Healthcare workers' perceptions of sexual violence during the COVID-19 pandemic in the Eastern Cape.

BACKGROUND: The South African government implemented lockdown restrictions in order to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). AIM: This study explored the effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual violence in the Eastern Cape province through the lens of healthcare workers' (HCWs) experiences. SETTING: A Thuthuzela care centre in the Eastern Cape province, South Africa. METHODS: This qualitative study brings together the findings from thematic analysis of semi-structured interviews conducted among 11 purposively selected HCWs in May 2022. RESULTS: Overall, three themes emerged from the study: the effects of COVID-19 on sexual violence, profile of the survivors and recommendations for combating sexual violence in the region. Most respondents believed that the COVID-19 pandemic caused a surge in the incidence of sexual violence, although all acknowledged that movement restrictions affected reporting. The participants treated mostly black women and children's survivors, who experienced physical injuries simultaneously. The respondents' narratives revealed that educational campaigns targeting boys and men could reduce sexual violence in the region. In addition, it was recommended that stricter laws and harsher penalties would serve as deterrents for perpetrators of sexual violence in the country. CONCLUSION: The COVID-19 lockdown restrictions exposed the vulnerabilities of black women and children to sexual violence in the study setting. Educational programmes aimed at re-orientating boys and men in both rural and urban communities should be implemented.Contributions: This study provides an insight into the perceived effect of the COVID-19 pandemic on sexual violence in the Amathole district and South Africa.

South African medical interns' perspectives on the use of point of care ultrasound.

BACKGROUND:  Point of care ultrasound (POCUS) has become such a part of patient care that it is included in undergraduate medical training in many high-income countries. In South Africa, despite the availability of ultrasound units, there is no information on the exposure or training required for medical interns to perform POCUS in their community service year. This study examines interns' self-reported POCUS training and competency, as well as their perceived readiness for their community service year. METHODS:  In this cross-sectional web-based survey, 43 interns were invited to complete a self-administered questionnaire after completing their 6-month decentralised family medicine rotation in 2022. RESULTS:  Thirty complete responses (69% response rate) were included for analysis. Eleven graduates from three medical schools reported undergraduate exposure to POCUS. Ten participants completed formal postgraduate ultrasound training. Eight participants felt confident to independently perform POCUS. Thirteen participants felt adequately prepared for their community service year, 10 of whom had received POCUS training. Nearly all the participants (29 of 30) felt that ultrasound training should be incorporated into both undergraduate and internship training. CONCLUSION:  Medical interns expressed a need for more POCUS training. Most of the studied sample did not feel adequately prepared to perform POCUS independently. The high uptake of additional ultrasound courses highlights the need to include POCUS training. More research is needed to determine the extent and level at which POCUS training should be offered to medical interns in the South African setting.Contribution: This study looks at the perceived need of South African medical interns for formal POCUS training. It highlights a potential gap in training based on the expected clinical requirements of the community service year.

Epidemiology of interpersonal violence at a regional hospital emergency unit in the Eastern Cape, South Africa.

BACKGROUND: This study describes the profile, mechanism and pattern of injuries, and highlights important gaps in clinicians' consultations with patients who experienced interpersonal violence (IPV) in the predominantly black South African township of Mdantsane, Eastern Cape. METHODS: This retrospective cross-sectional study was conducted at the Cecilia Makiwane Regional Hospital, Mdantsane. Medical records of patients who received emergency care for trauma between 01 December 2017 and 31 March 2018 were reviewed. The records of patients identified with IPV were selected for further analysis. Data were disaggregated by demographics, mechanism of injuries and circumstances of the incidents using simple descriptive statistics. RESULTS: A total of 1064 patients reported IPV as the mechanism of injury for emergency department (ED) visits, accounting for 42.4% of all trauma-related injuries. The majority of patients with IPV were men (72.0%), unemployed (78.0%) and single (89.0%). Blunt force injury was the most common pattern of injury (53.3%); about half (50.5%) of the incidents took place in the patients' homes. The majority of the patients (68%) knew their assailants, and a quarter of them were an intimate partner of the assailant (27.6%). The flow of patient with IPV to the ED was skewed towards the weekend (weekend effect). Also, there was an upward trend in the flow of patients with IPV to the ED from 19:00 onwards, reaching a peak at 20:00. CONCLUSION: Interpersonal violence is the most prevalent mechanism of injury reported in this region. It is crucial to engage stakeholders in the design of interventions in order to reduce IPV-related injuries in the region.

Coverage of diabetes complications screening in rural Eastern Cape, South Africa: A cross-sectional survey.

