Healthcare Workers In South Africa Research Articles

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program.

We developed a motivational interviewing (MI) counselling training and support program for lay counsellors in South Africa-branded "Thusa-Thuso-helping you help", commonly referred to as Thusa-Thuso. We present the results of a pilot study to determine the program's impact on MI technical skills and qualitatively assess the feasibility of a training-of-trainers (TOT) scale-up strategy among counselling staff of non-governmental (NGO) support partners of the human immunodeficiency virus (HIV) treatment program in South Africa. We enrolled adult (≥ 18 years) lay counsellors from ten primary healthcare clinics in Johannesburg (South Africa) selected to participate in the Thusa-Thuso training and support program. Counsellors attended the ten-day baseline and quarterly refresher training over 12 months (October 2018-October 2019). Each counsellor submitted two audio recordings of mock counselling sessions held during the ten-day baseline training and two additional recordings of sessions with consenting patients after each quarterly contact session. We reviewed the recordings using the MI treatment integrity (MITI) coding system to determine MI technical (cultivating change talk and softening sustain talk) and relational (empathy and partnership) competency scores before and after training. After 12 months of support with pilot site counsellors, we were asked to scale up the training to NGO partner team trainers in a once-off five-day Training of trainers (TOT) format (n = 127 trainees from November 2020 to January 2021). We report TOT training experiences from focus group discussions (n = 42) conducted six months after the TOT sessions. Of the 25 enrolled lay counsellors from participating facilities, 10 completed the 12-month Thusa-Thuso program. Attrition over the 12 months was caused by death (n = 3), site exclusion/resignations (n = 10), and absence (n = 2). MI competencies improved as follows: the technical skills score increased from a mean of 2.5 (standard deviation (SD): 0.8) to 3.1 (SD: 0.5), with a mean difference of 0.6 (95% confidence interval (CI): 0.04, 0.9). The MI relational skills score improved from a mean of 3.20 (SD: 0.7) to 3.5 (SD: 0.6), with a mean difference of 0.3 (95% CI: -0.3, 8.5). End-point qualitative data from the counsellors highlighted the value of identifying and addressing specific skill deficiencies and the importance of counsellors being able to self-monitor skill development using the MITI review process. Participants appreciated the ongoing support to clarify practical MI applications. The TOT program tools were valuable for ongoing on-the-job development and monitoring of quality counselling skills. However, the MITI review process was perceived to be too involved for large-scale application and was adapted into a scoring form to document sit-in mentoring sessions. The Thusa-Thuso MI intervention can improve counsellor motivation and skills over time. In addition, the program can be scaled up using an adapted TOT process supplemented with fidelity assessment tools, which are valuable for skills development and ongoing maintenance. However, further studies are needed to determine the effect of the Thusa-Thuso program on patient ART adherence and retention in care. Trial registration: Pan African Clinical Trials Registry No: PACTR202212796722256 (12 December 2022).

Experiences on the frontline: Qualitative accounts of South African healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic significantly impacted people's mental health significantly. Frontline healthcare workers (HCWs) were arguably most affected, particularly in low-to-middle-income countries like South Africa. Understanding their experiences is important to inform interventions for social and psychological support for future pandemics. This study explored the experiences of frontline HCWs in South Africa during the COVID-19 pandemic. The sample included HCWs from various professions and health sectors who worked with COVID-19 patients across South Africa. An exploratory descriptive qualitative design was used. Semi-structured interviews were conducted with 11 frontline HCWs recruited via purposive sampling. Data were analysed using principles of inductive thematic analysis. Four major themes were identified in the data: (1) Working during COVID-19 was an emotional rollercoaster; (2) Working during COVID-19 was physically and mentally exhausting; (3) Participants held negative attitudes towards the Department of Health; and (4) COVID-19 had a transformative impact on the daily life of HCWs. HCWs' experiences were diverse and marked by contradictions. Limited psychological support and resources aggravated experiences. However, a positive narrative of hope and gratitude also resonated with participants. Qualitative methodologies provided depth and insights into the diverse realities of frontline HCWs. This study provides significant insights into the experiences of a diverse group of frontline South African HCWs during COVID-19. It demonstrates a shift in the definition of a 'frontline' HCW and highlights the need for greater psychological support and individualised public health interventions during future pandemics.

