Level of patient safety culture among public healthcare professionals in Pretoria.

BACKGROUND: Patient safety culture (PSC) norms set within an organisation prevent harm during medical care. This study assessed the level of PSC among public healthcare professionals (HCPs) in Pretoria, South Africa. METHODS: A multi-centre cross-sectional study conducted in three hospitals and 25 clinics in regions 1 and 2 of Pretoria, using a self-administered questionnaire adapted from the Hospital Survey on Patient Safety Culture. Using the Raosoft online sample size formula, from 1238 public HCPs identified, the sample size was calculated at 294; this expanded to 319 as a result of respondents' willingness to participate in the study. RESULTS: Of the 319 respondents with a mean age of 39.9 years, the minimum and maximum ages were 22 and 66 years, respectively. The age group of 30-39 years had the highest participation rate (17.6%). Most respondents (41.1%) came from the Odi district hospital and there were more women (78.1%) and nurses (49.2%). Positive attitudes were found for all PSC components, with staff education and training scoring highest (98.7%). Patient safety culture received a satisfactory rating from HCPs from the targeted facilities. CONCLUSION: This study showed that public HCPs in Pretoria's regions 1 and 2 have a good PSC, particularly among nurses, professionals with more experience, and at primary care level.Contribution: To maintain or increase awareness of this concept among HCPs, the study advocates a PSC programme as well as ongoing education that can be supported by district and facility managers.

Awareness of health risks associated with smokeless tobacco use among users in Pretoria.

BACKGROUND: Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa. METHODS: This was a cross-sectional design, using a piloted, structured and self-administered questionnaire. RESULTS: Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30-39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%). CONCLUSION: This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem.

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria.

BACKGROUND: The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01 January 2020 to 30 June 2020. METHODS: A cross-sectional study using a piloted and researcher assistant-administered questionnaire. RESULTS: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30-39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12-23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15-20 years of age. CONCLUSION: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.

Preparedness level of frontline healthcare professionals in Tshwane regarding the COVID-19 pandemic.

BACKGROUND: Facing the highly transmissible viral infection referred to as the coronavirus disease 2019 (COVID-19) that threatens human life, South African frontline healthcare professionals have faced a major challenge. Being one of the African countries with a higher prevalence of COVID-19 cases, this study aimed to assess the preparedness levels of emergency doctors, nurses and clinical associates in the Tshwane district of South Africa regarding the COVID-19 pandemic. METHODS: This was a cross-sectional survey using a developed and piloted online questionnaire. It was conducted in the casualty departments (emergency medical units) of seven hospitals in the Tshwane district of South Africa. Only emergency doctors, nurses and clinical associates took part. RESULTS: Of the 87 respondents, the mean age was 33.9 years and the minimum and maximum ages were 22 and 62 years, respectively; 37 (42.5%) were aged 26-30 years, 54 (62.1%) were females, 46 (52.9%) were single persons, 35 (40.2%) were medical officers, 42 (48.3%) were healthcare professionals with 0-5 years of experience and 21 (24.1%) were from a provincial tertiary hospital. Of the healthcare professionals, 63 (72.4%) were assessed as being prepared regarding the COVID-19 pandemic. CONCLUSION: The current online survey demonstrated a good preparedness level regarding the COVID-19 pandemic management amongst frontline healthcare professionals working in seven hospitals of the Tshwane district. An educational training programme on disaster management or the COVID-19 pandemic should be implemented to ensure that all frontline healthcare professionals are adequately prepared for current and future outbreaks.

A Primary Care Approach to Abdominal Pain in Adults.

Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague symptomatology and difficult correlation to specific organ pathology obscures clinical findings leading to incorrect diagnoses. Although most presentations of abdominal pain are benign, a significant number of patients have life-threatening conditions that require a meticulous approach to management in order to prevent morbidity and mortality.The skill in assessing patients presenting with abdominal pain is fundamental for all primary care doctors. This review will discuss an approach to the assessment and diagnosis of abdominal pain in the primary care setting.

Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo.

BACKGROUND: Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC. METHODS: This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value < 0.05 was considered statistically significant. RESULTS: Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient's questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p< 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 (p< 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC. CONCLUSION: For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients' education on IC should be displayed in waiting areas at all medical centres.

Reasons women terminate their pregnancies legally and their contraceptive practices at Soshanguve 3 Community Health Centre, Tshwane district, South Africa.

