Community knowledge, attitudes and practices (KAP) on malaria in Swaziland: A country earmarked for malaria elimination

<p>Abstract</p> <p>Background</p> <p>The potential contribution of knowledge, attitudes and practices (KAP) studies to malaria research and control has not received much attention in most southern African countries. This study investigated the local communities' understanding of malaria transmission, recognition of signs and symptoms, perceptions of cause, treatment-seeking patterns, preventive measures and practices in order to inform the country's proposed malaria elimination programme in Swaziland.</p> <p>Methods</p> <p>A descriptive cross-sectional survey was undertaken in four Lubombo Spatial Development Initiative (LSDI) sentinel sites in Swaziland. These sentinel sites share borders with Mozambique. A structured questionnaire was administered to 320 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed.</p> <p>Results</p> <p>A substantial number of research participants showed reasonable knowledge of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and correct treatment practices. Almost 90% (n = 320) of the respondents stated that they would seek treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Most people (78%) perceived clinics and vector control practices as central to treating and preventing malaria disease. Indoor residual spraying (IRS) coverage and bed net ownership were 87.2% and 38.8%, respectively. IRS coverage was in agreement with the World Health Organization's (WHO) recommendation of more than 80% within the targeted communities.</p> <p>Conclusion</p> <p>Despite fair knowledge of malaria in Swaziland, there is a need for improving the availability of information through the preferred community channels, such as <it>tinkhundlas </it>(districts), as well as professional health routes. This recommendation emerges along with the documented evidence suggesting that as the level transmission and disease decreases so does the perception about the importance of malaria control activities. Finally, given the relatively moderate ownership of bed net there is a need for future studies to evaluate the distribution of insecticide-treated nets (ITNs) compared with IRS.</p

From malaria control to elimination in South Africa: The researchers’ perspectives

Background: Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in eligible countries. However, investigation regarding researchers’ perspectives on barriers and facilitating factors to effective implementation of a malaria elimination policy in South Africa (SA) is lacking. Aim: The aim of this study was to investigate the malaria researchers’ knowledge, understandings, perceived roles, and their perspectives on the factors influencing implementation of a malaria elimination policy in SA. Setting: Participants were drawn from the researchers who fulfilled the eligibility criteria as per the protocol, and the criteria were not setting-specific. Methods: The study was a descriptive cross-sectional survey conducted through an emailed self-administered semi-structured questionnaire amongst malaria researchers who met the set selection criteria and signed informed consent. Results: Most (92.3%) participants knew about SA’s malaria elimination policy, but only 45.8% had fully read it. The majority held a strong view that SA’s 2018 elimination target was not realistic, citing that the policy had neither been properly adapted to the country’s operational setting nor sufficiently disseminated to all relevant healthcare workers. Key concerns raised were lack of new tools, resources, and capacity to fight malaria; poor cross-border collaborations; overreliance on partners to implement; poor community involvement; and poor surveillance. Conclusion: Malaria elimination is a noble idea, with sharp divisions. However, there is a general agreement that elimination requires: (a) strong cross-border initiatives; (b) deployment of adequate resources; (c) sustainable multistakeholder support and collaboration; (d) good surveillance systems; and (e) availability and use of all effective intervention tools

Deterrents to Immediate Antiretroviral Therapy Initiation by Pregnant Women Living with HIV in Hhohho Region, Swaziland

Despite robust evidence that immediate antiretroviral therapy (ART)  initiation reduces transmission of HIV from mother to child, some pregnant women living with HIV in sub-Saharan Africa (SSA), and Swaziland in  particular, continue to refuse ART. This study explored the reasons which deter pregnant women living with HIV from immediate ART initiation in the Hhohho region, Swaziland, using grounded theory design. In-depth interviews with ten purposively selected pregnant women who refused immediate ART initiation were carried out in three high volume health facilities. The thematic analysis revealed key reasons that deterred women from immediate ART initiation. These were shock and perceived stigma, participants‘ conceptualisation of health and ART and the fear of ART and its side effects. The study offers qualitative evidence from Swaziland that might help illuminate issues that prevent pregnant women from accepting immediate ART initiation for their own health and that of their children. The evidence generated from this study can be used for developing targeted and culturally appropriate intervention strategies for Swazi women. (Afr J Reprod Health 2018; 22[4]: 72-80).Keywords: Prevention of Mother-to-Child transmission, lifelong ART, pregnant women, barriers, stigma, Swazilan

Lung Cancer Patients&rsquo; Conceptualization of Care Coordination in Selected Public Health Facilities of KwaZulu-Natal, South Africa

