On being a caregiver: The experiences of South African family caregivers caring for cancer patients.

The purpose of our study was to describe the experiences of family caregivers of cancer patients using the public healthcare system in South Africa. We used a qualitative descriptive design and conducted in-depth interviews with 20 purposively selected family caregivers. Data saturation determined the sample size, and qualitative content analysis was used to analyse the data. Three themes arose from the data: emotional responses and feelings towards the cancer diagnosis, fulfilling the role of the caregiver and living and coping with a changed life and a changed person. Caring for a person with cancer was not easy. Participants were overwhelmed with the care responsibilities, which were aggravated by poverty. Some felt emotionally broken and alone in this journey and experienced the rest of their family as uncaring. The lives the participants knew changed and they had to put their own lives on hold and make sacrifices involving their children, work, possible relationships and their normal activities to care for the sick person. For some, the sick person they cared for changed and became a person they did not know. Most participants used religious practices to cope with their situation; however, some used other coping mechanisms, such as recreation and even smoking.

'It depends on how the relationship was before you became ill': black South African women's experiences of life partner support through the trajectory of cervical cancer.

Spouses are the primary source of support for married patients and patients suffering from gynaecological cancers and play a major role in the positive, or negative, management of the disease and treatment. The purpose of the study was to explore the experiences of life partner support among hospitalised women receiving treatment for cervical cancer at an academic hospital in Tshwane, South Africa. An exploratory, qualitative study was conducted using a convenience sampling method. Seventeen (n = 17) women were interviewed. The data were analysed using open coding and a template analysis style. The support women treated for cervical cancer received from their life partner varied. Some were fully supported while others received limited support and some were even abandoned. Both the women and their life partners were challenged in terms of giving and receiving support. How the support they received from their life partners influenced their quality of life is not known and should be the next exploratory step before designing and testing a support intervention to maximise the outcomes for these patients.

Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a Community Health Worker: a pilot intervention study.

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.

The findings of a nurse-lead intervention for detection and prevention of oral cancer. A pilot study.

Despite the fact that South African men are among the group having the highest risk of developing oral cancer there is currently no population-based primary and secondary prevention services for oral cancer in South Africa. This study aimed to develop an intervention focusing on the prevention and detection of oral cancer and pilot test the intervention in a semi-urban resource-poor community in Tshwane. The intervention was assessed in terms of screening uptake, knowledge and awareness of oral cancer and perception of the educational material developed for the intervention. Statistics were used to calculate screening uptake while a pre- and post-intervention design was used to determine knowledge and awareness and perception of the educational material. Sampling was purposive and all people reporting for oral screening were recruited for the study. The sample totalled 65 (n= 65) and the participation rate was 100%. Notwithstanding a favourable report on the flyer as motivator to take up oral screening the number of people especially those in the high-risk group who reported for screening was disappointing. However, the strategy used to improve knowledge and awareness was successful. Ways to improve screening uptake should be explored and tested to improve the current intervention.

Combining breast and cervical screening in an attempt to increase cervical screening uptake. An intervention study in a South African context.

During 2008-2009, only 4% of women targeted for cervical screening were screened in Tshwane, South Africa. The purpose of the study was to determine whether cervical screening uptake could be improved when breast and cervical screening are combined. An intervention research design was used. The intervention was assessed in terms of two outcomes, namely cervical screening uptake and the findings of the screening. The study was conducted in a resource poor environment in Tshwane. Convenience sampling was used to recruit the sample (n = 299) and a baseline survey was conducted before delivering the intervention. Only 14% of the sample (n = 299) reported having been screened for cervical cancer previously. The total sample (n = 299) were willing to have a clinical breast examination; however, only 65.4% of those eligible for cervical screening (n = 283) used the opportunity to be screened. The majority of the sample screened (n = 185) using acetic acid for visual inspection (VIA) were VIA negative; 12.4% were VIA positive and 4.4% were VIA positive, invasive cancer; the screening of 8.7% failed. Despite women's lack of knowledge of cervical cancer and the screening thereof, combining cervical screening and breast screening lead to an increase in cervical screening uptake.

Men's lack of knowledge adds to the cervical cancer burden in South Africa.

The purpose of the study was to determine the level of knowledge regarding cervical cancer among Black men living in Ga-Rankuwa, South Africa. A quantitative survey was conducted. The population consisted of 980 (n = 980) convenience sampled men. Self-reported data were gathered using a structured interview and a pre-tested questionnaire served as data gathering instrument. The study provided evidence that men living in Ga-Rankuwa did not have knowledge of cervical cancer. None of the sample mentioned the HPV as risk factor while some knew that having multiple sexual partners add to a woman's risk. It is, however, doubtful whether the respondents experienced themselves as those with the multiple partners. More than 90% of the sample (n = 963) reported to have had more than one sexual partner in the previous 5 years while less than a quarter indicated that they would have to change their sexual behaviour to prevent cervical cancer. Men add to the cervical cancer burden in South Africa as their knowledge would not enable them to protect their partners from HPV infections, motivate them to be screened or allow them to protect themselves against this dreadful disease.

