Background: Cancer patients in Sub-Saharan Africa (SSA) are diagnosed late partly due to community lack of knowledge about the disease, social and cultural factors, health system challenges, and inadequate health care worker knowledge. These delays in diagnosis as well as inadequate treatment options contribute to the high mortality from lung cancer in SSA. Quality of life (QoL) is an important outcome measure for cancer patients undergoing treatment. Objective: To describe the quality of life among lung cancer patients in three teaching hospitals in SSA. Methods: This is a prospective cross-sectional study of lung cancer patients at three teaching hospitals in Sub-Saharan Africa (SSA- Kenya (BMC), Tanzania (MTRH) and South Africa (The Lung Laboratory Research and Intervention Unit Helen Joseph Hospital (Wits-Core)). Trained interviewers collected data on demographics, clinical information and performance status using the Eastern Cooperative Oncological Group Performance Scale (ECOG-PS). Patients' QoL was assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).   Results: A total of 210 lung cancer patients consented and were enrolled across the three sites. Global Health Status in this cohort is low, the median score was 41.7 (range: 0-100) and differed between sites. The Wits-Core patients had higher social functioning, while BMC and MTRH had higher financial difficulty scores. Poor ECOG-PS score (3-4) was associated with poorer Global QoL (GqoL) score (aOR = 2.9; 95% CI: 1.4 - 5.9), and patients with higher symptom burden had poorer GQoL. Conclusion: The QoL among lung cancer patients in the three sites is low. Poor QOL in the study is associated with level of education, performance status, fatigue, pain, dyspnoea, insomnia, loss of appetite and constipation.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementNo financial disclosure### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethical approval was obtained from the University of Witwatersrand Human Research Ethics Committee (Medical) (Ref: M180436), MTRH Institutional Research and Ethics Committee IREC (0004048), BMC/CUHAS Ethics & Review Committee (Certificate number CREC/278/2018) and National Institute for Medical Research (Certificate number MR/53/100/598).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesThe data used to support the research findings is included as part of the supporting information.

Background Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years. Methods A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants’ KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level. Results The baseline survey comprised 1163 participants. The median age was 63 years (range 50–98 years); 70% were female, and 69% had ≤ 8 years’ education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2–2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5–2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4–3.4); (High school: AOR = 4.4; 95% CI = 2.7–7.0); (University/college: AOR = 9.6; 95% CI = 4.7–19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention. Conclusions The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.

Background: Cancer has remained one of the leading causes of death worldwide. In Lesotho, breast and cervical cancers contribute about 43% of all the cancer cases annually. Aim: This study is aimed at comparing knowledge, attitudes, and practices between breast and cervical cancers among females in Maseru. Settings: This study consists of women residing in five study sites which have clinics that offer cervical and breast cancer-screening services. Methods: A cross-sectional study was conducted in June 2021 in Maseru, the Capital city of Lesotho. The participants were interviewed using a pre-tested questionnaire, through which their knowledge, practices about, and attitudes towards breast and cervical cancers were assessed. Results: A total of 228 women aged 15–75 years participated in the study and the majority were aged 30 years and above. Of the women interviewed for cervical cancer, 89.5% had heard of it, 11.8% had heard of its screening, and 7.4% had at least one examination. Similarly, for breast cancer, 77.6% of women who had heard of it, 72.9% had heard of screening, and 40.1% of women did at least one examination. Conclusion: The majority of women were more knowledgeable about cervical cancer than breast cancer. However, more women had heard about breast cancer screening than cervical cancer screening. Therefore, there is a need for awareness campaigns related to cervical cancers’ screening. Contribution: There is an urgent need to intensify awareness about cervical and breast cancer screening and availability of services at the nearby clinics.

Cervical cancer is the most common cancer among women in Kenya. However, only 3% of women are routinely screened. This study aimed to assess women’s knowledge and attitudes towards cervical cancer and cervical cancer screening in Kenya’s Isiolo and Tharaka Nithi counties.

Breast cancer and cervical cancer are the two leading cancers among women in Ethiopia. This study investigated knowledge and attitudes related to these two types of cancer among women in 4 zones of Ethiopia. This is the first study employing a validated questionnaire to investigate knowledge and attitudes relating to breast and cervical cancer in Ethiopia.

Background: Research consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility. Aim: To improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC). Setting: Du Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS). Methods: A cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance. Results: The ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers. Conclusion: Knowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Background: Major health sector reform and the need for baseline measures of performance to determine impact.Aim: Baseline audit of primary healthcare (PHC) performance.Setting: Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.Method: The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.Results: Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.Conclusion: Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.

Background Measuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the content and cross-cultural validity for wider use in South Africa (SA). Aim This study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform. Setting Public sector primary care clinics, users, practitioners and managers in urban and rural districts in the Western Cape Province. Methods Face value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version – ZA PCAT. Results All original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans. Conclusion The PCAT is a valid measure of primary care performance in SA. The PHC team domain is an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource- constrained environment.

BACKGROUND: In October 2003 South Africa embarked on a program of folic acid fortification of staple foods. We measured the change in prevalence of NTDs before and after fortification and assessed the cost benefit of this primary health care intervention. METHODS: Since the beginning of 2002 an ecological study was conducted among 12 public hospitals in four provinces of South Africa. NTDs as well as other birth defect rates were reported before and after fortification. Mortality data were also collected from two independent sources. RESULTS: This study shows a significant decline in the prevalence of NTDs following folic acid fortification in South Africa. A decline of 30.5% was observed, from 1.41 to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49-0.98; p = .0379). The cost benefit ratio in averting NTDs was 46 to 1. Spina bifida showed a significant decline of 41.6% compared to 10.9% for anencephaly. Additionally, oro-facial clefts showed no significant decline (5.7%). An independent perinatal mortality surveillance system also shows a significant decline (65.9%) in NTD perinatal deaths, and in NTD infant mortality (38.8%). CONCLUSIONS: The decrease in NTD rates postfortification is consistent with decreases observed in other countries that have fortified their food supplies. This is the first time this has been observed in a predominantly African population. The economic benefit flowing from the prevention of NTDs greatly exceeds the costs of implementing folic acid fortification.