The prevalence of and factors associated with depressive and anxiety symptoms during the COVID-19 pandemic among healthcare workers in South Africa.

Healthcare workers globally have experienced increased social and occupational stressors in their working environments and communities because of COVID-19 which has increased the risk of mental health concerns. This study aimed to explore the prevalence and correlates of depression and anxiety amongst healthcare workers during the COVID-19 pandemic in the Western Cape, South Africa. In addition, role-related stressors and coping strategies were explored. We conducted a cross-sectional survey of doctors and nurses working in public healthcare facilities across the Western Cape, South Africa. Participants completed the Generalized Anxiety Disorder-7 (GAD-7), the Center for Epidemiologic Studies Depression (CES-D), the Professional Quality of Life (PROQL-R-IV), and the Brief Coping Orientation to Problems Experienced (COPE-R) scales. Data were analysed using multivariable logistic regression analysis. The sample comprised 416 health workers (303 nurses, 113 doctors). Almost 40% of the sample (n = 161) had CES-D scores suggestive of probable depression, and 45.9% (n = 186) had GAD-7 scores suggestive of anxiety. In the logistic regression model, the odds of probable depression were higher for female participants compared to men (OR = 2.26, 95% CI 1.00-5.10) and for participants who used behavioural disengagement as a coping strategy (OR = 1.50, 95% CI 1.14-1.97). More time spent working with COVID patients was associated with increased odds of having high levels of anxiety [OR = 1.13, 95% CI (1.02-1.25). Substance use (OR = 1.39, 95% CI 1.08-1.81), venting (OR = 1.31, 95% CI 1.01-1.70), and self-blame (OR = 1.42, 95% CI 1.08-1.87) were some of the coping strategies used by healthcare workers. High levels of secondary traumatic stress and burnout were found to increase the odds of both depression and anxiety. Findings of this study suggest that there is a high prevalence of mental health issues among healthcare workers, and a critical need to focus on workplace mental health interventions to support these frontline workers.

Psychological distress among South African healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs.Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.

Post-pandemic memory T cell response to SARS-CoV-2 is durable, broadly targeted, and cross-reactive to the hypermutated BA.2.86 variant

Ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolution has given rise to recombinant Omicron lineages that dominate globally (XBB.1), as well as the emergence of hypermutated variants (BA.2.86). In this context, durable and cross-reactive Tcell immune memory is critical for continued protection against severe COVID-19. We examined Tcell responses to SARS-CoV-2 approximately 1.5 years since Omicron first emerged. We describe sustained CD4+ and CD8+ spike-specific Tcell memory responses in healthcare workers in South Africa (n= 39) who were vaccinated and experienced at least one SARS-CoV-2 infection. Spike-specific Tcells are highly cross-reactive with all Omicron variants tested, including BA.2.86. Abundant nucleocapsid and membrane-specific Tcells are detectable in most participants. The bulk of SARS-CoV-2-specific Tcell responses have an early-differentiated phenotype, explaining their persistent nature. Overall, hybrid immunity leads to the accumulation of spike and non-spike Tcells evident 3.5 years after the start of the pandemic, with preserved recognition of highly mutated SARS-CoV-2 variants.

Examining the uptake of COVID-19 vaccine booster doses among healthcare workers in South Africa: A mixed-methods study.

