Background: Epilepsy is a common neurological disorder affecting about 50 million people worldwide. Caregivers of people with epilepsy face significant emotional, physical and psychological distress due to the demands of caregiving. Limited resources, stigma and the lack of a proper support system often worsen these challenges. Aim: This study aimed to explore the lived experiences of caregivers of individuals with epilepsy in Botswana. Setting: This study was conducted in Gaborone, the capital city of Botswana, located in Botswana’s South-East District. Methods: An interpretive phenomenological approach was used to capture the lived experiences of 13 caregivers, recruited through purposive sampling. In-depth interviews were conducted to gather qualitative data, which were analysed using the General Inductive Approach. Results: Caregivers reported significant emotional distress, including anxiety, stress and social isolation due to the unpredictable nature of seizures. Financial difficulties were dominant concern, with many caregivers losing employment status due to caregiving responsibility. High cost of medication and access to healthcare services was another burden while stigma surrounding epilepsy further exacerbated emotional strain. Additionally, caregivers reported limited coping strategies, which further contributed to their psychological distress. Conclusion: The study highlights the urgent need for culturally sensitive interventions to address the psychological and economic burden faced by caregivers. Strengthening support system, ensuring reliable access to medication and providing financial aid could significantly improve caregivers’ well-being and by extension, the quality of life for individuals living with epilepsy in Botswana. Contribution: This study offers important insights into caregiver experiences in epilepsy, emphasising the need for family inclusive, caregiver centred nursing practices, educational enhancement and improved community policies in Botswana. It highlights the importance of structured psychosocial support, integrating epilepsy care into home services, and culturally relevant coping strategies. These findings aim to guide targeted interventions and create more responsive health systems in similar resource-limited settings.
BACKGROUND:Junior doctors experience high-pressure emotional interactions, often with limited support during their rural hospital rotation. Little is known about the effect of such encounters on the emotions and behaviour of clinicians. AIM:This study explores the experiences of interns during emotionally charged encounters in the workplace with clinical supervisors, colleagues and patients. SETTING:The study was conducted in a one regional and three rural district hospitals. METHODS:A qualitative exploratory study was conducted using semi-structured interviews with 12 interns undergoing training in the Eastern Cape, South Africa, between May 2024 and August 2024. A purposive sample of second-year medical interns who had completed a 2-month rotation in a rural district hospital setting was interviewed. Data were coded and subsequently analysed thematically. RESULTS:Three themes emerged: 'being a doctor in an emotionally charged clinical environment', 'the emotionally competent doctor' and 'the emotional support needs of junior doctors'. Emotionally charged clinical encounters elicited strong, distressing emotions in interns, including anxiety, frustration, and feelings of helplessness, which affected their well-being, service delivery, and clinical performance. Unregulated emotions resulted in counterproductive behaviours, such as abruptness, avoidance, or reluctance to seek guidance. Participants expressed a need for structured emotional competence (EC) training and additional emotional support. CONCLUSION:Junior doctors face emotionally charged encounters in their clinical practice. Unregulated emotions may drive counterproductive behaviours, affecting service delivery and patient care. Effective educational activities need to be developed to support the development of EC in undergraduate medical education. A programme targeting the emotional well-being of doctors, especially junior doctors, could provide additional support.Contribution: Identifies a need for EC training of doctors.
