Linkage to HIV care and early retention in HIV care among men in the 'universal test-and-treat' era in a high HIV-burdened district, KwaZulu-Natal, South Africa.

INTRODUCTION: Despite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa. METHODS: From January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant. RESULTS: The study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29-40), and more than half (56%; n = 193) were aged 18-34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months. CONCLUSION: While the implementation of the UTT strategy has had positive influence on improving linkage to care, men's access of HIV treatment remains inconsistent and may require additional innovative strategies.

Barriers and enablers for implementation of digital-linked diagnostics models at point-of-care in South Africa: stakeholder engagement.

The integration of digital technologies holds significant promise in enhancing accessibility to disease diagnosis and treatment at point-of-care (POC) settings. Effective implementation of such interventions necessitates comprehensive stakeholder engagements. This study presents the outcomes of a workshop conducted with key stakeholders, aiming to discern barriers and enablers in implementing digital-connected POC diagnostic models in South Africa. The workshop, a component of the 2022 REASSURED Diagnostics symposium, employed the nominal group technique (NGT) and comprised two phases: Phase 1 focused on identifying barriers, while Phase 2 centered on enablers for the implementation of digital-linked POC diagnostic models. Stakeholders identified limited connectivity, restricted offline functionality, and challenges related to load shedding or rolling electricity blackouts as primary barriers. Conversely, ease of use, subsidies provided by the National Health Insurance, and 24-h assistance emerged as crucial enablers for the implementation of digital-linked POC diagnostic models. The NGT workshop proved to be an effective platform for elucidating key barriers and enablers in implementing digital-linked POC diagnostic models. Subsequent research endeavors should concentrate on identifying optimal strategies for implementing these advanced diagnostic models in underserved populations.

Factors contributing to changes in contraceptive use among adolescent girls in Zambia: a decomposition analysis.

Despite its documented benefits, contraceptive use among adolescents remains low, particularly in low-and middle-income countries. This study aimed to decompose the main factors contributing to the changes in contraceptive use among adolescent girls in Zambia over the period 1996 to 2014. Data on adolescent girls aged 15-19 years from Zambia Demographic and Health Survey data were analysed using multivariate decomposition analysis of change. Stata 15/MP (Stata-Corp LLC) was used for analysis, at a 95% confidence level. A P-value of 0.05 was used to determine statistical significance. The sample included 9,072 adolescent girls. Contraceptive use increased by 3% from 7.6% in 1996 to 10.6% in 2013/14. Change in modern contraceptive use among adolescents was mainly due to differences in coefficients (changes in population behaviour). Increases in age contributed to the change in contraceptive use, resulting in 2.94 and 9.33% increases for 17- and 18-year-olds respectively. Marriage or living with a partner contributed the largest change (44%) while living in a rural area accounted for approximately 20%. Interventions targeting improving contraceptive use in adolescents should be responsive to the needs of various age groups, places of residence, and educational levels for maximum benefits.

Understanding adolescent girls' experiences with accessing and using contraceptives in Zambia.

BACKGROUND: Globally, the unmet need for contraception among adolescent girls is high and is driven by barriers to access and utilisation of contraceptives. Understanding adolescent girls' experiences with accessing and using contraceptives is crucial because it influences their decision to use and willingness to continue using health products and services. While determinants of contraceptive use have been extensively researched globally, few studies explore how adolescent girls experience contraceptive use in Zambia using qualitative methods. Therefore, this study aimed to understand Zambian adolescent girls' experiences using contraceptives. METHODS: Thematic analysis was used to analyse data generated from 7 focus group discussions and three in-depth interviews with adolescent girls aged 15 to 19 years in 4 districts in Zambia. NVivo version 12 pro (QSR International) software was used to manage and organise the data. RESULTS: Results revealed that adolescents' experiences concerning contraceptives across the continuum of care are shaped by various factors, including knowledge of contraceptives which comprises sources of information and contraceptives; experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives; perspectives about existing contraceptives; and preferred types of contraceptives. CONCLUSION: The multifactorial interaction relating to adolescents' personal experience, their community and the environment in which they access contraceptive services all contribute to their overall experience and influence their contraceptive decisions. Therefore, qualitative studies exploring adolescents' experiences with accessing and using contraceptives are vital for tailoring interventions responsive to the contraceptive needs of this age group.