This study aimed examin the factors associated with the uptake and non-acceptance of COVID-19 vaccine booster doses among healthcare workers (HCWs) in South Africa. We used a mixed-methods design with data from a web-based self-administered survey followed by semi-structured in-depth interviews (IDIs) with selected participants. Of the 6235 HCWs included in our analysis who had fully vaccinated, 3470 (56%) had taken their booster dose with a further 17% intending to get the booster. HCWs aged 35 to 49 years (OR = 1.30 [95% CI: 1.15-1.46]), and those aged 50 years or older (OR = 2.66 [95% CI: 2.32-3.05]) were more likely to get the booster dose. Females were less likely to have received the booster dose (OR = 0.88 [95% CI: 0.79-0.98]) with doctors more likely (OR = 1.58 [95% CI: 1.35-1.84]) than Nurses to have received the booster dose. HCWs in direct contact with patients (OR = 1.17 [95% CI: 1.00-1.38]) and who had previously received a flu vaccine (OR = 1.99 [95% CI: 1.56-2.55]) were more likely to have received the booster dose. Four themes emerged from the qualitative data analysis: (1) Vaccination as routine practice among HCWs; (2) Emergence of new COVID-19 variants necessitating vaccine boosters; (3) Fear of potential side-effects; and (4) Limited value of COVID-19 vaccine boosters. Some HCWs broadly accepted the value of vaccination, and believed that boosters were necessary to effectively combat emergent new virus strains, which contrasted with peers who believed that boosters offered little defence against virus mutations. Fear prohibited some HCWs from getting the booster, with some having experienced adverse side effects from their initial vaccination, whilst others were concerned about future complications. Waning booster uptake rates could be arrested through invigorated communication strategies, while effective evidence-based training can potentially create positive normative vaccination practices amongst HCWs.

Benefits of a short course on mental health well-being and resilience for healthcare workers in South Africa during the COVID-19 pandemic

PurposeThe study explored whether an asynchronous short online course in mental health well-being and resilience for healthcare workers (HCWs) showed improved self-reported results among participants during the second wave of the COVID-19 pandemic.Design/methodology/approachA descriptive cross-sectional study evaluated the course outcomes using the 10-item Connor and Davison's Resilience Scale, the World Health Organization's WHO-five well-being index and self-developed questions. Data were collected via online questionnaires before and after course completion.FindingsA total of 1 301 HCWs participated. The highest proportion of participants was from South Africa (SA) (93.7%) and females (78.7%). Analysed mean pre- and post-training scores showed increased scores in all five domains: knowledge, confidence in course outcomes, behaviour, resilience and well-being. Confidence in the course outcomes was the only common significant construct for both well-being and resilience. Mindfulness activities (β = 0.12, 95%CI [0.032, 0.213], p = 0.008) and self-care behaviours (β = 0.14, 95%CI [0.035, 0.241], p = 0.009) were significant predictors of participants' well-being. Coping mechanisms for stress (β = 0.12, 95%CI [0.036, 0.21], p = 0.006) and connecting with a social support network (β = 0.085, 95%CI [0.0007, 0.17], p = 0.048) were significant predictors of participants' resilience. Those working in the private sector, those working in clinical settings and those who were female showed significant associations with well-being and resilience.Research limitations/implicationsThe results are self-reported data which may be susceptible to social desirability and acquiescent effects. There are no guarantees that positive effects observed during this study are sustained over time. The study sample was selective in that it excluded those who did not consent for the use of their data and those who did not complete the course.Originality/valueThe research is noteworthy as literature shows that female HCWs tend to have worse mental health outcomes than males in the same field. Online learning can enable HCWs to conveniently access mental health education, accommodate their work commitments and explore topics that are potentially stigmatising.

Coping strategies employed by public psychiatric healthcare workers during the COVID-19 pandemic in southern Gauteng, South Africa.

Within the context of the novel coronavirus pandemic and new challenges to a resource-constrained public healthcare system, many healthcare workers in South Africa have faced numerous stressors that have compromised their mental health. While the current literature on COVID-19 in South Africa highlights the widespread psychosocial stress experienced by healthcare workers during the pandemic, little is known about the coping strategies utilized to continue service delivery and maintain one's mental health and well-being during this ongoing public health emergency. In this study, we sought to explore the coping strategies used by healthcare workers employed in the public psychiatric care system in southern Gauteng, South Africa during the coronavirus disease (COVID-19) pandemic. Psychiatric healthcare workers (n = 55) employed in three tertiary public hospitals and two specialized psychiatric facilities participated in in-depth interviews between July 2020 and March 2021. We found that coping strategies spanned multi-level and multi-systemic efforts. Intrapersonal, interpersonal, material, and structural coping were mapped across individual, family, and hospital systems. The most commonly utilized coping strategies included positive mindsets and reappraisal, social support systems, and COVID-19 specific protections. Findings also highlighted the contextual and interconnected nature of coping. Healthcare workers applied multiple coping strategies to combat the negative mental health effects of the COVID-19 pandemic. Better understanding these strategies, contexts in which they are employed, and how they interact can be used to develop evidence-based interventions to support healthcare workers experiencing healthcare-related stressors during the COVID-19 pandemic.