BACKGROUND:Cardiometabolic diseases such as obesity, hypertension, dyslipidaemia and type 2 diabetes are major contributors to morbidity and mortality. Diet is a modifiable risk factor, yet limited evidence exists on its influence on cardiometabolic outcomes among South African teachers. AIM:To identify dietary patterns and examine their associations with cardiometabolic risk factors among teachers in Makhado Municipality, Limpopo province. SETTING:Rural public schools within Makhado Municipality, Limpopo province, South Africa. METHODS:A cross-sectional study was conducted among 201 teachers selected using stratified random sampling. Data included demographic information, blood pressure, fasting glucose (FG), lipid profiles and anthropometry. Dietary intake was assessed using a validated food-frequency questionnaire that reflected habitual intake. Exploratory factor analysis identified dietary patterns. Associations were analysed using nonparametric tests in STATA version 17 (p 0.05). RESULTS:Six dietary patterns emerged: mixed, Western, meat-free, Mediterranean fish-free, animal starch product and low-carbohydrates and Mediterranean. The mixed pattern was associated with systolic blood pressure (p = 0.03). The Western pattern was associated with total cholesterol (p = 0.04) and low-density lipoprotein cholesterol (p = 0.02). Meat-free and Mediterranean fish-free patterns were associated with high-density lipoprotein cholesterol (p = 0.03), while the animal protein fruit pattern was associated with FG (p = 0.02). CONCLUSION:Distinct dietary patterns were associated with cardiometabolic risk among teachers, highlighting the need for culturally appropriate dietary interventions.Contribution: This study provides context-specific evidence that may inform the development of culturally appropriate nutrition interventions, workplace wellness programmes, and primary health care policies aimed at improving cardiometabolic health and reducing the burden of non-communicable diseases among teachers.
BACKGROUND:The clinical learning environment (CLE) in primary care is increasingly recognised as critical to undergraduate medical education. However, its design and implementation are shaped by multiple interdependent factors, such as mentorship, autonomy, relationships and logistics, which make it a complex challenge. AIM:This study aimed to map the literature on the contributing factors to conducive CLE for medical students in primary care settings, identify enablers and obstacles and strategies for improvement. SETTING:Primary care clinical learning environments, including community health centres, primary healthcare clinics, general practices, and district hospitals involved in undergraduate medical education. METHODS:A scoping review was conducted using the Joanna Briggs Institute methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. Four databases were searched with no language or date restrictions. Articles were screened independently by two reviewers. Data were charted using Gruppen's conceptual framework and thematically synthesised. RESULTS:A total of 34 articles were included. Common enablers included effective mentorship, student autonomy, positive interpersonal relationships, organisational alignment and supportive infrastructure. Obstacles included inadequate space, transport constraints, authoritarian teaching styles and a lack of student agency. Few articles proposed solutions, and many challenges were systemic and persistent. The CLE in primary care emerged as a wicked problem - a complex, context-sensitive issue involving multiple stakeholders without a definitive solution. CONCLUSION:A conducive CLE in primary care requires coordinated, multilevel strategies that address both human and structural domains. Isolated interventions are unlikely to produce lasting change.Contribution: This review highlights the CLE in primary care as a wicked problem and provides a framework for developing systemic, adaptive responses to support medical education in diverse contexts.
BACKGROUND:Effective patient referral systems are vital for ensuring timely access to advanced healthcare services, particularly in remote areas. In Zambia's rural districts such as Mbala, the referral system faces critical challenges, including poor road networks, limited ambulance services, unreliable communication infrastructure and a lack of medical personnel at lower-level facilities. These issues contribute to delays, preventable complications, and increased patient morbidity and mortality. AIM:This study aims to assess the effectiveness of the patient referral system in Mbala District by examining logistical, infrastructural and human resource constraints that hinder timely and appropriate patient transfers from rural health facilities to higher-level care. SETTING:The study was conducted in Mbala District, a predominantly rural district in Zambia's Northern province, where geographical barriers, limited health infrastructure, and resource constraints present significant challenges to the effectiveness of the patient referral system. METHODS:This study employed a descriptive cross-sectional design. Data were collected over 2 weeks using questionnaires from 18 health facility in-charges and community interviews, then analysed using Jeffreys's Amazing Statistics Program (JASP) version 0.19.3 to evaluate referral accessibility, timeliness and effectiveness. RESULTS:Statistical analyses show that communication reliability is the strongest predictor of referral success and satisfaction (β = 0.63, p = 0.002), also reducing delays by 1.89 h (β = -1.89, p = 0.007). Distance negatively affects referrals (r = -0.52), with over 70% of facilities beyond 25 km. Grid-powered facilities face 16-h daily power outages. A chi-square test found no significant link between community awareness and satisfaction (χ2 = 1.68, p = 0.1951). CONCLUSION:The referral system in Mbala District is significantly constrained by logistical and structural barriers. Targeted interventions, including improved transport logistics, communication infrastructure and staff training, are necessary to enhance patient outcomes in rural settings.Contribution: This study contributes empirical evidence on referral barriers in rural Zambia, highlighting communication, transport, distance, infrastructure and staffing as critical determinants of timely and effective patient referrals.
