Communication skills of general practitioners in Nairobi, Kenya: a descriptive observational study

Background High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs. Aim To evaluate the quality of communication in consultations by GPs. Design & setting Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya. Method One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and compared with the GPs’ demographics and the consultation complexity and duration using the Statistical Package for Social Sciences (SPSS, version 25). Results The GPs’ median age was 30.0 years (interquartile range [IQR] 29.0–32.0) and median consultation time was 7.0 minutes (IQR 3.0–9.0). Median overall score was 64.3% (IQR 48.4–75.7). GPs demonstrated skills in gathering information, making and explaining the diagnosis, and suggesting appropriate management. GPs did not make an appropriate introduction, explore the context or patients‘ perspectives, allow shared decision making, or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r = 0.680; P = 0.001). The score was higher in consultations of moderate complexity (78.1, IQR 57.1–86.7) versus low complexity (52.2, IQR 45.1–66.6) (P = 0.012). Conclusion Consultations were brief and biomedical by young GPs. GPs need further training in communication skills, particularly with regard to delivering person-centred consultations. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery

The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey

Background: Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of informa- tion on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods: A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences. Results: Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of \u3e3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of \u3c 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good. Conclusion: These primary care clinics in Nairobi showed gaps in performance. Performance was rated as accept- able-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, compre- hensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population

The clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study

Background Quality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, general practitioners (GP), with no post-graduate training in family medicine, offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya. Aim To evaluate GPs’ training and experience in the skills required for comprehensive primary care. Design and setting A cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, Kenya Method A questionnaire, originally designed for a national survey of primary care doctors in South Africa, was adapted. The study collected self-reported data on performance of clinical skills by 25 GPs. Data were analysed in the Statistical Package for Social Sciences. Results GPs were mostly under 40 years, with less than 10 years of experience and an equal gender distribution. GPs reported moderate performance with adult health, communication and consultation, and clinical administration; and weak performance with emergencies, child health, surgery, ear-nose-and-throat, eyes, women’s health and orthopaedics. The GPs lacked training in specific skills such as proctoscopy, contraceptive devices, skin procedures, intra-articular injections, red reflex test and use of a genogram. Conclusion General practitioners lacked training and performed poorly in some of the essential skills required in primary care. Continuing professional development, training in Family Medicine and deployment of family physicians to the clinics could improve the comprehensiveness of care

Faith-based organisations and HIV prevention in Africa : a review

CITATION: Mash, R. & Mash, R. 2013. Faith-based organisations and HIV prevention in Africa: A review. African Journal of Primary Health Care & Family Medicine, 5(1): 1-6, doi: 10.4102/phcfm.v5i1.464.The original publication is available at http://www.phcfm.orgBackground: Faith-based organisations (FBOs) are potentially an important role-player in HIV prevention, but there has been little systematic study of their potential strengths and weaknesses in this area. Objectives: To identify the strengths and weaknesses of FBOs in terms of HIV prevention. The questions posed were, (1) ‘What is the influence of religion on sexual behaviour in Africa?’, and (2) ‘What are the factors that enable religion to have an influence on sexual behaviour?’. Method: A literature search of Medline, SABINET, Africa Wide NIPAD and Google Scholar was conducted. Results: The potential for Faith-based organisations to be important role-players in HIV prevention is undermined by the church’s difficulties with discussing sexuality, avoiding stigma, gender issues and acceptance of condoms. It appears that, in contrast with high-income countries, religiosity does not have an overall positive impact on risky sexual behaviour in Africa. Churches may, however, have a positive impact on alcohol use and its associated risky behaviour, as well as self-efficacy. The influence of the church on sexual behaviour may also be associated with the degree of social engagement and control within the church culture. Conclusion: Faith-based organisations have the potential to be an important role player in terms of HIV prevention. However, in order to be more effective, the church needs to take up the challenge of empowering young women, recognising the need for their sexually-active youth to use protection, reducing judgemental attitudes and changing the didactical methods used.http://www.phcfm.org/index.php/phcfm/article/view/464Publisher's versio