Physiotherapy management of children with cerebral palsy in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Cerebral Palsy (CP) is the most common childhood physical disability worldwide. Approximately 1.5 to 4 children per live births live with CP, globally. There have been no specific treatments that can reverse the brain damage responsible for the complex clinical dysfunctions of CP. There are, however, several interventions that are currently being used by physiotherapists, most of which are deemed to be ineffective and unnecessary. We will conduct a scoping review aimed at mapping evidence on the physiotherapy management of children living with CP in low- and middle-income countries (LMICs). METHODS: The scoping review will be guided by the Arksey and O'Malley and Levac et al. frameworks. The databases that will be used to search for literature include PubMed, MEDLINE, CINAHL, EBSCOhost, Web of Science, and ProQuest One Academic and Scopus. Gray literature articles will also be included in this review, provided they meet our inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline will be used to report the results of the scoping review. The screened results will be reported using the PRISMA flow diagram guidelines, and the results will be charted using an electronic data charting form and analyzed using thematic analysis. DISCUSSION: Understanding how physiotherapists manage children with CP in LMICs is essential for the development of internationally sound, yet locally relevant, intervention strategy for physiotherapists. It is anticipated that the results of the scoping review will inform the thinking geared towards the development of a contextualised evidence-based framework for physiotherapists to effectively manage CP in children. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework. https://doi.org/10.17605/OSF.IO/VTJ84.

Facilitators and Barriers to HPV Self-Sampling as a Cervical Cancer Screening Option among Women Living with HIV in Rural Uganda.

Background: There is a paucity of studies exploring women living with HIV's (WLWH) experiences relating to human papillomavirus (HPV) self-sampling as cervical cancer (CC) screening approach, either at the clinic or at the home setting, using qualitative methods. Our study explored facilitators and barriers to HPV self-sampling as a CC screening approach among human immunodeficiency virus (HIV)-infected women, as supported by the new WHO guidelines of using the HPV test as a screening modality. Methods: The study was guided by the health promotion model (HPM), which helps individuals achieve higher levels of well-being. The phenomenology design was used to explore the deeper facilitators and barriers of women regarding self-sampling, either at home or in clinical settings, at Luweero District Hospital, Uganda. The in-depth interview (IDI) guide was translated from English to Luganda. Qualitative data analysis was guided by content analysis techniques. The transcripts were coded in NVivo 20.7.0. The coded text was used to generate categories of analytically meaningful data that guided the formation of themes, the interpretation of results, and the final write-up. Results: WLWH were motivated to screen for HPV using the clinic-based approach because of perceived early diagnosis and treatment, visualization of the cervix, and free service, while reduced distance, privacy and the smooth sample collection kit were motivators for the home-based approach. A barrier that cut across the two HPV self-sampling approaches was a lack of knowledge about HPV. The barriers to clinic-based HPV self-sampling screening included lack of privacy, perceived painful procedures for visual inception under acetic acid (VIA), and fear of finding the disease. Stigma and discrimination were reported as the major barriers to the home-based HPV self-sampling approach. The major reasons why some WLWH refused to screen were fear of finding the disease, stress, and financial disruptions related to being diagnosed with CC disease. Conclusions: Therefore, early diagnosis for HPV and CC enhances clinic-based HPV self-sampling, while privacy enhances the home-based HPV self-sampling approach. However, fear of finding a disease and the lack of knowledge of HPV and CC hinders HPV self-sampling. Finally, designing pre- and post-testing counselling programs in HIV care is likely to increase the demand for HPV self-sampling.

Food handlers' knowledge, attitudes and self-reported practices regarding safe food handling in charitable food assistance programmes in the eThekwini District, South Africa: cross-sectional study.

