South African Family Practice (E-Journal)
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Breast cancer survivorship in South Africa: A holistic primary care approach
No full textAs breast cancer incidence increases and survival improves, an increasing number of breast cancer survivors (BCS) require long-term follow-up and support. Primary care providers play a central role in maintaining continuity of care, promoting endocrine therapy adherence, managing complications such as lymphoedema and supporting psychosocial well-being. This article aims to provide a structured approach to breast cancer survivorship care, aligned with national cancer care policies and guidelines and international best practices, focused on primary care integration. A case vignette aims to bridge theory and practice, contextualise decision-making and encourage patient-centred care as it relates to breast cancer survivorship in the South African context
Tuberculosis prevention in children, adolescents, and pregnant and postpartum women in South Africa
No full textTuberculosis (TB), particularly drug-resistant TB (DR-TB), remains a major public health concern in South Africa (SA), with children, adolescents, and pregnant and postpartum women (CAPPW) facing heightened risks because of biological and social vulnerabilities. This article highlights the importance of a multipronged prevention framework that combines infection control measures, psychosocial support, education, and nutritional supplementation, alongside pharmacological interventions such as Bacillus Calmette-Guérin (BCG) vaccination and tailored TB preventive therapy (TPT). Drawing on national guidelines and recent academic literature, the article provides an overview of current evidence and recommendations for TPT regimens (including 6H, 3HP, 3RH, 4R, 12H, and 6LFX) and their eligibility, safety considerations, drug interactions, and formulations suitable for CAPPW. By strengthening awareness and streamlining guideline-based prevention efforts, the article equips healthcare workers to make informed, patient-centred decisions to improve treatment outcomes and ultimately reduce TB transmission in high-burden settings
Transforming higher education: Embracing gender diversity for an inclusive future
No full textNo abstract available
Patient-centred interventions for drug-resistant tuberculosis: A scoping review
No full textBackground: People on drug-resistant tuberculosis (DR-TB) treatment face multiple challenges, which include severe disease and treatment side effects, together with psychosocial and socioeconomic challenges. These challenges impact patients’ ability to remain in care and complete their treatment.Methods: We conducted a scoping review to synthesise evidence on patient-centred care interventions that have been offered to DR-TB patients to facilitate retention in care. Studies published from 2005 until 2023 were retrieved from primary research articles, grey literature and review articles published in peer-reviewed journals.Results: Among the 347 articles sought for retrieval, 172 were subsequently excluded from the analysis for various reasons. Ultimately, 14 studies met the inclusion criteria, providing valuable insights into patient-centred interventions for DR-TB patients. These interventions aimed to mitigate the complex challenges faced by DR-TB patients during treatment and were categorised into four groups, consistent with the World Health Organization (WHO) recommendations on social support for people with DR-TB: (1) informational, (2) emotional, (3) companionship and (4) material support. Most studies (n = 11) offered DR-TB patients integrated forms of support. Material support was the most common form of support utilised across the studies (n = 12), followed by informational (n = 9), companionship (n = 7) and emotional support (n = 5).Conclusion: Patient-centred care interventions improve retention in care and treatment outcomes among DR-TB patients.Contribution: The study contributes to the discourse on the value of patient-centred care in managing people with DR-TB
A socio-ecological analysis of parents’ experiences of stillbirth in Limpopo, South Africa
No full textBackground: Stillbirth is a profoundly personal experience shaped by sociocultural norms, healthcare systems, and policies. Limited research exists on parents’ lived experiences in South Africa. This study explored socio-ecological factors influencing parents’ experiences of stillbirth in Limpopo, South Africa.Methods: This qualitative exploratory study used in-depth interviews with 12 purposively selected parents. Interviews were conducted in Xitsonga, transcribed, translated, and thematically analysed using ATLAS.ti.Results: The findings revealed that parents’ experiences of stillbirth were shaped by a range of interconnected factors across multiple levels of the socio-ecological framework. At the individual level, participants expressed varying understandings of stillbirth, emotional distress, self-doubt and fear of recurrence. Interpersonal relationships played a dual role, with some participants receiving strong emotional support from partners and family members, while others experiencing blame and stigma. Organisational factors included positive and negative experiences with religious institutions and healthcare services, with reports of compassionate care and critical gaps in communication and response time. Societal influences were reflected in cultural beliefs, such as Xirheti, which shaped perceptions of repeated stillbirths and contributed to stigma. At the policy level, participants not only recognised the importance of antenatal care as promoted by national guidelines but also highlighted systemic barriers such as delayed transport and limited access to timely healthcare services.Conclusion: Addressing the impact of stillbirth requires a multi-level approach that integrates personal, social, cultural, healthcare, and policy dimensions to support parents.Contribution: This study offers evidence to inform more family-centred and system-responsive approaches in primary and maternal healthcare