No Condom; No Sex': Easy to Say; but not Possible for all South African women

Cervical cancer is the most common cancer in South African women. The human papillomavirus (HPV) is the biggest risk factor for developing this cancer. However; condom use protects against HPV transmission. The purpose of the study was to investigate whether Black women living in Tshwane; South Africa; were able to protect themselves against cervical cancer by insisting on condom use. The study was exploratory; qualitative and contextual; and a convenience snowball sampling method was used. The sample size was determined through data saturation (n = 20). Self-reported data were gathered by means of interviews; and analysed using Tesch's approach. Four themes emerged; (1) knowledge of cervical cancer; (2) sexual behaviour; (3) social problems and (4) emotions. The study provided evidence that women were not able to protect themselves from cervical cancer by insisting on condom use. Women lacked knowledge of cervical cancer and did not associate condom use with self-protection against this disease. Most of their sex partners refused to use condoms. Poverty; physical abuse; helplessness and fear prevented women from insisting on the use of condoms. Primary prevention strategies should focus on empowering women to protect themselves from cervical cancer and not leave this important issue to someone who might refuse it

Treatment of oral thrush in HIV/AIDS patients with lemon juice and lemon grass (Cymbopogon citratus) and gentian violet.

PURPOSE: The purpose of the study was to investigate the safety and efficacy of lemon juice and lemon grass (Cymbopogon citratus) in the treatment of oral thrush in HIV/AIDS patients when compared with the control group using gentian violet aqueous solution 0.5%. Oral thrush is a frequent complication of HIV infection. In the Moretele Hospice, due to financial constraints, the treatment routinely given to patients with oral thrush is either lemon juice directly into the mouth or a lemon grass infusion made from lemon grass (Cymbopogon citratus) grown and dried at the hospice. These two remedies have been found to be very efficacious therefore are used extensively. Gentian violet, the first line medication for oral thrush in South Africa, is not preferred by the primary health clinic patients due to the visible purple stain which leads them to being stigmatized as HIV-positive. Cymbopogon citratus and Citrus limon have known antifungal properties. METHODS: The study design was a randomised controlled trial. Ninety patients were randomly assigned to one of three groups: gentian violet, lemon juice or lemon grass. Inclusion criteria included being HIV-positive with a diagnosis of oral thrush. The study period was 11 days and patients were followed up every second day. International ethical principles were adhered to during the study. RESULTS: Of the 90 patients, 83 completed the study. In the intention-to-treat analysis, none of the p-values were significant therefore the null hypothesis could not be rejected. In the analysis of the participants who actually completed the trial, the lemon juice showed better results than the gentian violet aqueous solution 0.5% in the treatment of oral thrush in an HIV-positive population (p<0.02). The null hypothesis in terms of the lemon grass and gentian violet could also be rejected on the basis of the Chi-square test and the likelihood ratio test (p<0.05). CONCLUSIONS: Though the patient population was small, the use of lemon juice and lemon grass for the treatment of oral candidiasis in an HIV population was validated by the randomised controlled trial.

Palliative care: a positive outcome for cancer patients?

The development of palliative care in terms of recognizing the needs of the dying, palliative care becoming a nursing and medical speciality, the involvement of the World Health Organization in palliative care and the continuous development of treatment modalities available to cancer patients creates the expectation that the outcomes for the patient should also be positively influenced. The purpose of the study was to determine the most common symptoms of advanced cancer patients treated in a public and private hospital in Tshwane, and whether advances in palliative care improved the outcomes for these patients by decreasing the prevalence of symptoms experienced. The design of the study was a quantitative survey. The population consisted of patients with advanced cancer receiving palliative treatment as out patients in radiation and medical oncology clinics in a public and private hospital the Tshwane Metropolitan area. The sampling method was convenient and the sample size was 148 participants (n = 148). Data was gathered by means of an interview and self report. Data analysis was done by means of descriptive statistics. The results of the study indicated that a high number of patients still experience problems that could have been prevented. Pain was found to be the biggest problem for patients (76.4%) followed by weakness and fatigue (65.5%), nausea and vomiting (65.5%) and a dry mouth (46.6%). Thirst was reported by 41.2% of the sample. The study provides evidence that the development of palliative care did not have a positive outcome for patients by reducing the prevalence of symptoms experienced.

Health care practices influencing health promotion in urban black women in Tshwane.

Health promotion is a multifaceted activity. Women and children are particularly vulnerable regarding access to quality health care, with young African women reportedly the poorest and most economically marginalised and least educated sector in South Africa. Understanding the context within which a person lives is an essential component in the health educator's teaching strategy. Understanding urban black women's health care practices will enable health promoters to develop interventions that are successful. The problem investigated was to gain an understanding of the health care practices of urban black women that could influence health promotion activities. The design was qualitative exploratory. The respondents were women living in an urban township in Tshwane, South Africa. The sampling method was convenient and purposive and the sample size was determined by saturation of the data. Data was gathered through semi-structured interviews using six specific themes and the analysed using open coding. The results indicated that the social environment created by the registered nurses in the primary health influenced the health care practices of the women negatively. Practices regarding the seriousness of a health problem suggest a possible reason for late admission of a person with a serious health problem.