OBJECTIVE: This study aimed to assess food handlers' knowledge, attitudes and self-reported practices towards safer donated foods. DESIGN: This cross-sectional study was conducted from January to May 2021. SETTING: This study was conducted in the eThekwini District, South Africa. PARTICIPANTS: A convenience sampling-based cross-sectional survey of food handlers (n=252) served as the study's main source of data. A total of eight study sites across five municipal planning regions of eThekwini District were visited. The principal investigator administered the validated structured standardised questionnaire, using participants' language of choice, which was either English or isiZulu. All the questions in the questionnaire were asked in exactly the same manner, following the same flow, in order to avoid bias and ensure consistency. Furthermore, the close-ended nature of questions in the questionnaire mitigated the risks of question manipulation. The questionnaire was adapted from the WHO's five keys to a safer food manual. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the knowledge, attitudes and self-reported practices towards safer donated foods. The secondary outcomes were the sanitary conditions of infrastructure and facilities, food handlers' observed food handling behaviour and nutritional information/labelling. RESULTS: The results show that the food handlers had good knowledge, positive attitude and acceptable behaviours towards safe food handling and general hygiene, with mean scores (SD) of 62.8 (14.6), 92.5 (14.1) and 80.4 (13.3), respectively. Significant correlations were found between knowledge and attitudes (p=0001), knowledge and practices (p<0001), and attitudes and practices (p=0.02). However, the correlations between knowledge versus attitude and attitude versus practice were poor (Spearman's r<0.3), and the association between knowledge versus practice was moderate (0.3-0.7). The majority of food handlers (92.5%) did not understand the value of thorough cooking and temperature control. About 53% of respondents acknowledged to never adequately reheating cooked meals, 5% did not see the significance of preventing cross-contamination and 5% were unsure. CONCLUSIONS: Despite the relatively positive knowledge, attitude and practice levels of the food handlers, safe food handling and hygiene practices, such as thorough cooking and temperature control, properly reheating cooked meals and taking precautions to prevent cross-contamination, require some emphasis.

The Prevalence of Compassion Fatigue among Oncology Healthcare Professionals in Three Public Healthcare Facilities in Kwazulu-Natal, South Africa.

Compassion fatigue (CF) is a serious global challenge among healthcare professionals dealing with diseases with poor health outcomes in clinical settings. Chronic exposure to the suffering of others is inevitable in the oncology setting and remains one of the main contributors to CF. Therefore, this study determined the prevalence of CF among oncology healthcare professionals (OHPs) in three public healthcare facilities in KwaZulu-Natal, South Africa. This cross-sectional descriptive study was conducted among 73 OHPs using the Professional Quality of Life Scale version 5 questionnaire, and the data were analysed using the Statistical Package for Social Sciences. More than half (56.2%) of the participants reported average scores for CF, with 43.8% of them scoring low. The participants from Inkosi Albert Luthuli Central Hospital had the highest CF mean score (26.8) compared to those from Addington Hospital (21.2) and Greys Hospital (22.9). Female OHPs had a higher mean score (24.3) for CF, compared to their male counterparts (20.6). The CF scores were positively correlated with older age and longer work experience of the OHPs. The prevalence of CF among OHPs was average, compared to those reported by other local and international studies. Nevertheless, these results cannot be taken lightly, given the straining effects of unmanaged CF on the healthcare system generally and on patient care in particular. The results of this study can potentially contribute to policy development and the planning of intervention strategies towards the effective management of CF among OHPs.

"Why Am I Even Here If I Can't Save the Patients?": The Frontline Healthcare Workers' Experience of Burnout during COVID-19 Pandemic in Mthatha, South Africa.

INTRODUCTION: Globally, the high prevalence of burnout in healthcare workers (HCWs) is of the utmost concern. Burnout is a state of emotional exhaustion, depersonalization and a decreased sense of personal accomplishment. While the 2019 Coronavirus (COVID-19) exacerbated the burnout prevalence among HCWs, limited studies have explored this phenomenon using qualitative methodologies in the Eastern Cape Province and South Africa generally. This study explored how frontline healthcare workers experienced burnout during the COVID-19 pandemic in Mthatha Regional Hospital. METHODS: Ten face-to-face in-depth interviews were conducted with non-specialized medical doctors and nurses who directly cared for COVID-19-infected patients during the pandemic in Mthatha Regional Hospital (MRH). In-depth interviews were digitally recorded and transcribed verbatim. Data were managed through NVIVO 12 software before being thematically analyzed using Colaizzi's analysis method. RESULTS: Four main themes emerged from the analysis. These themes were burnout manifestation (emotional strain, detachment and irritability, uncertainty-induced fear, and anxiety, physical exhaustion, yet, low job accomplishment, dread and professional responsibility), precursors of burnout (occupational exposure to high mortality, staff shortages, elongated high patient volume and workload, disease uncertainties and consistent feeling of grief), alleviating factors of burnout (time off work, psychologist intervention, periods of low infection rate and additional staff), and the last theme was every cloud has a silver lining (improved infection prevention and control (IPC) measures, learning to be more empathetic, the passion remains and confidence grows). CONCLUSION: The COVID-19 pandemic brought about a rapid change in the work environment of healthcare workers who are the backbone of efficient healthcare services, thereby rendering them vulnerable to increased burnout risks. This study provides strategic information for policymakers and managers on developing and strengthening welfare policies to promote and protect frontline health workers' well-being and work functioning.