BACKGROUND:Cardiometabolic abnormalities substantially increase morbidity among individuals with type 2 diabetes mellitus (T2DM), particularly in primary health care (PHC) settings. In Nigeria, evidence on comprehensive metabolic risk profiling beyond glycaemic control remains limited. AIM:To determine the cardiometabolic risk profile and identify factors associated with adverse cardiometabolic outcomes among adults with T2DM. SETTING:The study took place at government-owned PHC facilities in Makurdi, Benue State, Nigeria. METHODS:This facility-based analytical cross-sectional study systematically recruited 120 eligible adults aged ≥ 30 years with T2DM. Socio-demographic and clinical data were obtained using structured questionnaires and medical records. Laboratory analyses assessed glycaemic status, lipid profile and renal function. Renal impairment was determined using estimated glomerular filtration rate (eGFR) based on standard clinical thresholds. Cardiometabolic abnormality was defined as the presence of at least one abnormal component: poor glycaemic control, dyslipidaemia or renal impairment. Data were analysed using descriptive statistics and logistic regression. RESULTS:The mean age was 56 ± 10.8 years, with females comprising 61.7%. The mean diabetes duration was 4 ± 3.2 years. Overall, 84.8% had at least one cardiometabolic abnormality. Poor glycaemic control, dyslipidaemia and renal impairment occurred in 65.8%, 65.0% and 29.2%, respectively. The mean cardiometabolic risk score was 1.87 ± 1.05. Longer diabetes duration independently predicted poor glycaemic control (p 0.05). CONCLUSION:Adults with T2DM attending PHC clinic had a high burden of cardiometabolic abnormalities, highlighting the need for integrated diabetes management strategies.Contribution: The study provides context-specific evidence to support routine lipid and renal function assessment in resource-limited settings.
BACKGROUND:Despite global declines in human immunodeficiency virus (HIV) infections, South African men remain disproportionately affected. Understanding men's HIV service preferences is essential for designing effective interventions. AIM:This qualitative study identified key attributes influencing men's preferences for HIV testing, prevention and treatment services in Gauteng province, South Africa. SETTING:Data were collected through focus group discussions and in-depth interviews between November 2023 and March 2024 across sites in Randburg, Soweto, Orange Farm and Pretoria. METHODS:A qualitative exploratory design employed focus group discussions with men aged 20-64 years and key informant interviews with HIV programme stakeholders. Stratified purposive sampling ensured demographic diversity. Recordings were transcribed verbatim and independently dual-coded. Framework analysis following Ritchie and Spencer's five-step approach systematically identified themes, which were refined into discrete attributes. RESULTS:Thirty-two focus group participants and 19 interview participants (median age 35 years [interquartile range [IQR] = 28-43], all Black African men, 82% secondary-educated) identified 10 priority HIV service attributes: accessibility, quality of care, cost-efficiency, comprehensive service packages, privacy and confidentiality, cultural sensitivity, technological solutions, community engagement, health awareness and stigma mitigation. Participants emphasised geographic proximity, welcoming nonjudgemental environments, affordability and privacy as critical in service utilisation. CONCLUSION:Findings emphasise the importance of comprehensive, private, affordable care delivered through welcoming environments with digital health awareness integration.Contribution: Validated attributes will inform a discrete choice experiment to quantify preference structures and guide the development of evidence-based, male HIV service delivery models in South Africa.
