A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa.

BACKGROUND: Cervical cancer is a preventable but highly prevalent cancer in many low -and middle-income countries including South Africa. Cervical cancer outcomes can be improved with improved vaccination, a well-coordinated and efficient screening programme, increased community awareness and uptake, and increased knowledge and advocacy of health professionals. This study therefore aimed to ascertain the knowledge, attitudes, practices and barriers of cervical cancer screening among nurses of selected rural hospitals in South Africa. METHODS: A quantitative cross-sectional study was conducted in five hospitals in the Eastern Cape Province of South Africa between October and December 2021. A self-administered questionnaire was used to assess demographic characteristics of nurses and cervical cancer knowledge, attitudes, barriers and practices. A knowledge score of 65% was deemed adequate. Data were captured in Microsoft Excel Office 2016 and exported to STATA version 17.0 for analysis. Descriptive data analyses were used to report the results. RESULTS: A total of 119 nurses participated in the study with just under two thirds (77/119, 64.7%) being professional nurses. Only 15.1% (18/119) of participants were assessed as having obtained a good knowledge score of ≥ 65%. The majority of these (16/18, 88.9%) were professional nurses. Of the participants with a good knowledge score, 61.1% (11/18) were from Nelson Mandela Academic Hospital, the only teaching hospital studied. Cervical cancer was deemed to be a disease of public health importance by 74.0% (88/119). However, only 27.7% (33/119) performed cervical cancer screening. Most of the participants (116/119, 97.5%) had an interest of attending more cervical cancer training. CONCLUSION: The majority of nurse participants did not have adequate knowledge about cervical cancer and screening, and few performed screening tests. Despite this, there is a high level of interest in being trained. Meeting these training needs is of utmost importance to implementing a comprehensive cervical cancer screening programme in South Africa.

Protocol of mixed-methods assessment of demographic, epidemiological and clinical profile of decentralised patients with cancer at Nelson Mandela Academic Hospital and Rob Ferreira Hospital, South Africa.

INTRODUCTION: Cancer is the second leading cause of death globally. However, cancer care services are often concentrated in urban centres. Two of South Africa's hospitals have decentralised cancer care delivery since February 2018 and August 2019, respectively. This study aims to describe the demographic, epidemiological and clinical profile of various cancers at Nelson Mandela Academic Hospital (NMAH) and Rob Ferreira Hospital (RFH), in South Africa's Eastern Cape and Mpumalanga provinces, respectively. METHODS AND ANALYSIS: This study will be conducted in the Eastern Cape and Mpumalanga provinces. A mixed-methods study design will be undertaken to gain insight on the characteristics of randomly sampled patients who are treated for cancer at NMAH and RFH between 1 March 2018 and 28 February 2022. A validated, researcher-administered survey questionnaire will be used to assess demographic characteristics, and prevalence of different cancers among patients. Concurrently, a document review will be undertaken on patients with cancer using a patient registry to ascertain the duration of diagnosis, type of cancer(s), management plan and patient survival time. STATA V.17 will be used for data analysis. The Shapiro-Wilk test will be used to explore the distribution of numerical variables. The χ2 or Fisher's exact tests will be used depending on the value of the expected frequencies to compare categorical variables. Kaplan-Meier survival estimates will be used to determine the survival time. Hazard ratios will be used to determine the predictors of death. The level of statistical significance will be set at p value ≤0.05. The 95% CI will be used for the precision of estimates. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committees of the University of the Witwatersrand (M210211) and Walter Sisulu University, South Africa (Ref: 040/2020). Findings will be reported through peer-reviewed journal(s), presentations at conferences and at partner meetings.

Model of delivery of cancer care in South Africa's Eastern Cape and Mpumalanga provinces: a situational analysis protocol.