'In fact, that's when I stopped using contraception': a qualitative study exploring women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa.

OBJECTIVES: This study explored women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa. SETTING: In October 2021, we conducted a qualitative study at Umlazi Township in KwaZulu-Natal province, South Africa, through face-to-face in-depth interviews. PARTICIPANTS: Women from four primary healthcare facilities were recruited through a criterion-based sampling strategy. Using NVivo V.11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. RESULTS: The study included 15 female participants, aged between 18 and 35 years, of whom two-thirds were aged 18-24 years. We found that women were concerned about unpleasant contraceptive methods side effects such as prolonged or irregular menstrual periods, bleeding, weight gain and/or severe pains, resulting in discontinuation of their use. In addition to contraceptive stockouts, women indicated that healthcare providers did not appropriately counsel or inform them about the available contraceptive methods, including how to use them. Key themes included the following: negative effects of contraceptive methods; stockouts of preferred contraceptive methods; inconsistent or incorrect use of contraceptive methods; lack of counselling regarding contracepive methods; and misconceptions about contraception. CONCLUSIONS: Interventions aimed at reducing contraceptive stockouts are required to ensure that women are empowered to choose contraception based on their own preference, convenience and/or experience. It is imperative that counselling on contraceptive methods' side effects be improved, to ensure that women have freedom to make informed decisions about their preferred method, proper management of side effects and to assist them with method switching as needed, instead of discontinuation.

Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study.

BACKGROUND: Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. OBJECTIVE: The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. METHODS: This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. RESULTS: This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. CONCLUSIONS: This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34341.

Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review.

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia.

Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.

Linkage to HIV Care Following HIV Self-testing Among Men: Systematic Review of Quantitative and Qualitative Studies from Six Countries in Sub-Saharan Africa.

Gender disparities are pervasive throughout the HIV care continuum in sub-Saharan Africa, with men testing, receiving treatment, and achieving viral suppression at lower rates, and experiencing mortality at higher rates, compared with women. HIV self-testing (HIVST) has been shown to be highly acceptable among men in sub-Saharan Africa. However, evidence on linkage to HIV care following a reactive HIVST result is limited. In this systematic review, we aimed to synthesize the quantitative and qualitative literature from sub-Saharan Africa on men's rates of linkage to HIV care after receiving a reactive HIVST result. We systematically searched 14 bibliometric databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram was used to document the screening results. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Of 22,446 references screened, 15 articles were eligible for inclusion in this review. Linkage to HIV care following a reactive HIVST result was subject to several barriers: financial constraints due to travelling costs, potential long waiting hours at the clinics, stigma, discrimination, and privacy concerns. Men's rates of seeking confirmatory testing and linking to HIV care following a reactive HIVST result were inconsistent across studies. Combining financial incentives with HIVST was found to increase the likelihood of linking to HIV care following a reactive HIVST result. The variable rates of linkage to HIV care following a reactive HIVST result suggest a need for further research and development into strategies to increase linkage to HIV care.

Lung cancer awareness training experiences of community health workers in KwaZulu-Natal, South Africa.