Mental health experiences of HIV/TB healthcare workers during the COVID-19 pandemic – lessons for provider well-being and support from a qualitative study in seven South African provinces

BackgroundCOVID-19 has substantially reshaped health service delivery. Healthcare workers have had to serve more clients, work longer shifts, and operate in conditions of uncertainty. They have experienced multiple stressors related to the additional ‘labour of care’, including managing the frustration of inadequate therapeutic or symptom relief options, witnessing clients dying, and having to give this news to clients’ family members. Ongoing psychological distress among healthcare workers can severely undermine performance, decision-making and well-being. We sought to understand the impact of the COVID-19 pandemic on the mental health experiences of healthcare workers delivering HIV and TB services in South Africa.MethodsWe used a pragmatic and exploratory design to understand HCWs’ mental health experiences with in-depth qualitative data. We implemented the study in ten high HIV/TB burden districts across seven of South Africa’s nine provinces among healthcare workers employed by USAID-funded implementing partners. We conducted in-depth interviews (virtual) with 92 healthcare workers across 10 cadres.ResultsHealthcare workers reported experiencing a range of extreme and rapidly fluctuating emotions because of COVID-19 that negatively impacted on their well-being. Among these, many healthcare workers report experienced a great deal of guilt at their inability to continue to provide quality care to their clients. In addition, a constant and pervasive fear of contracting COVID-19. Healthcare workers’ stress coping mechanisms were limited to begin with, and often further interrupted by COVID-19 and non-pharmaceutical response measures e.g., ‘lockdowns’. Healthcare workers reported a need for greater support for managing the everyday burden of work – not only when experiencing a mental well-being ‘episode’. Further, that whenever they were exposed to stressor events, e.g., supporting a child living with HIV who reports sexual abuse to the healthcare worker, that this this would trigger additional support interventions and not rely on the healthcare worker seeking this out. Further, that supervisors spend more effort demonstrating appreciation toward staff.ConclusionsThe COVID-19 epidemic has added significant mental health burden for healthcare workers in South Africa. Addressing this requires broad and cross-cutting strengthening of everyday support for healthcare workers and centring staff’s mental well-being as core to delivering quality health services.

Usability of a novel lateral flow assay for the point-of-care detection of Neisseria gonorrhoeae: A qualitative time-series assessment among healthcare workers in South Africa.

Accurate and user-friendly rapid point-of-care diagnostic tests (POCT) are needed to optimize treatment of Neisseria gonorrhoeae, especially in low-resource settings where syndromic management is the standard of care for sexually transmitted infections. This study aimed to assess the acceptability and usability of a novel lateral flow assay and portable reader for the point-of-care detection of N. gonorrhoeae infection (NG-LFA). This mixed-methods study was conducted as part of a diagnostic performance and usability evaluation of a prototype NG-LFA for detection of N. gonorrhoeae in symptomatic men and women at primary healthcare facilities in the Buffalo City Metro, South Africa. The Standardized System Usability Scale (SUS) was administered, and in-depth interviews were conducted among healthcare professionals (HCPs) and fieldworkers (FWs) at pre-implementation, initial use and 3- and 6-month study implementation to assess user expectations, practical experience, and future implementation considerations for the NG-LFA. Data collection and analysis was guided by the Health Technology Adoption Framework, including new health technology attributes, learnability, satisfaction, and suitability. The framework was adapted to include perceived durability. A total of 21 HCPs and FWs were trained on the NG-LFA use. SUS scores showed good to excellent acceptability ranging from 78.8-90.6 mean scores between HCPs and FWs across study time points. All transcripts were coded using Dedoose and qualitative findings were organized by learnability, satisfaction, suitability, and durability domains. Usability themes are described for each time point. Initial insecurity dissipated and specimen processing dexterity with novel POCT technology was perfected over time especially amongst FWs through practical learning and easy-to-use instructions (learnability). Participants experienced both positive and negative test results, yielding perceived accuracy and minimal testing challenges overall (satisfaction). By 3- and 6-month use, both HCPs and FWs found the NG-LFA convenient to use in primary health care facilities often faced with space constraints and outlined perceived benefits for patients (suitability and durability). Findings show that the NG-LFA device is acceptable and usable even amongst paraprofessionals. High SUS scores and qualitative findings demonstrate high learnability, ease-of-use and suitability that provide valuable information for first-step scale-up requirements at primary healthcare level. Minor prototype adjustments would enhance robustness and durability aspects.