The anthropocene – the biggest threat to health on the African continent

CITATION: Mash, R., et al. 2019. The anthropocene – the biggest threat to health on the African continent. African Journal of Primary Health Care and Family Medicine, 11(1):a2151, doi:10.4102/phcfm.v11i1.2151.The original publication is available at https://phcfm.org/index.php/phcfmNo abstract available.https://phcfm.org/index.php/PHCFM/article/view/2151Publisher's versio

The Astana Declaration and future African primary health care

No abstract available

Conference report: Undergraduate family medicine and primary care training in Sub-Saharan Africa : reflections of the PRIMAFAMED network

Internationally, there is a move towards strengthening primary healthcare systems and encouraging community-based and socially responsible education. The development of doctors with an interest in primary healthcare and family medicine in the African region should begin during undergraduate training. Over the last few years, attention has been given to the development of postgraduate training in family medicine in the African region, but little attention has been given to undergraduate training. This article reports on the 8th PRIMAFAMED (Primary Care and Family Medicine Education) network meeting held in Nairobi from 21 to 24 May 2016. At this meeting the delegates spent time presenting and discussing the current state of undergraduate training at 18 universities in the region and shared lessons on how to successfully implement undergraduate training. This article reports on the rationale for, information presented, process followed and conclusions reached at the conference

Reasons for inconsistent condom use by young adults in Mahalapye, Botswana

Background: Botswana is one of the countries significantly affected by the HIV and AIDS epidemic. Despite an extensive preventive campaign, the incidence of HIV remains high.Condoms are an important contributor to prevention of new HIV infections, although they are not consistently used by young adults. Aim: The aim of this study was to explore the reasons why condoms are not consistently usedby young adults. Setting: Mahalapye District Hospital and Airstrip Clinic, Botswana. Method: This was a phenomenological qualitative study using individual in-depth interviews.Eleven participants were purposively selected, including six males and five females. Data were transcribed and analysed using the framework method. Results: All participants acknowledged the importance of utilising condoms to prevent unplanned pregnancies and sexually transmitted infections. Reasons not to use condoms were a need to have a child,implied lack of trust or faithfulness, long-term relationships need to please the partner and decreased pleasure. Other contributing factors were lack of knowledge of benefits, less fear of contracting HIV and AIDS as it can now be controlled with medication,influence of tradition, alcohol and drug abuse, peer pressure, power and gender issues and the refusal of the partner. The female condom was largely rejected by young adults in general and by women in particular because of its size and the perception that it is complicated to insert. Conclusion: The current preventive campaign against HIV and AIDS needs to take cognisance of the factors affecting decisions on the use of condoms by young adults and the obstacles to their use, particularly the new belief that HIV and AIDS is no longer a significant concern

Multimorbidity in non-communicable diseases in South African primary healthcare

Background. Multimorbidity in non-communicable diseases (NCDs) is a complex global healthcare challenge that is becoming increasingly prevalent. In Africa, comorbidity of communicable diseases and NCDs is also increasing.Objectives. To evaluate the extent of multimorbidity among patients with NCDs in South African (SA) primary healthcare (PHC).Methods. A dataset obtained from a previous morbidity survey of SA ambulatory PHC was analysed. Data on conditions considered active and ongoing at consultations by PHC providers were obtained.Results. Altogether 18 856 consultations were included in the dataset and generated 31 451 reasons for encounter and 24 561 diagnoses. Hypertension was the commonest NCD diagnosis encountered (13.1%), followed by type 2 diabetes (3.9%), osteoarthritis (2.2%), asthma (2.0%), epilepsy (1.9%) and chronic obstructive pulmonary disease (COPD) (0.6%). The majority of patients (66.9%) consulted a nurse and 33.1% a doctor. Overall 48.4% of patients had comorbidity and 14.4% multimorbidity. Multimorbidity (two or more conditions) was present in 36.4% of patients with COPD, 23.7% with osteoarthritis, 16.3% with diabetes, 15.3% with asthma, 12.0% with hypertension and 6.7% with epilepsy. Only 1.1% also had HIV, 1.0% TB, 0.4% depression and 0.04% anxiety disorders.Conclusion. About half of the patients with NCDs had comorbidity, and multimorbidity was common in patients with COPD and osteoarthritis. However, levels of multimorbidity were substantially lower than reported in higher-income countries. Future clinical guidelines, training of PHC nurses and involvement of doctors in the continuum of care should address the complexity of patients with NCDs and multimorbidity