BACKGROUND: Lung cancer is the leading cause of cancer mortality worldwide. Awareness interventions in the developing world remain scarce. Community health workers (CHWs) are a critical component towards ensuring efficient delivery of healthcare services in low- and middle-income countries. AIM: This study explored the experiences of CHWs of their training as lung cancer awareness intervention implementers. SETTING: The study was conducted in a resource-poor setting, with CHWs from previously disadvantaged communities. METHODS: On the last day of training, 10 CHWs were requested to voluntarily participate in a focus group discussion regarding their experiences of the training, utilising a discussion guide. RESULTS: The participants expressed positive experiences with the training. They cited the amenable and conducive learning environment established by the facilitator. The participants felt empowered through the newly acquired knowledge and wanted to help their communities. However, some participants expressed a desire to have other forms of learning incorporated in future training. The participants were also cognisant of existing gaps in their own knowledge that could be elaborated upon in preparation for potential questions by the community. Some participants confirmed their role as agents of change. CONCLUSION: The authors propose large-scale intervention studies of lung cancer awareness utilising the CHW programme to gather conclusive evidence regarding their effectiveness at a community level.Contribution: This article provides insight into the training of community health workers on lung cancer awareness and future research on the integration of the intervention into already existing programmes.

Exploring patients' lived experience on the barriers to accessing low back pain health services.

BACKGROUND: The burden of chronic low back pain (CLBP) is a major concern to public health. However, the treatment of CLBP in primary care has shown to be ineffective in South Africa. Understanding the barriers encountered by patients in accessing CLBP healthcare services is paramount in the development of context-specific intervention strategies. AIM: To explore the patients' lived experiences on the barriers to accessing diagnostic, referral and treatment services for CLBP. SETTING: A health facility-based study conducted at five primary public hospitals in KwaZulu-Natal, South Africa. METHODS: A phenomenological study by means of in-depth interviews using the general interview guide approach. Interviews were conducted by a research assistant with relevant experience and qualifications in qualitative methods. A total of 15 participants were recruited to participate in this study. All interviews were audio-recorded and transcribed. Data were analysed iteratively until saturation was reached, where no new themes were emerging. All the transcripts were exported to NVivo 12 Pro for analysis. RESULTS: The results of this study identified the following barriers: travel, long waiting periods, shortage of personnel, poor infrastructural development, inadequate healthcare personnel, communication barrier, social influence, beliefs around cause and effect, misdiagnosis and inappropriate and/or ineffective treatment approaches. CONCLUSION: This study concluded that barriers to patients' accessing diagnostic, referral and treatment services exist. Efforts should be made towards developing health systems in underserved communities.Contribution: This is the first study to be conducted in South Africa that explored the barriers associated with accessing healthcare services for chronic low back pain. Based on the results of this study, in order to improve health outcomes for low back pain there need to be a change of emphasis in primary health care by ensuring sufficient allocation of resources towards musculoskeletal disorders.

Men's conceptualization of gender-based violence directed to women in Alexandra Township, Johannesburg, South Africa.

BACKGROUND: Gender-based violence (GBV) is a crucial global public health challenge disenfranchising women and girls from enjoying their fundamental human rights, thereby threatening their well-being. While the concept of GBV does not imply that violence is always unidirectional, literature shows that women and girls are the most common victims of this type of violence. One in three women, globally, have suffered physical or sexual violence by an intimate partner or non-partner. Evidence has shown that a number of women who experience GBV varies widely, with 37% being in Eastern Mediterranean, 37.7% in South-East Asia, 29.8% in America, 36.6% in Africa, 44% in sub-Saharan Africa (SSA) and 53% in South Africa. METHODS: Using a semi-structured face-to-face interview with fifteen conveniently sampled adult males, who met the selection criteria, this study explored men's conceptualisation of GBV in Alexandra Township, using qualitative research methods. RESULTS: Socio-economic factors and evolving cultural dynamics were perceived to be among the key factors aggravating gender-based violence. Participants viewed poverty and substance abuse as the main causes of violence towards women, a phenomenon tied to the growing frustration emanating from men's inability to provide for their families. Cultural factors related to the patriarchal system and diminishing value of respect between men and women were identified as root causes of GBV. The participants also blamed the government for what they considered to be "too many rights" for women, resulting in men exerting their authority through abuse. Participants also expressed concerns over feminisation of GBV, asserting that men fall prey to GBV too. Partner infidelity and insecurities also contributed to GBV. CONCLUSION: The study results provided important insights on how men conceptualize GBV in Alexandra Township, South Africa. These results revealed that socio-economic conditions, alongside some gender stereotypes are pervasive and shape how men view GBV in Alexandra Township. This evidence is necessary for developing interventions aimed at curbing GBV and may also be suggestive of the need to redesign programmes targeting men, so that certain stereotypes can be uprooted.