BACKGROUND: Various reasons have been cited in studies conducted in South Africa on why women legally terminate their pregnancies. We sought to determine the reasons for women to terminate their pregnancies legally and their contraceptive practices. This study was conducted at Soshanguve 3 Community Health Centre (CHC), located in a semi-rural zone in the north-west of Pretoria, Gauteng province of South Africa. METHOD: A cross-sectional study design was adopted in this study. RESULTS: Of the 250 respondents, high participation (23.2%) was noted amongst women aged 18-20 years. Eighty-three (33.2%) respondents did not have children, 108 (43.2%) had completed their secondary school education and 226 (90.4%) were Christian. Of the participants, 80% were single and 62.8% were unemployed. About 85.6% (214) of respondents had not had a previous abortion. A total of 24% of respondents requested abortion because they wanted to focus on their education, while 23.1% were not ready to be parents and 21.7% experienced financial difficulties. With regard to practice, all respondents had already used contraception and the most used contraceptive was the male condom (43.5%), followed by an injectable contraceptive (7.1%). CONCLUSION: While academic reasons, not being ready to be a parent and financial difficulties were named as the main reasons for terminating a pregnancy legally, the selected pregnant women at Soshanguve 3 CHC demonstrated an unsatisfactory practice of contraceptive measures.

Influence of patients' living conditions on tuberculosis treatment outcomes in a South African health sub-district.

BACKGROUND: Tuberculosis (TB) remains a serious public health concern because it continues devastating communities. This survey was conducted in the sub-district 2 of the Tshwane health district, South Africa. It aimed at determining the influence of patients' living conditions on TB treatment outcomes. Human immunodeficiency virus (HIV) status, food security and exposure to cigarette smoke were considered as living conditions; and cure, death, default, failure and relapse were considered TB treatment outcomes. METHODS: Record review using the Aitahealth database, clinic registers as well as a piloted, structured and administered questionnaire. RESULTS: Convenience sampling applied; 180 respondents were obtained. Tuberculosis respondents with negative HIV status had a cure rate of 67.3% whilst those with positive HIV status had 37%. Tuberculosis respondents with good food security had 45.9% of cure rate. Tuberculosis respondents exposed to cigarette smoke had a death rate of 65.2%, while respondents not exposed to cigarette smoke showed 75% of cure rate. CONCLUSION: HIV status, food security and exposure to cigarette smoke, as components of living conditions, showed an association with TB treatment outcomes in the selected sample; in the sense HIV infection reduced the cure rate, increased the death and default rates of TB patients in the same sample. Good food security increased the cure rate of TB patients, but exposure to cigarette smoke decreased the cure rate and increased the death rate amongst respondents having TB treatment in the current survey.

The attitude and perceptions of doctors at Letaba Hospital towards family medicine: A qualitative study.

BACKGROUND: It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors' misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions. METHODS: A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty. RESULTS: The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary health- care and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors' level of surgical ability. Based on individual interviews, 11 themes were extracted and a 'wheel' model was created, depicting the core values of the FM discipline. CONCLUSION: The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills.

Knowledge, attitudes and practices of contraceptive methods among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa.

INTRODUCTION: There is an alarmingly high rate of women in South Africa, who are of childbearing age, who still opt for abortions or Voluntary Termination of Pregnancy (VTOP). Despite the availability of free contraceptive methods and health education in all health facilities across the country, to reduce and prevent unwanted pregnancies and VTOP there is still an alarming increase in the rate of VTOP. This study sought to determine the knowledge, attitudes and practices of contraceptive methods among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa. METHODS: A across-sectional survey using a piloted, structured and self- administered questionnaire. Convenience sampling was applied and the sample size was 126. RESULT:   The mean age of the 126 participants was 26.1 years. Findings obtained after analysis of participants' data were grouped following the university categorisation. Below 50% referred as "poor" outcome, from 50 to 74% was referred as "satisfactory" outcome and beyond 74% was considered as "excellent" outcome. Knowledge was poor for 28 (22.2%) of women. It was satisfactory for 91 (72.2%) women and excellent for 7 (5.5%) women. Looking at the attitude: 124 (98.4%) approved the use of contraception, 1 (0.79%) disapproved and 1 (0,79%) abstained due to religious beliefs. Regarding the practice of contraception: 92 (73.0%) have already used contraceptive methods while 34 (27.0%) have not. CONCLUSION: In summary, the study showed a satisfactory knowledge of contraceptive methods, a positive attitude towards contraception and a huge number of participants who have already used contraceptive methods, among women seeking voluntary termination of pregnancy at Jubilee Hospital, Pretoria, South Africa.