BACKGROUND:Sexual and reproductive health (SRH) services are crucial for adolescents, yet utilisation remains low in the Arsi Zone of Ethiopia. Identifying the factors affecting adolescents' use of SRH services is important to address the problem. AIM:To explore and describe adolescents' awareness and barriers to SRH services in Arsi Zone, Ethiopia, and improve SRH service use, ultimately reducing preventable SRH-related illness and death among adolescents. SETTING:The study was conducted at six districts of Arsi Zone, Oromia, Ethiopia. METHODS:A school-based cross-sectional study was conducted among 651 randomly selected adolescents aged 15-19 years in Arsi Zone of Ethiopia, from 01 January 2024 to 29 February 2024. Data were collected using a self-administered structured questionnaire. A multivariable logistic regression model was employed to analyse the data. Measures of association were expressed as adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs). RESULTS:This study revealed that being involved in SRH discussions with trusted individuals was significantly associated with SRH utilisation, with better odds (AOR = 2.12; 95% CI: 1.22-3.67). Absence of fear when seeking care was significantly associated with higher utilisation of SRH services (AOR = 2.07; 95% CI: 1.12-3.83). The presence of an SRH problem, such as a sexually transmitted infection (STI), was strongly associated with SRH service utilisation (AOR = 4.88; 95% CI: 2.26-10.54). In addition, the perceived convenience of service operating hours was significantly associated with higher SRH service utilisation (AOR = 3.19; 95% CI: 1.57-6.52). CONCLUSION:The findings highlight a significant gap between awareness and use of SRH services among adolescents. This emphasises the need for targeted interventions to improve awareness and access to SRH services for adolescents.Contribution: The study provides empirical evidence on Ethiopian adolescents' SRH, addressing gaps in service access, structural and sociocultural barriers, and service use. Its findings offer actionable insights for designing, implementing and evaluating adolescent SRH policies and programmes and contribute to the academic literature.
Background: The increasing prevalence of diabetes mellitus among children and adolescents in South Africa presents a major public health challenge, compounded by limited resources, inadequate infrastructure and poor disease management. Given these challenges, innovative solutions such as ChatGPT are essential to offer immediate, personalised education and social support to children and adolescents with diabetes. Aim: The study explored the integration of ChatGPT to support children and adolescents with diabetes in South African healthcare. Setting: This study was conducted with experts working in various organisations and institutions across Gauteng province of South Africa. Methods: A qualitative research design was used, with semi-structured interviews conducted with paediatric endocrinologists, diabetologists, diabetes educators and senior academics through purposive and snowball sampling. Data were analysed using thematic analysis and ATLAS.ti version 23. Results: The findings of the study revealed four key themes: perceptions of ChatGPT (both positive and negative); ethical concerns related to data security, reliability and technology overreliance; factors influencing acceptance, including usability, trust and accuracy; and obstacles to integration, such as technological, social and financial barriers. Conclusion: The study underscores the critical need for policy and regulatory frameworks, infrastructure development and government support in facilitating ChatGPT integration in South African healthcare to improve diabetes care. Contribution: This study contributes to the broader discourse on digital health innovations and their role in enhancing chronic disease management among vulnerable populations in South Africa.
Community participation is a foundational principle of primary health care (PHC), yet its meaningful implementation remains limited in many low- and middle-income countries (LMICs), including Malawi. Although formal community governance structures such as Health Advisory Committees (HACs), Village Development Committees (VDCs) and Area Development Committees (ADCs) are recognised in policy, their influence on facility-level decision-making is often constrained by hierarchical leadership arrangements, weak coordination and persistent power asymmetries between health professionals and community representatives. This article examines community participation in Malawi’s PHC system through a distributed leadership (DL) lens and explores how leadership practices can be strengthened to enhance facility-community governance. A narrative review and policy analysis were conducted using National Health Policy documents and relevant literature on PHC governance, community participation and DL in Malawi. Community structures play an important role in representing community interests and monitoring service delivery but largely function in advisory capacities. Leadership authority remains concentrated at facility and district levels, limiting shared ownership. Coordination among health workers, community committees and local government structures is weak, resulting in fragmented leadership and limited accountability for service improvement. The article argues that challenges in community participation are fundamentally leadership challenges. Distributed leadership provides a practical framework for strengthening PHC by promoting shared responsibility, collaboration and accountability across community and facility levels.