The COVID-19 Impact on the Trends in Yellow Fever and Lassa Fever Infections in Nigeria.

Lassa fever (LF) and yellow fever (YF) belong to a group of viral hemorrhagic fevers (VHFs). These viruses have common features and damages the organs and blood vessels; they also impair the body's homeostasis. Some VHFs cause mild disease, while some cause severe disease and death such as in the case of Ebola or Marburg. LF virus and YF virus are two of the most recent emerging viruses in Africa, resulting in severe hemorrhagic fever in humans. Lassa fever virus is continuously on the rise both in Nigeria and neighboring countries in West Africa, with an estimate of over 500,000 cases of LF, and 5000 deaths, annually. YF virus is endemic in temperate climate regions of Africa, Central America (Guatemala, Honduras, Nicaragua, El Salvador), and South America (such as Brazil, Argentina, Peru, and Chile) with an annual estimated cases of 200,000 and 30,000 deaths globally. This review examines the impact of the COVID-19 pandemic on the trend in epidemiology of these two VHFs to delineate responses that are associated with protective or pathogenic outcomes.

Lung Cancer Patients' Conceptualization of Care Coordination in Selected Public Health Facilities of KwaZulu-Natal, South Africa.

BACKGROUND: Cancer patients commonly receive care, including comprehensive treatment options, from multiple specialists within and across facilities offering varying levels of care. Given this multi-layered approach to cancer care, there is a need for coordinated care enhanced through integrated information flow for optimal patient care and improved health outcomes. OBJECTIVE: This study aimed to explore how patients conceptualized cancer care coordination in an integrated health care system in KwaZulu-Natal. METHODS: The study employed a grounded theory design to qualitatively explore the patients' experiences and views on cancer care coordination using in-depth interviews. Guided by the grounded theory principles, data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organize data, and review and interpret comprehensive findings. This process culminated in the development of themes relating to barriers to cancer care coordination and the interface between the primary and tertiary settings. Theoretical saturation was achieved at 21 in-depth interviews with consenting respondents. RESULTS: This study revealed that care coordination was affected by multilevel challenges, including pertinent health system-level factors, such as difficulty accessing specialty care timeously, weak communication between patients and healthcare providers, and unmet needs concerning supportive care. We found that negative experiences with cancer care erode patient trust and receptiveness to cancer care, and patients advocated for better and proactive coordination amongst different care facilities, services, and providers. CONCLUSIONS: An integrated care coordination setup is essential to create and sustain a high-performance health care system. These findings make a case for developing, implementing, and evaluating interventions to enhance the quality of cancer care for patients and ultimately improve health outcomes for patients in KwaZulu-Natal. This study will provide comprehensive data to inform professionals, policymakers, and related decisionmakers to manage and improve cancer care coordination.

Mapping evidence on factors contributing to maternal and child mortality in sub-Saharan Africa: A scoping review protocol.

BACKGROUND: Maternal and child mortality remains a major public health issue in sub-Saharan Africa (SSA), with the region having the highest under-five mortality rates, where approximately 1 in 11 children, dies before the age of 5 years. This is nearly 15 times the average in high-income countries (HICs). This scoping review is aimed at mapping evidence on the factors contributing to maternal and child mortality in SSA. METHODS: This study will be conducted using a scoping review to map existing literature on the factors contributing to maternal and child mortality in SSA. The search will comprise of peer-reviewed and grey literature, using the EBSCOhost platform. Keyword search from electronic databases such as PubMed/MEDLINE, Google Scholar, Science Direct and World Health Organization library, will be conducted. Information will be obtained from the included studies, using a data charting table. We will use NVIVO version 10 software to analyse the data, and the narrative account of the study will be presented by means of a thematic content analysis. DISCUSSION: We expect to find relevant literature that can help us in mapping evidence on the factors contributing to maternal and child mortality in SSA. This study results are anticipated to identify research gaps and in turn, guide the design of future primary studies. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: Open Science Framework registration number (DOI 10.17605/OSF.IO/XF5VN).