BACKGROUND: There is a paucity of data on the coverage of diabetes mellitus (DM) complications screening in primary healthcare facilities in South Africa (SA). This study assesses the extent of screening for DM complications among individuals with type 2 DM attending primary health facilities in rural Eastern Cape (EC), SA. METHODS: The study adopted a descriptive, cross-sectional design and obtained data from 372 individuals with type 2 diabetes attending six selected primary healthcare centres (PHCs) in two EC districts. Demographic and clinical data were obtained through questionnaire-based interviews and reviews of medical records. We assessed the extent of screening for estimated glomerular filtration rate (eGFR), fasting lipogram, eye examination, foot examination and glycated hemoglobin (HbA1c) in the past year. RESULTS: Participants mean age was 62 (standard deviation [s.d.] ± 11) years, and their mean duration of diagnosis was 9 (s.d. ± 8) years. In the past year, HbA1c result was available for 71 (19.1%) of the participants; 60 (16.1%) had eGFR results, while only 33 (8.9%) had documented lipid results. In total, 52 (14.0%) had carried out eye examinations, while only 9 (2.3%) had undergone foot examinations in the past year. About two-thirds of the participants (59.9%) had not undergone any form of complication screening in the past year, and none had undergone the complete screening panel. CONCLUSION: The coverage of screening for DM complications was low across all indicators. Studies to understand barriers to and facilitators of DM complications screening at PHCs are required. Also, interventions to improve diabetes complication screening in the region are needed and should target the primary healthcare providers.

Correlates and cascade of HIV care in patients with psychiatric disorders in the Eastern Cape province, South Africa.

Background: The cascade of human immunodeficiency virus (HIV) care in patients with psychiatric disorders is poorly understood. Aim: This study determined the prevalence of HIV and described its cascade of care among patients with psychiatric disorders in the Eastern Cape province, South Africa. The study also examined the correlates of HIV comorbidity with psychiatric disorders in the cohort. Methods: In this cross-sectional study, a total of 368 individuals attending the Psychiatric Outpatients' Department of Cecilia Makiwane Hospital in Eastern Cape were interviewed with a structured questionnaire. Relevant items on demographics and clinical information were extracted from the medical records. Virologic suppression was defined as viral load < 1000 RNA copies/mL. Results: The HIV prevalence after the intervention was 18.8% and a significant proportion of participants already knew their status (n = 320; 87.0%). Linkage to care and antiretroviral therapy initiation occurred in 61 participants, of those diagnosed with HIV (88.4%), with 84.1% being eligible for viral load monitoring (n = 58) and 53.4% having achieved virologic suppression. Being female (AOR = 5.48; 95% CI 2.61-11.51) and black (adjusted odds ratio [AOR] = 3.85; 95% confidence interval [CI] 1.06-14.03) were independent predictors of HIV comorbidity in individuals living with psychiatric disorders. Conclusion: This study found a moderately high prevalence (close to 19%) of HIV in individuals with psychiatric disorders, with a significant correlation with being female and being black people. This study also found a significant gap in the linkage to antiretroviral therapy (ART) initiation and a low rate of virologic suppression of 53.4%. Clinicians, therefore, should monitor and provide interventions for patients with concomitant HIV infection along this cascade of care.

Management approach of patients with violent and aggressive behaviour in a district hospital setting in South Africa.

Aggressive and violent behaviour is very common in the hospital setting. Simple agitation may unpredictably progress to overt aggression and violence by any patient in the emergency centres (ECs). Aggressive behaviour often manifests in forms of verbally abusive language, verbal threats and intimidating physical behaviour. Violent behaviour comprises the intentional use of physical force or power, threatened or actual, against self (suicidal), or another (homicidal) or properties, group or community, that could potentially result in injuries, death, psychological harm or deprivation. Therefore, individuals with unusual agitation and aggression should be treated as an emergency in both the community and healthcare settings in order to mitigate the progression to physical violence. Whilst the incidence and prevalence of aggressive and violent behaviour are higher in individuals with an underlying mental disorder, substance use disorder or comorbid mental disorder and substance use disorder, other individuals can also present with these behaviours in the ECs. Therefore, the front-line clinicians must be knowledgeable and competent in managing patients with aggressive behaviour with a view to de-escalate the situation and preventing or curtailing violence. This paper presents an evidence-based approach for managing patients with aggressive and violent behaviour, including a review of the steps for admitting patients for assisted or involuntary care.

Prevalence and determinants of tobacco use amongst South African adults with mental illness in the Eastern Cape.