Background: Maternal health literacy influences how pregnant women access, understand and use healthcare services for themselves and their children. Limited maternal health literacy is associated with poor maternal and foetal outcomes. Aim: To assess maternal health literacy and its associated factors among pregnant women attending antenatal clinics in the Western Cape. Setting: The study was conducted in antenatal clinics of the Western Cape. Methods: A cross-sectional survey was conducted among 248 pregnant women using the Maternal Health Literacy Inventory in Pregnancy (MHELIP), together with measures of socio-demographics, depression and functional health literacy (reading and understanding). Data were analysed using the Statistical Package for Social Sciences (SPSS) version 29. Descriptive statistics summarised participant characteristics and maternal health literacy domains, while non-parametric tests and logistic regression identified predictors of maternal health literacy. Results: Participants had a mean age of 27.4 years (± 7.53; range: 18-45), and 60.5% (n = 150) reported more than two pregnancies. Most respondents (80.0%, n = 196) had limited maternal health literacy, with a mean MHELIP score of 57.8 out of 100 (standard deviation [s.d.]: 10.8; range: 21–87). Adequate maternal health literacy was significantly associated with higher reading, understanding, and decision-making scores, while women with no risk of depression scored higher in assessing maternal health information (p < 0.05). Reading and understanding significantly predicted maternal health literacy (odds ratio [OR]: 1.20), explaining 10.0% of the variance. Conclusion: Most pregnant women had limited maternal health literacy, underscoring the need for tailored antenatal education. Contribution: The findings inform the development of maternal health literacy programmes to support informed decision-making among pregnant women in South Africa.
Background: Retaining medical doctors remains a major challenge for health systems, particularly in low- and middle-income countries (LMICs), where workforce instability undermines continuity of care and service delivery. Although total rewards are widely used to improve retention, it remains unclear whether doctors stay because rewards are available or because they perceive them as fair and adequate. Aim: To examine whether reward adequacy and reward expectation mediate the relationship between total rewards and medical doctor retention. Setting: The study was conducted in public healthcare facilities in Ghana. Methods: A quantitative cross-sectional survey was conducted among 400 medical doctors recruited through stratified facility-level sampling. Data were collected using a structured questionnaire and analysed using Statistical Package for the Social Sciences (SPSS) version 26 and SmartPLS version 4. Partial least squares structural equation modelling assessed measurement validity and bootstrapped direct and indirect effects. Results: Total rewards had no significant direct effect on retention intention (β = 0.048, p = 0.507). Total rewards positively influenced reward adequacy (β = 0.689, p < 0.001), and reward adequacy positively influenced retention intention (β = 0.623, p < 0.001). Reward adequacy significantly mediated the total rewards–retention relationship (β = 0.429, p < 0.001), whereas reward expectation did not. Conclusion: The retention value of total rewards depends primarily on doctors’ perceptions of adequacy, fairness and sufficiency. Health systems should prioritise transparent and equitable reward structures rather than relying solely on financial and non-financial incentives. Contribution: The study identifies reward adequacy as the principal mechanism through which total rewards influence medical doctor retention in an LMIC primary healthcare context.
