Towards universal health coverage for people with stroke in South Africa: a scoping review.

OBJECTIVES: To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA). SETTING: SA. DESIGN: Scoping review. SEARCH METHODS: We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results. RESULTS: Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available. CONCLUSION: This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

Physiotherapists awareness of bone demineralisation and falls risk in people living with HIV and their perceptions about fall risks management

Thesis (MScPhysio)--Stellenbosch University, 2020.ENGLISH SUMMARY : Background: Sub-Saharan Africa has the greatest disease burden due to HIV globally. Improved access to better antiretroviral regimens has increased numbers and longevity of people living with HIV (PLWH). However, recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss at younger-than-expected ages in PLWH. The benefits of anti-retroviral drugs may be overshadowed if PLWH suffer from excess morbidity such as falls, fractures and functional impairments. Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim: This research aimed to describe the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. It further aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions about current falls prevention in the care of PLWH in selected regions of sub-Saharan Africa. Method: The research consisted of a scoping review and a primary study. The scoping review included peer-reviewed studies (excluding narrative reviews) available in English with any information referring to falls in PLWH. Any data regarding bone demineralisation in these studies were also extracted. The results were used to explain concepts arising from the qualitative study. In the primary study, an interpretative exploratory qualitative research method with a phenomenological approach was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. Results: The scoping review identified 14 studies on falls in PLWH, with all but one study published in high income countries (HIC). Prevalence of falls in PLWH approximated that of seronegative counterparts, but the studies were mostly in middle-aged to older adults in whom geriatric syndromes may already be prevalent. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention as perceived by the physiotherapists were sub-optimal and lacked a patient-centred approach. Conclusion: Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH. More awareness also needs to be created among other healthcare professionals and PLWH. Meanwhile, research on falls in younger PLWH and in sub-Saharan Africa, where HIV is most prevalent and where more robust clades exist, is needed. Relevant stakeholders including governments and PLWH themselves require concerted efforts in addressing health system challenges affecting the implementation of falls prevention services to PLWH at primary care level.AFRIKAANSE OPSOMMING : Agtergrond: Sub-Sahara-Afrika het die grootste siektelas as gevolg van MIV wêreldwyd. Verbeterde toegang tot beter antiretrovirale regimens het die aantal en lewensverwagting van mense wat leef met MIV (MLM) verhoog. Nogtans dui onlangse navorsing op ‘n skynbaar verhoogte geneigdheid tot valle asook versnelde beenverlies in jonger-as-verwagte MLM. Die voordele van antiretrovirale medikasie kan oorskadu word as MLM ly aan oormatige morbiditeit, soos valle, frakture en funksionele gestremdhede. Fisioterapeute speel ʼn belangrike rol in die optimalisering van funksie en lewenskwaliteit in MLM deur die voorkom van valle en die vermindering van die skade waartoe dit lei. Doel: Die doel van hierdie navorsing was om die omvang en aard van bestaande navorsing rakende val in MLM te beskryf, en ook om die verband tussen verminderde beendigtheid en valle in MLM te beskryf. Die navorsing het verder ten doel gehad om fisioterapeute se bewustheid van val-risiko en versnelde beendigtheidvermindering in MLM, asook hul persepsies oor huidige valvoorkoming in die sorg van MLM, in geselekteerde streke in sub-Sahara-Afrika te ondersoek. Metodes: Die navorsing het bestaan uit ʼn omvangsbepaling en ʼn primêre kwalitatiewe studie. Die omvangsbepaling het ingesluit eweknie-geëvalueerde studies (uitsluitend narratiewe oorsigte) met enige inligting rakende valle in MLM en wat in Engels beskikbaar was. Enige data aangaande verminderde beendigtheid is ook onttrek uit die studies. Die resultate is gebruik om konsepte voortspruitend uit die kwalitatiewe studie te verduidelik. In die primêre studie is ʼn interpretatiewe verkennende kwalitatiewe navorsingsmetode met ʼn fenomenologiese benadering gebruik om fisioterapeute se persepsies en ervarings rakende beengesondheid en valle in MLM te ondersoek. In-diepte semi-gestruktureerde telefoniese onderhoude is gebruik om data in te samel van fisioterapeute wat in primêre MIV-sorg werk. Hoofresultate: Die omvangsbepaling het 14 studies oor valle in MLM geïdentifiseer. Al die studies, behalwe een, was publikasies vanuit hoë-inkomste lande. Die prevalensie van valle in MLM en hul seronegatiewe eweknieë was soortgelyk, maar die studies het egter meestal middeljariges tot ouer volwassenes ingesluit, in wie geriatriese sindrome alreeds mag voorkom. Aansienlike konsensus is bevind aangaande medikasiegebruik as ‘n risikofaktor, terwyl die bewyse vir funksionele- en kognitiewe gestremdhede as risikofatore wisselvallig was. Min studies het risikofaktore vir valle in MLM vergelyk met dié in ouderdoms- en geslags-vergelykbare seronegatiewe bevolkings. Tans is daar geen bewyse vir ingrypings om die valrisiko in MLM te verminder of voorkom nie. Die primêre studie het ‘n gebrekkige bewustheid omtrent verhoogte valrisiko en verminderde beendigtheid in MLM onder fisioterapeute onthul. Fisioterapeute het as sulks nie valle of frakture aan MIV of antiretrovirale behandeling gekoppel wanneer hulle wel sulke gebeure tydens hul algemene pasiënt-ondersoeke waargeneem het nie. In retrospek kon sommige fisioterapeute egter risikofaktore wat verband hou met val by mense met MIV, herken. Huidige dienste vir val-voorkoming, soos waargeneem deur fisioterapeute, is bemerk as suboptimaal en het nie ʼn pasiënt-gesentreerde benadering nie. Gevolgtrekking: Dit mag nodig wees vir fisioterapeute om meer bewus te wees van die potensiële valrisiko en verminderde beendigtheid in MLM en om roetineweg te assesseer vir die verskynsels in ouer sowel as jonger MLM. Groter bewustheid moet ook geskep word onder ander gesondheidsorgwerkers en MLM. Intussen is meer navorsing nodig omtrent valle in jonger MLM en in sub-Sahara-Afrika, waar MIV mees algemeen, en as robuuster klades, voorkom.Master