A ‘COMMON SENSE’ approach to geriatric patients in clinical practice
No full textSouth Africa has a critical shortage of geriatricians and a growing ageing population. Most geriatric patients are cared for by their primary care practitioner who may not have been trained in the care of the older adult. The comprehensive geriatric assessment (CGA) is the cornerstone of the geriatric consultation but can be time-consuming. By using a common sense approach to the geriatric patient, none of the important components of the CGA will be missed. The mnemonic ‘COMMON SENSE’ can be used as a tool to assist in identifying the common conditions that older adults experience, as well as highlight specific considerations that become increasingly important in this population. Many simple and time-effective screening tools are available to assist in diagnosing the geriatric syndromes which can be easily implemented in a busy primary care practice
Stakeholders’ views on public-private partnerships for rehabilitation services in South Africa ahead of National Health Insurance
No full textBackground: Quality rehabilitation services are limited in rural South African areas, such as KwaZulu-Natal (KZN). Public-private partnerships (PPPs) are increasingly valued as an effective model for public health delivery in developing countries; yet, their application in South Africa’s rehabilitation sector, especially with the upcoming National Health Insurance (NHI) for universal health coverage, remains unclear. This study examined perspectives on using PPPs for rehabilitation services within the District Health System in KZN in preparation for the NHI.Methods: A qualitative study in eThekwini, Amajuba and King Cetshwayo districts of KZN included 57 participants, selected through purposive sampling. Participants were rehabilitation practitioners, managers and social development representatives. Data were collected via focus groups and interviews and analysed using thematic analysis.Results: Participants noted that the NHI’s strategy of incorporating the private sector is designed to alleviate government pressure and provide financial incentives. Challenges mentioned include service availability, patient care and tariff disputes. Discrepancies between public and private sectors and the private sector’s financial sensitivities pose significant challenges to NHI implementation. A knowledge gap exists regarding the role of PPPs in the NHI context for rehabilitation services. Practitioners emphasised the necessity of adequate government funding for private sector partnerships to strengthen public health infrastructure.Conclusion: Stakeholders express varied views on PPPs for rehabilitation, highlighting the need for clear guidelines and funding support as South Africa nears NHI implementation.Contribution: This study provides insights into stakeholders’ views on PPPs for rehabilitation, identifying key benefits and challenges to inform effective NHI-aligned implementation strategies
A guide for arterial line insertion for the South African primary care practitioner
No full textThis article provides information on the reasons for inserting an arterial line, how to insert this line, the equipment required to insert an arterial line, and the possible complications that may arise from this procedure. It is hoped this information will guide primary care practitioners working in the South African environment and increase their confidence for inserting arterial lines
Point-of-care ultrasound competency of doctors working in Cape Town emergency departments
No full textBackground: Point-of-care ultrasound (PoCUS) is a core competency in emergency medicine, and its use in other primary healthcare settings is growing. The study investigates the PoCUS competency, training and qualifications of doctors working in public emergency departments.Methods: An online survey was distributed to doctors at five public Cape Town emergency departments, followed by a practical assessment of an Extended Focused Assessment with Sonography in Trauma (eFAST) and a basic cardiac ultrasound examination. Descriptive and inferential statistics are presented.Results: All participants had attended an in-person PoCUS course before, and 45 (83.3%) were trained by supervisors at work. Eleven participants (20.4%) were credentialled. In the practical assessment, 73.5% were rated as competent in eFAST and 55.9% in basic cardiac ultrasound. The median scores were 80.4% (eFAST) and 76.9% (cardiac ultrasound). Credentialled participants were more likely to achieve a pass mark ( 60%) in eFAST (p 0.001) and cardiac ultrasound (p 0.001).Conclusion: All the emergency department doctors who use PoCUS had received formal PoCUS training, and the majority of PoCUS providers had an adequate skill level in the applications tested. The credentialled providers performed better overall. There is a need for further research to investigate the persistently low credentialling rate and potential solutions, not only among practitioners in emergency departments but also generalists and primary care practitioners.Contribution: Our study provides a unique snapshot of the PoCUS skills of junior doctors and trainees in public Cape Town emergency departments