INTRODUCTION: Cancer contributes to a significant proportion of morbidity and mortality globally. Low-income and middle-income countries such as South Africa tend to be characterised by poor and inequitable access to cancer services. Cancer resources are more likely to be found in urban areas, tertiary centres and quaternary hospitals. However, little is known about the linkages to care, continuity of care and packages of cancer care in rural South African settings. This study describes cancer service delivery for South Africa's Eastern Cape and Mpumalanga provinces. METHODS AND ANALYSIS: A mixed-methods qualitative and quantitative research methods of three substudies which include semistructured interviews with patients, focus group discussions with health providers and a quantitative record review that will be carried out at both Rob Ferreira hospital, Witbank hospital and Nelson Mandela Academic hospital in Mpumalanga and Eastern Cape province, respectively. Instruments assess demographic characteristics, explore packages of cancer care, explore challenges experienced by health professionals, and maps out the referral pathway of patients with a cancer diagnosis in the study sites. Numerical, quantitative data will be explored for normality using the Shapiro-Wilk test and reported using either the mean, SD and range or the median and IQR depending on the normality of the distribution. Qualitative data will be analysed using the phenomenological approach. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committee of Walter Sisulu University (040/2020) and the University of the Witwatersrand (M210211), South Africa. To the research team's knowledge, this is the first study presenting the model of cancer delivery in South Africa's Eastern Cape and Mpumalanga province. This will thus provide better understanding of cancer service delivery systems, packages of cancer care from primary care to quaternary care.

Lessons Learnt during the Implementation of WISN for Comprehensive Primary Health Care in India, South Africa and Peru.

INTRODUCTION: The World Health Organization introduced the workload indicators of staffing needs (WISN) in 1998 to improve country-level health workforce planning. This study presents the primary care health workforce planning experiences of India, South Africa and Peru. METHODS: A case study approach was used to explore the lessons learnt in the implementation of WISN in India and South Africa. It also describes the methods developed and implemented to estimate health workforce in Peru. We identify the barriers and facilitators faced by countries during the implementation phase through the triangulation of literature, government reports and accounts of involved health planners in the three countries. RESULTS: India implemented WISN in a referral pathway of three district health facilities, including a primary health centre, community health centre and district hospital. Implementation was impeded by limited technical support, poor stakeholder consultation and information systems challenges. South Africa implemented WISN for health workforce planning in primary care and found the skills mix and staff determinations to be unaffordable. The Peruvian Ministry of Health considered using WISN but decided to develop a context-specific tool to estimate the health workforce needed using its available resources such as the National Register of Health Personnel. The main challenge in using WISN was the insufficient information on its inputs. CONCLUSION: While India and South Africa had unique experiences with the integration of WISN in their health system, none of the countries has yet benefited from the implementation of WISN due to financial, infrastructure and technical challenges. Since the methodology developed by the Peruvian Ministry of Health is context-specific, its implementation has been promising for health workforce planning. The learnings from these countries' experiences will prove useful in bringing future changes for the health workforce.

Barriers to the Implementation of the HIV Universal Test and Treat Strategy in Selected Primary Care Facilities in South Africa's Eastern Cape Province.

BACKGROUND: The South African government implemented the Universal Test and Treat (UTT) approach to treating HIV in the second half of 2016. As part of a contribution to the successful implementation of UTT, this study looked at barriers to implementation of UTT emanating from weaknesses of the health system in 2 Community Health Centers in South Africa's Eastern Cape Province. METHODS: This was a quantitative cross-sectional design which had both descriptive and analytical components. Convenience sampling was used to select and recruit 2 primary care facilities and 30 nurses. Self-administered questionnaires were used to solicit data from facility managers and nurses. In addition, a record review was used to access 6 months' data for the period 1 October 2017 to 31 March 2018. Data were analyzed using Stata 14.1. Categorical data were presented using frequency and contingency tables. The 95% confidence interval (95% CI) is used for the precision of estimates and the P-value of statistical significance is P < .05. RESULTS: Facilities were found to have poor leadership and governance; human resource challenges that include shortages, lack of skills and lack of developmental support; poorly resourced service delivery platforms and poor information management. Of the three 90-90-90 targets, health facilities only satisfactorily achieved the second 90 of initiating all who test positive for HIV within a week (93.1% or n = 288/307). CONCLUSIONS: This study has been able to identify potential barriers to the implementation of the UTT strategy at the selected facilities including the lack of structured programs in place to monitor performance of healthcare staff, knowledge gaps, and a lack of good clinical governance practices as evidenced by the lack of customized protocols and Standard Operating Procedures.