Palliative care is an integral component of comprehensive primary health care and is particularly relevant for older adults living with chronic and progressive illnesses. In low- and middle-income countries (LMICs), including many African settings, access to palliative care remains limited despite substantial need. Sociocultural beliefs shape perceptions of ageing, illness, suffering and death, and influence how palliative care needs are recognised and addressed within primary care and family medicine contexts. To synthesise existing evidence on how sociocultural beliefs influence palliative care needs and utilisation among older adults in LMICs, with implications for primary care and family practice. A narrative literature review was conducted using published qualitative, quantitative and mixed-methods studies identified through searches of major electronic databases and relevant grey literature. Evidence was synthesised thematically, focusing on sociocultural influences relevant to primary care settings. Key themes identified included cultural constructions of ageing and suffering, family-centred decision-making, religious and spiritual interpretations of illness, and misconceptions surrounding palliative care. These factors influence symptom reporting, care-seeking behaviour, referral patterns and utilisation of palliative care services at the primary care level. Sociocultural beliefs are fundamental to understanding palliative care needs among older adults in LMICs. To improve access and quality of care, culturally sensitive palliative care models that involve families, recognise spiritual concerns and dispel myths are crucial. More empirical research from under-represented LMIC regions is required to inform contextually appropriate policy and practice.
BACKGROUND:Diabetic retinopathy (DR) is a major cause of avoidable vision loss, yet public awareness is low, hindering early detection and treatment. Many people living with diabetes are unaware of their risk for DR and the need for screening. AIM:To assess the knowledge, attitudes and practices of people living with diabetes regarding DR prevention. SETTING:Ten primary health care clinics in the Maruleng sub-district in Limpopo province of South Africa. METHODS:A cross-sectional study utilised a self-reported questionnaire with yes/no questions to measure knowledge and practices, and attitudes were assessed with a 5-point Likert scale. Scores above the median for knowledge, attitudes and practices were indicative of good knowledge and practices and positive attitudes. RESULTS:Almost two-thirds of participants (n = 255; 65.6%) were female. Approximately 268 participants (61.2%) knew that uncontrolled high blood sugar can lead to DR. The majority (n = 355; 86.1%) showed positive attitudes towards their eye health, while 216 (55.8%) had good practices towards DR prevention. Higher education and duration of diabetes were associated with good knowledge (adjusted odds ratio [AOR]: 2.2; 95% confidence interval [CI]: 1.3-3.9; p 0.05) and (AOR: 1.9; 95% CI: 1.2-2.9; p 0.05), respectively, while good knowledge about diabetic eye complications was associated with positive attitudes (AOR: 2.0; 95% CI: 1.3-3.1; p 0.05). Patients diagnosed with diabetes mellitus for more than five years were more likely to attend regular eye exams (AOR: 2.3; 95% CI: 1.5-3.6; p 0.05). CONCLUSION:Although participants had high median scores for knowledge and attitudes, important deficiencies were noted that could hinder effective DR screening.Contribution: These findings provide the baseline evidence on the need for ongoing patient education in primary care to enhance DR prevention.
BACKGROUND:The coronavirus disease (COVID-19) vaccination campaign in South Africa constituted the most significant public health intervention in recent history, occurring against the backdrop of a prevailing quadruple burden of disease. AIM:To evaluate the implementation of the COVID-19 vaccination campaign, focusing on rollout speed and geographic equity and to examine the temporal associations between vaccination coverage and mortality trends. SETTING:All South African residents aged 12 years and older who were eligible for COVID-19 vaccination during the study period. METHODS:A retrospective, ecological population-based time-series analysis to assess vaccination rollout trends and geographic equity, and to examine the association between vaccination coverage and excess mortality. The Logic Model and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework were applied to interpret implementation performance. RESULTS:The vaccination campaign expanded rapidly in the early phases, but vaccination activity declined significantly over a three-year period (p 0.001). By February 2024, approximately 49.7% of the eligible population had received at least one dose, below the national target of 67%. Coverage was higher in metropolitan than in district municipalities (p 0.05). Statistically significant non-causal temporal associations were observed between vaccination coverage and excess mortality. CONCLUSION:Early vaccine coverage was achieved, but uptake was insufficient to meet national coverage targets. Geographic disparities suggest potential inequities in access, offering empirical insights to strengthen primary health care integration, equitable service delivery, and data-driven implementation strategies.Contribution: This study supports dual-framework implementation science for evaluating large-scale public health interventions to inform health system strengthening and emergency preparedness.