Vascular thrombosis after single dose Ad26.COV2.S vaccine in healthcare workers in South Africa: open label, single arm, phase 3B study (Sisonke study)

ObjectiveTo assess the rates of vascular thrombotic adverse events in the first 35 days after one dose of the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) in healthcare workers in South Africa...

Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa.

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body's immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.

Psychological Responses to Coronavirus Disease 2019 amongst Healthcare Workers in South Africa during the Pandemic

Background: It is important to understand HCWs’ (healthcare workers) psychological responses to the Coronavirus disease 2019 (COVID-19) pandemic as they are exposed to the virus on a daily basis. This study helps identify some of the challenges they face. Aim: The overall aim of the study was to investigate psychological responses to COVID-19, including vaccinations and stressors, amongst healthcare HCWs in South Africa during the pandemic. Setting: HCWs who worked in private and state hospitals and private practice in Tshwane, South Africa. Methods: A quantitative approach using a cross-sectional survey design was used. Several standardised and validated questionnaires were used in the survey including the Coronavirus-19 Fear Scale, the COVID-19-related stigma scale and the COVID-19 stress scale. A purposive sample (N=103) was analysed using descriptive statistics and chi-square. Results: There were 103 completed questionnaires. Many (76% and 54%) either knew someone close who contracted COVID or died from COVID-19, respectively. Most (58%) were in favour of being vaccinated. A significant proportion (42%; p= 0.009) of the HCWs felt uncomfortable when thinking about COVID. Physical reactions such as sweating, or a pounding heart were reported by 17% of the HCWs. A majority of the HCWs disagreed with any form of stigmatization of COVID-19. Most of the HCWs expressed a need for mental health support during the COVID-19 pandemic. About three-quarters of the respondents expressed a need to talk to someone about their worries about COVID-19. Conclusion: Most of the respondents either knew someone who either contracted COVID-19 or died because of it. Many experienced anxiety symptoms when thinking about COVID-19. Many HCWs reported anxiety and stress symptoms such as insomnia, palpitations, sweating and difficulty concentrating. An overwhelming majority of the HCWs stated that people should not be discriminated against or stigmatized in any way because of COVID-19. The majority of the HCWs expressed a need for psychological support during the COVID-19 pandemic. About 20% of the HCWs were against being vaccinated. This is worrisome as they are at high risk. The HCWs clearly expressed a need for more attention and support towards their mental health during the COVID-19 pandemic.

Low influenza vaccine uptake by healthcare workers caring for the elderly in South African old age homes and primary healthcare facilities

