on economies and mental health.