Background: Cancer patients commonly receive care, including comprehensive treatment options, from multiple specialists within and across facilities offering varying levels of care. Given this multi-layered approach to cancer care, there is a need for coordinated care enhanced through integrated information flow for optimal patient care and improved health outcomes. Objective: This study aimed to explore how patients conceptualized cancer care coordination in an integrated health care system in KwaZulu-Natal. Methods: The study employed a grounded theory design to qualitatively explore the patients&rsquo; experiences and views on cancer care coordination using in-depth interviews. Guided by the grounded theory principles, data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organize data, and review and interpret comprehensive findings. This process culminated in the development of themes relating to barriers to cancer care coordination and the interface between the primary and tertiary settings. Theoretical saturation was achieved at 21 in-depth interviews with consenting respondents. Results: This study revealed that care coordination was affected by multilevel challenges, including pertinent health system-level factors, such as difficulty accessing specialty care timeously, weak communication between patients and healthcare providers, and unmet needs concerning supportive care. We found that negative experiences with cancer care erode patient trust and receptiveness to cancer care, and patients advocated for better and proactive coordination amongst different care facilities, services, and providers. Conclusions: An integrated care coordination setup is essential to create and sustain a high-performance health care system. These findings make a case for developing, implementing, and evaluating interventions to enhance the quality of cancer care for patients and ultimately improve health outcomes for patients in KwaZulu-Natal. This study will provide comprehensive data to inform professionals, policymakers, and related decisionmakers to manage and improve cancer care coordination

Mapping the factors contributing to long waiting times and interventions to reduce waiting times within primary health care facilities in South Africa: a scoping review protocol

Globally, patient waiting time has been identified as a major characteristics of a functional health system. In South Africa, 83% of the general population must visit the PHC facilities, which is burdened by long waiting times, overcrowding, staff shortages, poor quality of care, ineffective appointment arrangements, and lack of medication. Patients may tend to associate waiting time with poor service quality, especially if the wait is long. PHC facilities often struggle to reduce patient waiting times due to inadequate infrastructure, lack of skilled staff, lack of availability of medicine and equipment and poor documentation of data. This research is aimed mapping evidence on the health system interventions in improving quality of care and reducing waiting times in the outpatient department within PHC facilities

“Why Am I Even Here If I Can’t Save the Patients?”: The Frontline Healthcare Workers’ Experience of Burnout during COVID-19 Pandemic in Mthatha, South Africa

Introduction: Globally, the high prevalence of burnout in healthcare workers (HCWs) is of the utmost concern. Burnout is a state of emotional exhaustion, depersonalization and a decreased sense of personal accomplishment. While the 2019 Coronavirus (COVID-19) exacerbated the burnout prevalence among HCWs, limited studies have explored this phenomenon using qualitative methodologies in the Eastern Cape Province and South Africa generally. This study explored how frontline healthcare workers experienced burnout during the COVID-19 pandemic in Mthatha Regional Hospital. Methods: Ten face-to-face in-depth interviews were conducted with non-specialized medical doctors and nurses who directly cared for COVID-19-infected patients during the pandemic in Mthatha Regional Hospital (MRH). In-depth interviews were digitally recorded and transcribed verbatim. Data were managed through NVIVO 12 software before being thematically analyzed using Colaizzi’s analysis method. Results: Four main themes emerged from the analysis. These themes were burnout manifestation (emotional strain, detachment and irritability, uncertainty-induced fear, and anxiety, physical exhaustion, yet, low job accomplishment, dread and professional responsibility), precursors of burnout (occupational exposure to high mortality, staff shortages, elongated high patient volume and workload, disease uncertainties and consistent feeling of grief), alleviating factors of burnout (time off work, psychologist intervention, periods of low infection rate and additional staff), and the last theme was every cloud has a silver lining (improved infection prevention and control (IPC) measures, learning to be more empathetic, the passion remains and confidence grows). Conclusion: The COVID-19 pandemic brought about a rapid change in the work environment of healthcare workers who are the backbone of efficient healthcare services, thereby rendering them vulnerable to increased burnout risks. This study provides strategic information for policymakers and managers on developing and strengthening welfare policies to promote and protect frontline health workers’ well-being and work functioning

The COVID-19 Impact on the Trends in Yellow Fever and Lassa Fever Infections in Nigeria

Lassa fever (LF) and yellow fever (YF) belong to a group of viral hemorrhagic fevers (VHFs). These viruses have common features and damages the organs and blood vessels; they also impair the body’s homeostasis. Some VHFs cause mild disease, while some cause severe disease and death such as in the case of Ebola or Marburg. LF virus and YF virus are two of the most recent emerging viruses in Africa, resulting in severe hemorrhagic fever in humans. Lassa fever virus is continuously on the rise both in Nigeria and neighboring countries in West Africa, with an estimate of over 500,000 cases of LF, and 5000 deaths, annually. YF virus is endemic in temperate climate regions of Africa, Central America (Guatemala, Honduras, Nicaragua, El Salvador), and South America (such as Brazil, Argentina, Peru, and Chile) with an annual estimated cases of 200,000 and 30,000 deaths globally. This review examines the impact of the COVID-19 pandemic on the trend in epidemiology of these two VHFs to delineate responses that are associated with protective or pathogenic outcomes

Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: A scoping review.

BackgroundKnowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people's knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA).MethodsSystematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O'Malley's framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review's narrative account.ResultsA total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19.ConclusionsMost of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID-19