BACKGROUND: Given the physical and mental health consequences of tobacco use amongst individuals with mental illness, it was imperative to assess the burden of tobacco use in this population. AIM: This study examined the patterns and factors associated with tobacco use in individuals attending the outpatient unit. SETTING: Cecilia Makiwane Hospital Mental Health Department in Eastern Cape province, South Africa. METHODS: Lifetime (ever use) use and current use of any tobacco products were examined in a cross-sectional study of 390 individuals between March and June 2020. A logistic regression was fitted to determine the correlates of lifetime and current use of any tobacco products. RESULTS: The rates of ever use and current use of tobacco products were 59.4% and 44.6%, respectively. Of the participants interviewed, lifetime tobacco use was more prevalent amongst individuals with schizophrenia (67.9%) and cannabis-induced disorders (97.3%) and lower in those with major depressive disorders (36.1%) and bipolar and related disorders (43.5%). Men were six times more likely to have ever used or currently use tobacco products in comparison to women. Also, those who had a salaried job or owned a business were over three times more likely to have ever used or currently use tobacco products compared with those receiving government social grants. CONCLUSIONS: The prevalence of tobacco use in this study was significantly higher than the general population in the Eastern Cape. Therefore, smoking prevention and cessation interventions targeted at the general population should target this often neglected sub-population in the region.

Skills for communicating severe acute respiratory syndrome-coronavirus-2 result to patients and/or relatives.

Clinicians notify positive results of the severe acute respiratory syndrome coronavirus-2 polymerase chain reaction to patients and/or relatives, whilst short message service (SMS) has been adopted as a means of disseminating negative results. Therefore, clinicians should be adequately equipped to provide telephonic consultation whilst delivering a positive test result to patients. The news of the coronavirus disease 2019 (COVID-19) test result often invokes fear of impending death in patients, especially the elderlies and those with comorbidities. In addition, several survivors have reported persistent symptoms and COVID-19-related stigma, which precludes them from immediate re-integration into their workplaces. Consequently, COVID-19 results are perceived as bad news by the members of the public. This article justifies why COVID-19 test results are bad news and also discusses the notification steps to follow when delivering COVID-19 results, whilst also addressing patients' immediate concerns. The article concludes by highlighting an important safety net for COVID-19 patients and the attending clinician.

Prevalence and factors associated with suicidal ideation amongst college students in the Nelson Mandela Bay Municipality, South Africa.

BACKGROUND: Suicidal behaviour amongst college students constitutes a significant social and public health problem globally. This study determined the prevalence and associated factors of suicidal ideation amongst students of higher education in the Nelson Mandela Bay Municipality (NMBM), South Africa. METHODS: In this institution-based cross-sectional study, a multistage cluster sampling of 826 participants, drawn from a college in NMBM, was conducted from January to March 2020. Data were collected with a standardised self-administered questionnaire. Multivariable logistic regression analysis was used to identify the factors associated with suicidal ideation. RESULTS: Participants' ages ranged from 18 to 24 years, with a mean age of 20.49 years (standard deviation, 1.88 years). The lifetime prevalence of suicidal ideation and plans in the preceding 12 months were 24.5% and 9.6%, respectively. The odds of suicidal ideation were higher in students who experienced bullying (adjusted odds ratio [AOR], 1.89; 95% confidence interval [CI], 1.35-2.65), mental illness (AOR, 1.89; 95% CI, 1.35-2.65), a history of sexual assault (AOR, 2.50; 95% CI, 1.20-5.21) and experience of sexual assault by or to a close family member (AOR, 1.69; 95% CI, 1.01-2.82). Underlying chronic illness was associated with a twofold risk for suicidal ideation in both sexes. CONCLUSION: About a quarter of the students sampled at the college had experienced suicidal ideation and some had had suicidal plans in the preceding 12 months. Screening for the identified risk factors amongst the student population coupled with prompt interventions would mitigate the risk of suicide in the study population.

Diabetic patients' perspectives on the challenges of glycaemic control.

INTRODUCTION: The factors affecting the control of diabetes are complex and varied. However, little is documented in the literature on the overall knowledge of diabetic patients about glycaemic control. This study explored the patients' perspectives on the challenges of glycaemic control. METHODS: In this qualitative study, semi-structured interviews were conducted with seventeen purposively selected diabetic patients with HBA1c ≥ 9% at Mthatha General Hospital, South Africa. The interviews were conducted in the isiXhosa language and were audiotaped. Two experienced qualitative researchers independently transcribed and translated the interviews.Thematic content analysis was conducted. RESULTS: Three main themes emerged: overall knowledge of diabetes and treatment targets, factors affecting the control of diabetes and how glycaemic control could be improved.The majority of the participants demonstrated poor knowledge of treatment targets for diabetes. The majority of the participants reported that lack of money affected their control of diabetes. Some of the participants reported that the nearest clinics do not have doctors; hence,they are compelled to travel long distances to see doctors. CONCLUSION: Poverty, lack of knowledge and access to doctors affect the control of diabetes in the rural communities of Mthatha, South Africa. The government should address recruitment and retention of doctors in primary health care.