BackgroundThe elderly bear the highest burden of South Africa’s estimated annual > 10 million influenza cases and > 11,000 influenza-related deaths. Unvaccinated healthcare workers (HCWs) are at high occupational risk of contracting influenza, and may transmit influenza to elderly patients in their care. Thus, the South African National Department of Health recommends that HCWs receive annual influenza vaccination. This study aimed to determine influenza vaccination coverage among HCWs; identify reasons for their vaccination status; and investigate if HCWs recommend vaccination to their elderly patients.MethodsA descriptive study was conducted in 18 community health centres and 44 private sector and non-governmental organisation managed old age homes across South Africa, using a self-administered structured questionnaire, which was distributed to 360 HCWs present on the day of data collection. Data were captured using Microsoft Excel® and imported to Epi Info™ 7 (Centers for Disease Control and Prevention, USA) for descriptive statistical analysis. Ethics approval (SMUREC/P/36/2018: PG) and permission to conduct the study at the facilities were obtained. All participants provided informed consent.ResultsThe response rate was 76.7% (276/360). Most participants were female (90.9% [251/276]), nursing professionals (81.2% [224/276]) with a mean age of 41.1 ± 11.7 years. Although 62.7% of participants indicated having ever received at least one dose of the influenza vaccine, influenza vaccine uptake for 2017 and 2018 was 24.36% (41/276) and 33.3% (92/276) respectively. The main reasons given for never being vaccinated against influenza were related to the unavailability of the vaccine (70.9%) and vaccine hesitancy (27.2%). Most participants (67.8% [187/276]) recommended vaccines to elderly patients in their care.ConclusionThe main reasons behind low influenza vaccine uptake by HCWs in South Africa who care for the elderly were related to unavailability of the vaccine and vaccine hesitancy. Strategies to educate HCWs on the importance of influenza vaccination, while concurrently increasing sustained and easy access to the vaccine by HCWs are needed to preserve public health.

Mental health literacy among primary healthcare workers in South Africa and Zambia.

In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. The study population for this cross-sectional survey comprised PHC workers (n=250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Time to redefine a primary vaccination series?

Time to redefine a primary vaccination series?

COVID-19 hospital admissions and mortality among healthcare workers in South Africa, 2020–2021

This study describes the characteristics of admitted HCWs reported to the DATCOV surveillance system, and the factors associated with in-hospital mortality in South African HCWs. Data from March 5, 2020 to April 30, 2021 were obtained from DATCOV, a national hospital surveillance system monitoring COVID-19 admissions in South Africa. Characteristics of HCWs were compared with those of non-HCWs. Furthermore, a logistic regression model was used to assess factors associated with in-hospital mortality among HCWs. In total, there were 169678 confirmed COVID-19 admissions, of which 6364 (3.8%) were HCWs. More of these HCW admissions were accounted for in wave 1 (48.6%; n = 3095) than in wave 2 (32.0%; n = 2036). Admitted HCWs were less likely to be male (28.2%; n = 1791) (aOR 0.3; 95% CI 0.3-0.4), in the 50-59 age group (33.1%; n = 2103) (aOR 1.4; 95% CI 1.1-1.8), or accessing the private health sector (63.3%; n = 4030) (aOR 1.3; 95% CI 1.1-1.5). Age, comorbidities, race, wave, province, and sector were significant risk factors for COVID-19-related mortality. The trends in cases showed a decline in HCW admissions in wave 2 compared with wave 1. Acquired SARS-COV-2 immunity from prior infection may have been a reason for reduced admissions and mortality of HCWs despite the more transmissible and more severe beta variant in wave 2.

Cross-cultural adaptation and validation of the 5C scale to identify factors associated with COVID-19 and influenza vaccine hesitancy among healthcare workers in Cape Town, South Africa – a protocol

Background: Healthcare workers are at an increased risk of acquiring vaccine-preventable diseases and are known to be reliable sources of information for the patients and their relatives. Knowledge and attitudes of healthcare workers about vaccines are thus important determinants of their own vaccination uptake and their intention to recommend vaccinations to their patients. However, culturally adapted tools and studies to address vaccine uptake and hesitancy as well as related behaviors among healthcare workers in the Global South are limited. Methods: We propose a mixed methods project to understand the extent and determinants of vaccination hesitancy among healthcare workers and construct a validated scale to measure this complex and context-specific phenomenon in Cape Town. We will summarize responses as counts and percentages for categorical variables and means with standard deviations (or medians with inter quartile ranges) for continuous variables. We will run the Shapiro-Wilks test to assess the normality. Analysis of the variance, chi-square tests, and equivalents will be conducted as appropriate for group comparisons. Logistic regression models will also be performed to assess association between variables. We will focus on the seasonal influenza and COVID-19 vaccines. We will use an existing tool developed and validated in Germany and the United States of America to measure five psychological determinants of vaccination (referred to as the 5C scale), as the basis to develop and validate a scale to measure the scope and determinants of vaccine hesitancy and acceptance among healthcare workers in Cape Town. Discussion and conclusion: Through this study, we hope to expand the scientific evidence base on vaccination acceptance and demand among healthcare workers in South Africa and build resources to enable better understanding of, detection, and response to vaccination hesitancy in Cape Town.

Factors Influencing Healthcare Workers’ Perception of South African Health System Capability for Managing COVID-19 Pandemic

Background: During the emergence of the COVID-19 pandemic in South Africa in March 2020, there was an urgent mobilization of healthcare workers (HCWs) who had to adapt quickly to a challenging health system. Therefore, this paper examines factors associated with HCWs’ perceptions of the South African health system’s capability for managing COVID-19 during the early stages of the pandemic. Methods: Data utilised in this paper were obtained from an online survey conducted among HCWs using a structured questionnaire on a data-free online platform. The study population included all HCWs in South Africa. Bivariate and multivariate logistic regression models were used to examine the factors influencing HCWs’ perceptions of the South African health system capability for managing COVID-19. Results: Of the 5,274 respondents, 22.0% indicated that the South African health system would manage the COVID-19 pandemic. Increased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with being male (aOR = 1.55 95%CI [1.22-1.97], p<0.001), being 50-59 years old (aOR = 1.94 [1.31-2.87], p=0.001) and 60 years and older (aOR = 2.27 [1.34-3.84], p=0.002), working in other sector (aOR = 1.42 [1.10-1.84], p=0.007), and having confidence in their overall knowledge about COVID-19 (aOR = 1.92 [1.52-2.41], p<0.001). Decreased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with HCWs being White (aOR = 0.29 [0.22-0.38], p<0.001) and Indian/Asian (aOR = 0.45 [0.33-0.62], p<0.001), being medical practitioner (aOR = 0.55 [0.41-0.73], p<0.001), and having moderate (aOR = 0.70 [0.50-0.99], p=0.042) or high risk perceptions (aOR = 0.55 [0.39-0.77], p<0.001) of contracting COVID-19. Conclusion: In the early days of the pandemic, most HCWs felt that the health system would not cope with COVID-19. Healthcare workers’ experience (a proxy for HCWs’ age), work sector, confidence in their knowledge about COVID-19, and their risk perceptions were key factors affecting their perception of the health system’s capability.

Disease Severity and Comorbidities among Healthcare Worker COVID-19 Admissions in South Africa: A Retrospective Analysis.

Healthcare workers (HCWs) are among the most vulnerable in regard to contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Comorbidities are reported to increase the risk for more severe COVID-19 outcomes, often requiring hospitalization. However, the evidence on disease severity and comorbidities among South African HCWs is lacking. This retrospective study analyzed the prevalence of comorbidities among HCW hospitalized with COVID-19 and its association with the severity of outcomes. Data from public and private hospitals in nine provinces of South Africa were extracted from the national hospital surveillance database for COVID-19 admissions. A total of 10,149 COVID-19 HCWs admissions were reported from 5 March 2020 to 31 December 2021. The risk of disease severity among HCWs increased with age, with those older (≥60 years) having seven times the odds of disease severity (aOR 7.0; 95% CI 4.2–11.8) compared to HCWs in the younger age (20–29 years) group. The most commonly reported comorbidity was hypertension (36.3%), followed by diabetes (23.3%) and obesity (16.7%). Hypertension (aOR 1.3; 95% CI 1.0–1.6), diabetes (aOR 1.6; 95% CI 1.3–2.0), and HIV (aOR 1.6; 95% CI 1.2–2.1) were significantly associated with disease severity. In conclusion, age, gender, and existing comorbidities were strong predictors of the prognosis of severe COVID-19 among HCWs in South Africa. The information is important in the development of occupational health policies and vulnerability risk assessments for HCWs in light of future COVID-19 waves or similar outbreaks.