Falls in people living with HIV: a scoping review

Objectives Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.Methods A scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.Results Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.Conclusion More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed

Bridging the chasm between patients’ needs and current rehabilitation care: perceptions of adults presenting for primary care in the Eastern Cape

Abstract Background The need for rehabilitation in low-to-middle income countries (LMICs) is rapidly increasing as more people are living longer with chronic diseases. Primary health care (PHC) is ideally placed to provide the spectrum of care required to meet most of the complex and evolving population's health needs locally. This study aimed to describe the patient journeys of adults attending primary care in the Eastern Cape province of South Africa to understand the factors that affected their access to primary care rehabilitation services (or the lack thereof) and obtain suggestions on how rehabilitation may be enhanced at primary care. Methods A maximum variation sampling approach was used to purposefully select persons with varied chronic health conditions and demographic characteristics to gain diverse perspectives regarding their rehabilitation needs and ways in which the current rehabilitation services at primary care may be enhanced. Data were collected via face-to-face semi-structured interviews between March and June 2022 which were electronically recorded. Inductive thematic analysis of transcribed data was done and coded in Atlas.ti.22®. Results Twenty-five adult patients participated in the study. The patients had different experiences at their local PHC facilities that affected their access to rehabilitation at primary care. The study found that most patients were not able to access rehabilitation at primary care. There were several personal and contextual factors that resulted in the patients having a low perceived need to receive rehabilitation that potentially lowered patients' demand for and utilization of rehabilitation at primary care. Patients suggested increasing rehabilitation workforce at primary care, improving availability of assistive devices, increasing their knowledge regarding rehabilitation, and facilitating socio-economic integration into their communities. Conclusions Patients attending primary care are not guaranteed access to rehabilitation by virtue of having entered the PHC system. It is important to consider the patient perspectives regarding their health needs and suggestions for enhancing care

Towards strengthening of rehabilitation at primary care: exploring the needs and perspectives regarding rehabilitation services in two low resource contexts

File A: Coded data from participant responses for adult patients and primary care providers from the Eastern Cape (EC), South Africa (SA) and Manicaland, Zimbabwe.</p

Development of an innovative strategy to determine functioning attributed to health conditions in low-resource settings

Objectives Rehabilitation is a health strategy that aims to reduce functioning problems. There is a lack of country-level data on the burden and type of functioning problems to inform service planning and management of patients’ rehabilitation needs, particularly at primary care level in low-resource settings. Health researchers need an application that automates synthesis of data extracted from several peer-reviewed publications to determine the most prevalent functioning problems compared across several health states. This article describes the journey leading to the conceptualization and development of the Rehab4all application and compares the application's performance to a standard desktop program. Methods A descriptive case study approach was used to report on the following steps involved in the development of the web-based Rehab4all application: (i) preliminary literature review to assess the evidence gap of country-level data on functioning problems comparable across several health states; (ii) an initial attempt to perform data extraction and synthesis in Excel; (iii) design and development of Rehab4all ; (iv) piloting of the Rehab4all application; and (v) implementation of application with input data from South Africa and Zimbabwe. Results The Rehab4all application offers a feasible solution for synthesizing data from several peer-reviewed publications to provide information on context-specific, priority functioning problems at country level through the integrated global International Classification of Functioning, Disability and Health Framework (ICF). Conclusion This bespoke innovation provides impetus for further development, profile comparison and shared information between countries to co-develop strategies which can strengthen rehabilitation service delivery

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke