South African Healthcare Research Articles

South African physiotherapists' attitudes to medicine prescription as an extension of practice.

The extension of medicine prescription rights to other healthcare providers was proposed to reduce pharmacotherapeutic service delivery challenges in the South African healthcare sector. The scope of practice of physiotherapists is being reviewed to possibly include prescription rights to promote service delivery. Our study assessed the attitudes of registered South African physiotherapists to the inclusion of prescription rights in their scope of practice, including enablers and challenges, and the drug classes they believe to be most relevant. A cross-sectional descriptive survey of South African registered physiotherapists was completed using an online questionnaire. A total of 359 participants completed the questionnaire, where 88.2% agreed that prescribing rights should be introduced, and 87.64% would want to be trained to prescribe. Participants identified several benefits: improved service delivery (91.3%); reduced healthcare delivery costs (89.8%); decreased need for multiple healthcare practitioner consultations (93.2%). Concerns included: inadequate training (55%); increased workload (18.7%); increased insurance premiums against medical liability claims (46.2%). Drugs of relevance included analgesics (95.6%) and bronchodilators (96.0%), while low preference was placed on drugs unrelated to physiotherapy. Chi-square analysis revealed associations between specific drug classes and fields of expertise. South African physiotherapists agree that prescribing and a limited formulary would benefit their scope of practice; however, educational concerns are evident. Findings support the drive to extend the South African physiotherapy scope of practice, however, investigation will be needed to determine the most appropriate way to capacitate future physiotherapists and current graduates should the extension be approved.

Incidence of spine surgery in the South African private healthcare sector: ten-year trends within a large open medical scheme.

Studies from developed countries suggest a dramatic increase in the utilization of spine surgery in recent decades, however less is known about spine surgery rates in the developing world. The aim of this study was to investigate ten-year trends in the incidence of spine surgery within South Africa's largest open medical scheme. This retrospective review included adult inpatient spine surgeries funded by the scheme between 2008 and 2017. The incidence of spine surgery was investigated by age group-overall and for degenerative pathologies, fusion and instrumentation. Surgeons per 100,000 members were determined. Trends were evaluated by linear regression and by crude 10-year change in incidence. A total of 49,575 spine surgeries were included. The incidence of surgery for lumbar degenerative pathology showed a significant upward trend among 60-79year olds but declined among 40-59year olds. The incidence of lumbar fusion and lumbar instrumentation declined significantly among 40-59year olds with little change among 60-79year olds. The ratio of orthopaedic spinal surgeons decreased from 10.2 to 6.3 per 100,000 members whereas the ratio of neurosurgeons decreased from 7.6 to 6.5 per 100,000. Spine surgery in the South African private healthcare sector bears some similarity to developed countries in that it is dominated by elective procedures for degenerative pathology. However, the findings did not reflect the marked increases in the utilization of spine surgery reported elsewhere. It is hypothesized that this may be partly related to differences in the supply of spinal surgery.

Persistence of SARS-CoV-2 IgG Antibody Response among South African Adults: A Prospective Cohort Study.

This study assesses the durability of severe acute respiratory coronavirus-2 (SARS-CoV-2) anti-nucleocapsid (anti-N) immunoglobulin G (IgG) after infection and examines its association with established risk factors among South African healthcare workers (HCWs). Blood samples were obtained from 390 HCWs with diagnosis of coronavirus disease 2019 (COVID-19) for assay of the SARS-CoV-2 anti-N IgG at two time points (Phase 1 and 2) between November 2020 and February 2021. Out of 390 HCWs with a COVID-19 diagnosis, 267 (68.5%) had detectable SARS-CoV-2 anti-N IgG antibodies at the end of Phase I. These antibodies persisted for 4-5 and 6-7 months in 76.4% and 16.1%, respectively. In the multivariate logistic regression model analysis, Black participants were more likely to sustain SARS-CoV-2 anti-N IgG for 4-5 months. However, participants who were HIV positive were less likely to sustain SARS-CoV-2 anti-N IgG antibodies for 4-5 months. In addition, individuals who were <45 years of age were more likely to sustain SARS-CoV-2 anti-N IgG for 6-7 months. Of the 202 HCWs selected for Phase 2, 116 participants (57.4%) had persistent SARS-CoV-2 anti-N IgG for an extended mean period of 223 days (7.5 months). Findings support the longevity of vaccine responses against SARS-CoV-2 in Black Africans.

Health professionals’ knowledge about female genital schistosomiasis. A qualitative investigation in a schistosomiasis endemic area in South Africa

Female Genital Schistosomiasis (FGS) is a neglected tropical disease that affects the lives of millions of women living in endemic areas. The aim of this study was to identify South African healthcare professionals' perceptions and experiences of Female Genital schistosomiasis. This qualitative study took place in Ugu District, KwaZulu-Natal, South Africa, in one Community Health Centre and two Primary Health Care clinics. The purpose was to explore local healthcare professionals' views and knowledge on FGS in an area endemic for Schistosoma haematobium, referred to as bilharzia, or isichenene in isiZulu. The empirical findings collected through interviews and observations are discussed in relation to the well-established research on FGS. This project also took cognizance of the United Nations (UN) sustainability development goals (SDGs) with a focus on gender and sanitation, as well as control programmes to prevent schistosomiasis. The study showed that there was a multi-faceted gap in knowledge between local midwives and professional nurses’ work-related knowledge and the medical research team. Among the main causes are skewed power relations, whereby the women affected by FGS often have low socioeconomic status in society while the higher power structures do not prioritize FGS. This leads to health professionals being in a “middle position” where they are responsible for community health but are governed by their training and the guidelines of the institution in which they are a part. Furthermore, the study showed the importance of culture since nurses and midwives consult with patients, as they are part of a framework where their role is constrained due to governmental policies, protocols for patient care and the local culture. To provide adequate health services for FGS patients, this study indicates that policy, female patient management protocols, curricula, post graduate training, clinical practice and schistosomiasis prevention programs should include FGS.

Hormone Replacement Therapy for the South African healthcare provider: Part I

Hormone Replacement Therapy for the South African healthcare provider: Part I

Interventions to Improve Service Delivery in Rural Mpumalanga Hospitals of South Africa

Purpose: This study investigated the effects of healthcare service quality dimensions on service delivery improvement and patient satisfaction in the South African public healthcare sector. Theoretical framework: The quality of service delivery in the healthcare sector and its influence on patient satisfaction have gained attention globally, including in South Africa. Factors that affect service delivery, such as empathy, efficiency, tangibility, safety, reliability, responsiveness, assurance, communication, and discipline, have attracted the attention of both academics and healthcare practitioners, particularly in public healthcare facilities. Design/methodology/approach: A quantitative research design was followed. A data set of 500 was collected from Mpumalanga Province, South Africa, and a structural equation modelling approach was used to test ten hypotheses using Smart PLS statistical software. Findings: The research findings supported all the proposed hypotheses, with four hypotheses being insignificant. The study contributes to the literature on the effects of health service quality dimensions on service delivery improvement and patient satisfaction in an often-neglected context, namely Africa. Research, Practical &amp; Social implications: The study provides recommendations for healthcare policies and strategies to improve service delivery in the public healthcare sector based on the research findings. Originality/value: The results indicate that the Healthcare sector needs to focus on quality service to be provided to the public. It also contributed to the body of knowledge on this topic in South Africa.

Team approach to osteoarthritis management: Viewpoints of biokineticists and physiotherapists in South Africa.

The rehabilitative nature of biokinetics and physiotherapy in osteoarthritis management highlights a complex interaction between different professions to achieve effective outcomes for the patient. The success of a team approach is dependent on key competencies for optimal patient-focused care and appropriate cross-referral systems. To explore and describe the viewpoints of biokineticists and physiotherapists regarding a team approach to osteoarthritis management in the South African public and private healthcare setting. A descriptive methodology with a convenience sampling technique was used. The target population consisted of biokineticists (n=47) and physiotherapists (n=165) located within the South African healthcare sectors. A self-administered, online questionnaire surveyed rehabilitative professionals' views of a team approach to osteoarthritis management. There is no evidence that the biokineticists and physiotherapists differ with respect to how they rate the communication between team members in osteoarthritis management (p=0.68). Communication was viewed as neither of a high nor low quality by biokineticists (43%) and physiotherapists (36%). Biokineticists (54%) and physiotherapists (69%) felt adequately equipped on their understanding of the role of various healthcare professions involved in osteoarthritis management (p=0.22). However, 43% of rehabilitative professionals indicated that they had not been exposed to interprofessional education initiatives (p=0.61). Both professions were well-versed on the roles of various professions involved in osteoarthritis management, however, communication was not optimal. While this study creates an awareness of the benefits of team-based management for osteoarthritis, the findings could stimulate debate on the optimal implementation of key competencies required for effective teamwork, thereby facilitating patient-focused care and referral systems.

Perspectives on Music Healing by Traditional Healers and Music Therapists

Abstract The majority of South Africans use both traditional and Western healthcare services. Although traditional healers have long since recognized and utilized the healing power of music, music therapy as a profession in this country is largely aligned with Western medical approaches, as it is regulated by the Health Professions Council of South Africa. This alignment leaves little recognition to traditional health practitioners. In the current study, we explored music therapists’ and traditional healers’ perceptions of their roles and relationships with each other in South African healthcare with the hope of initiating dialogue. Four traditional healers (TH) and four music therapists (MT) participated in interviews within this multiple case study, and thematic analysis was used to interpret the data. We identified eight overarching themes that appeared most salient to the music therapists and traditional healers (framed from their perspectives): (1) Both our practices support wellbeing, with music as a tool; (2) We both seek to enhance general well-being, but with different specializations; (3) We both focus on relational connection; (4) We both emphasize the importance of culture; (5) THs emphasize spirituality; (6) We hold curious, yet cautious regard for each other’s practices; (7) MT may aid in addressing psychosocial needs in South Africa; and (8) We both welcome a pluralism of approaches. Both groups of practitioners envisioned a future healthcare system that embraces multiple modalities while reflecting on the need to engage in issues related to boundaries of scopes of practice. They highlighted the need for greater trust between practitioners from different approaches to serve a diverse population better.

Considering the philosophy of Ubuntu in South African healthcare ethical practices

Considering the philosophy of Ubuntu in South African healthcare ethical practices

Clinical recommendations for chronic musculoskeletal pain in South African primary health care.

Chronic musculoskeletal pain (CMSP) is prevalent globally and places a significant burden on individuals, healthcare systems and economies. Contextually appropriate clinical practice guidelines (CPGs) on CMSP are advocated to translate evidence into practice. This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). The PHC sector in South Africa (SA). Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors.Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.

Healthcare Resource Utilization in Controlled Versus Uncontrolled Adults Living With Type 1 Diabetes in the South African Public Healthcare Sector

ObjectivesThis study aimed to understand the cost implications of managing people living with type 1 diabetes mellitus in the South African public healthcare system. MethodsA multicenter, noninterventional retrospective chart review study was performed. Data on healthcare resource consumption, demographics, risk factors, clinical history, and acute events were collected. Direct medical costs were collected over a 1-year period, stratified by controlled versus uncontrolled patients. In addition, the costs in people with controlled (glycated hemoglobin < 7%) versus uncontrolled glycated hemoglobin (≥ 7%) at time horizons of 1, 5, 10, and 25 years were modeled using the IQVIA Core Diabetes Model. ResultsThe costs based on the retrospective chart review were $630 versus $1012 (controlled versus uncontrolled population). The modeled costs at various time horizons were as follows: at 1 year, $900 versus $1331; at 5 years, $4163 versus $6423; at 10 years, $7759 versus $16 481; and at 25 years, $16 969 versus $66 268. The largest cost in the controlled population was severe hypoglycemia requiring nonmedical assistance, severe hypoglycemia requiring medical assistance, and treatment costs. In the uncontrolled population, the largest cost was the cost of diabetic ketoacidosis, severe hypoglycemia requiring nonmedical assistance, severe hypoglycemia requiring medical assistance, and foot complications. ConclusionsStrict glycemic control reduces healthcare resource use overall. Patients in the controlled group still experienced high resource use related to hypoglycemic events. The introduction of a structured patient education program and analog insulins may result in less episodes of hypoglycemia and potential cost savings.

Effectiveness of COVID-19 primary and booster vaccination in HIV-infected individuals

Effectiveness of COVID-19 primary and booster vaccination in HIV-infected individuals

The mental health and wellbeing of healthcare workers during COVID-19 in South Africa.

Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts. The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa. This study's sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa. The authors used a qualitative survey design exploring participants' general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis. The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves. An overarching thread of uncertainty seems central to HCWs' experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic. These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.

Strategies to integrate physiotherapists into primary health care in South Africa.

Health services are inaccessible in low-income countries. The National Health Insurance (NHI) bill, linked to primary health care (PHC), was introduced in South Africa to improve access to health services. Physiotherapists contribute to healthcare and improve individuals' health status across their lifespan. The South African healthcare system has many challenges: physiotherapists mostly practising at secondary and tertiary levels of care; a shortage of physiotherapists in the public health systems and rural areas; the omission of physiotherapy in health policies. To explore strategies to integrate physiotherapy services in PHC settings in South Africa. Our study used a qualitative, exploratory and descriptive approach to collect data from nine doctorate physiotherapists at South African universities. Data were thematically coded. The themes are to (1) improve societal knowledge of physiotherapy, (2) ensure policy representation of the profession, (3) transform physiotherapy education, (4) broaden the role of physiotherapy, (5) eradicate professional hierarchy and (6) increase the physiotherapy workforce. Physiotherapy is not well known in South Africa. Physiotherapy is needed to feature in health policies to transform education focussing on disease prevention, health promotion and functioning in PHC. Broadening physiotherapy roles should consider the regulator's ethical rules. Physiotherapists should proactively collaborate with other health professionals to dismantle professional hierarchies. Without addressing the urban-rural, private-public divide, the physiotherapy workforce cannot improve, to the detriment of PHC. Implementing the suggested strategies may facilitate physiotherapy integration into PHC in South Africa.

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.

Physical activity resource needs of occupational therapists in primary public health care in Gauteng, South Africa

INTRODUCTION: Resource constraints in primary health care settings in South Africa give rise to challenges for occupational therapists. This study aimed to determine the physical activity resource needs (including objects used and space demands) of occupational therapists in the primary health care context of Gauteng, South Africa METHOD: A qualitative, descriptive research design was used. The participants were occupational therapists working in primary health care settings in Gauteng. Convenience and snowball sampling were used. Data were collected through two online asynchronised focus groups, conducted over three days each. Thematic analysis was used to analyse the data FINDINGS: Findings included the resource constraints experienced by occupational therapists and how the occupational therapists' adaptability helped them overcome these constraints. Space, resources for basic and instrumental activities of daily living, assistive devices, Bobath plinths and recyclable and low-cost materials were identified as being particularly useful physical activity resource needs CONCLUSION: Although limited physical activity resources were available in the settings, therapists' skills in adaptability proved useful in using unconventional resources instead. This study's results identify physical resources deemed as most useful to provide occupational therapy services in primary health care. Furthermore, the results provide information to the education faculty in order to adapt the undergraduate curriculum to better prepare occupational therapy students for practice in primary health care Implications for practice • The findings can be communicated to management of primary health care facilities in order to procure or advocate for the procurement of resources deemed as essential in primary health care practice contexts. • Innovation, problem-solving and adaptability can be valuable characteristics used in professional reasoning that may enable occupational therapists to overcome physical resource barriers. • Faculty at tertiary educational institutions may utilise the findings in order to adapt curriculums to better prepare occupational therapists for work in the South African primary health care context. • Occupational therapy students should gain experience in developing and adapting activities using recyclable and reusable materials for diverse clients, including children and adults.

Clinical Characteristics and Glycaemic Control in Adults Living with Type 1 Diabetes: A 1-Year Retrospective Chart Review at Two South African Public Sector Tertiary Hospitals

Abstract Background: An estimated 11.8% of the South African population are living with diabetes. There is a paucity of data related to the clinical characteristics and glycaemic control in people living with T1DM within the South African public healthcare sector. Objective: To describe the clinical characteristics and glycaemic control of people living with T1DM in a public health care setting. Methods: The study was an observational study conducted at two tertiary public sector hospitals in South Africa by means of a chart review. The study involved adults living with T1DM treated with human insulin for 12 months prior to the date of informed consent. Results: A total of 224 patients with T1DM were enrolled, with 190 (84.8%) from Chris Hani Baragwanath Academic Hospital and 34 (15.2%) from Klerksdorp Tshepong Hospital Complex. One patient withdrew consent, leaving a total analysed population of 223. Of the 223 patients, 37 (16.6%) were controlled (most recent glycosylated haemoglobin (HbA1c) &lt; 7%) while the remainder 186 (83.4%) were uncontrolled (most recent HbA1c ≥ 7%). The mean age of the study group was 33 ± 9 years. The majority of participants were female (122 [54.7%]) and of black ethnicity (215 [96.4%]). The mean number of hypoglycaemic events per patient-year was 151.4 (SD ± 213.9). Diabetic ketoacidosis occurred more frequently in the uncontrolled group. Conclusion: The majority of patients in this study did not achieve target HbA1c, placing them at higher risk for long-term diabetes complications. Poor glycaemic control, leading to long term complications, as well as hypoglycaemia and diabetic ketoacidosis adds further strain to the resource constrained public healthcare in South Africa.

Progress towards unique patient identification and case-based surveillance within the Southern African development community.

Population mobility makes patient-tracking and care linkage in the South African Development Community (SADC) challenging. Case-based surveillance (CBS) through individual-level clinical data linked with a unique patient-identifier (UPI) is recommended. We conducted a mixed-methods landscape analysis of UPI and CBS implementation within selected SADC countries, this included: (1) SADC UPI implementation literature review; (2) assessment of UPI and CBS implementation for high HIV-prevalence SADC countries; (3) UPI implementation case-study in selected South African primary healthcare (PHC) facilities. Research into CBS and UPI implementation for the SADC region is lacking. Existing patient-identification methods often fail and limit patient-tracking. Paper-based records and poor integration between health-information systems further restrict patient-tracking. Most countries were in the early-middle stages of CBS and faced UPI challenges. Our South African case-study found that the UPI often goes uncaptured. Difficulties tracking patients across prevention and care cascades will continue until a functional and reliable UPI is available.

The Effect of Marketing Initiatives and Expenditure on Organisational Performance in the South African Healthcare Market

The Effect of Marketing Initiatives and Expenditure on Organisational Performance in the South African Healthcare Market

Disease and design in twentieth-century South Africa: exploring the consequences of the 1918–19 Spanish Flu pandemic through contributions of émigré Dutch architects

The architectural history of healthcare in South Africa remains greatly understudied, as do the consequences of the 1918–19 Spanish Flu, which ravaged its population. Yet that pandemic had great consequences for South African society, spatial planning and the development of healthcare, of which the latter two were still in their infancy at the time. This article explores the link between disease and design in South Africa through the presentation of the histories of selected hospitals, maternity homes, orphanages and a special care school designed by émigré Dutch architects from the 1920s to the 1970s. It is the product of desktop and archival research, site visits and interviews undertaken in both South Africa and the Netherlands. It outlines the disparity of care that was provided for different groups and is a first attempt to identify healthcare ideas transposed into the subcontinent fuelled by the tragic experiences of the Spanish Flu pandemic. Due to this health crisis, communities – structured in terms of language, faith and race – attempted to develop their own facilities for the care of their own. Where communities had no means of their own, charitable organisations tried to fill the void. Over the course of the twentieth century, public healthcare was centralised, but many of the community and charitable institutions persist. By chance or choice, émigré Dutch architects made a disproportionately large contribution to the development of healthcare facilities in South Africa, not only in the number and range of facilities they designed, but also by introducing contemporary ideas into South African healthcare design.