A community service doctor's experiences of mental healthcare provision in rural Eastern Cape.

BACKGROUND:  Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. METHODS:  The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. RESULTS:  The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. CONCLUSION:  Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.

Prevalence of Micronutrient Deficiency among People Living with HIV in Selected Rural Districts of the Eastern Cape Province of South Africa.

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) leads to immune suppression, and micronutrients play vital roles in human immune responses. Hence, this study aimed to evaluate the effects of viral load suppression in adult HIV-infected patients receiving antiretroviral therapy (ART) on micronutrient deficiency and its prevalence in selected rural districts in the Eastern Cape Province of South Africa. This cross-sectional study was conducted from February 2019 to February 2021 among 50 consenting HIV-infected patients attending community health centers within the three selected districts. The data were analysed with ArcGIS v.10.8 to create geospatial maps; the Global Positioning System (GPS) for analysis and presentation; and SPSS version 25 for inferential statistics involving the t-test and Fisher's exact test, with the level of significance set at p < 0.05. Of the 50 participants, a significant difference of p = 0.003 was observed in mean age among viral load-suppressed (42.9 ± 8.89 years) and unsuppressed (32 ± 6.3 years). In addition, significant differences in the mean viral load and CD4 counts (p < 0.05) were seen. Only iron micronutrient showed a statistically significant difference (p < 0.001) between the viral load-suppressed group (mean 14.8, SD 6.1) and the unsuppressed group (mean 8.1, SD 1.6). Of the 38 individuals from the OR Tambo district, overall micronutrient deficiency was 60.5% (13 (34.2%) deficient for zinc, 9 (23.7%) deficient for iron, 5 (13.2%) for folate, and 1 (2.63%) for vitamin D). In all three study districts, deficiencies in zinc, iron, and folate micronutrients exceeded 25%, particularly in those with an unsuppressed viral load. To address these micronutrient deficiencies, people living with HIV (PLHIV) require robust nutritional supplementation programs.

To queue or not to queue: Facility managers and mental health care users' experiences of integrated health care in a rural South African district.

BACKGROUND: A key feature of South Africa's state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level. METHODS: Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis. RESULTS: The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users. CONCLUSION: This research provided first insights into facility managers' and service users' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.

Traditional uses of wild and tended plants in maintaining ecosystem services in agricultural landscapes of the Eastern Cape Province in South Africa.

BACKGROUND: Many communities in developing countries rely on ecosystem services (ESs) associated with wild and cultivated plant species. Plant resources provide numerous ESs and goods that support human well-being and survival. The aim of this study was to identify and characterize wild and tended plant species, and also investigate how local communities in the Eastern Cape Province in South Africa perceive ESs associated with plant resources. METHODS: The study was conducted in six local municipalities in the Eastern Cape Province, between March 2016 and September 2021. Data on socio-economic characteristics of the participants, useful plants harvested from the wild and managed in home gardens were documented by means of questionnaires, observation and guided field walks with 196 participants. The ESs were identified using a free listing technique. RESULTS: A total of 163 plant species were recorded which provided 26 cultural, regulating and provisioning ESs. Provisioning ESs were the most cited with at least 25 plant species contributing towards generation of cash income, food, traditional and ethnoveterinary medicines. Important species recorded in this study with relative frequency of citation (RFC) values > 0.3 included Alepidea amatymbica, Allium cepa, Aloe ferox, Artemisia afra, Brassica oleracea, Capsicum annuum, Cucurbita moschata, Hypoxis hemerocallidea, Opuntia ficus-indica, Spinacia oleracea, Vachellia karroo and Zea mays. CONCLUSION: Results of this study highlight the importance of plant resources to the well-being of local communities in the Eastern Cape within the context of provision of essential direct and indirect ESs such as food, medicinal products, construction materials, fodder, regulating, supporting and cultural services. The ESs are the basis for subsistence livelihoods in rural areas, particularly in developing countries such as South Africa. Therefore, such body of knowledge can be used as baseline data for provision of local support for natural resource management initiatives in the province and other areas of the country.

Plants Used for the Traditional Management of Cancer in the Eastern Cape Province of South Africa: A Review of Ethnobotanical Surveys, Ethnopharmacological Studies and Active Phytochemicals.

Cancer occurrence is rapidly increasing all over the world, including in developing countries. The current trend in cancer management requires the use of herbal remedies since the majority of anticancer drugs are known to be costly, with unwanted side effects. In the Eastern Cape province, the use of medicinal plants for cancer management has been climbing steadily over the past two decades due to their cultural belief, low cost, efficacy, and safety claims. With the aim of identifying some potential anticancer plants for probable drug development, this study was undertaken to review plants reported by ethnobotanical surveys in the Eastern Cape province of South Africa for the traditional management of cancer. Information regarding plants used for cancer management in the Eastern Cape province was obtained from multidisciplinary databases and ethnobotanical books. About 24 plant species belonging to twenty families have been reported to be used for the traditional management of cancer in the Eastern Cape province. Among the anticancer plant species, only 16 species have been explored scientifically for their anticancer activities. This review authenticated the use of anticancer plant species in the Eastern Cape province and, therefore, identified several promising unexplored species for further scientific evaluation.

Are plants used in the Eastern Cape province for cosmetics fully commercialized?

Plants have been used for years for various cosmetic purposes. In the Eastern Cape province of South Africa, a large proportion of the population reliant (to some extent) on botanical resources for beauty and health. Despite the use of these botanical resources for various cosmetic purposes, only a few have been fully commercialized or used as ingredients in cosmetic formulation. The present study aimed to review plant species that are fully explored commercially for cosmetic products in the Eastern Cape province. A survey of cosmetic products with plant-based ingredients was done covering the major supermarkets (SPAR, Shoprite, and Pick n Pay), cosmetic shops (Clicks), and pharmacies in the Eastern Cape province, and electronic databases including Embase, Google Scholar, Medline, PubMed, Scopus, SciFinder®, Springer, Science Direct, and Web of Science were used as data sources for ethnobotanical information. Surprisingly, out of 150 plant species used by both Xhosa men and women for various cosmeceutical purposes, only six plant species have been used commercially with regard to cosmeceutical application. These plants species belong to five major plant families, namely Lamiaceae (two species), Asphodelaceae (one species) Cucurbitaceae (one species), Oleaceae (one species), and Verbenaceae (one species). The findings revealed that the use of Eastern Cape plants for cosmetic purposes has not been fully explored commercially. Thus, there is a need for cosmeceutical industries to explore these species commercially in order to develop new possible cosmetic products for local and international markets.

High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

BACKGROUND: Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS: Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS: The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION: Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.

Diversity of use and local knowledge of wild and cultivated plants in the Eastern Cape province, South Africa.

BACKGROUND: Traditional ecological knowledge among indigenous communities plays an important role in retaining cultural identity and achieving sustainable natural resource management. Hundreds of millions of people mostly in developing countries derive a substantial part of their subsistence and income from plant resources. The aim of this study was to assess useful plant species diversity, plant use categories and local knowledge of both wild and cultivated useful species in the Eastern Cape province, South Africa. METHODS: The study was conducted in six villages in the Eastern Cape province, South Africa between June 2014 and March 2017. Data on socio-economic characteristics of the participants, useful plants harvested from the wild, managed in home gardens were documented by means of questionnaires, observation and guided field walks with 138 participants. RESULTS: A total of 125 plant species belonging to 54 genera were recorded from the study area. More than half of the species (59.2%) are from 13 families, Apiaceae, Apocynaceae, Araliaceae, Asparagaceae, Asphodelaceae, Asteraceae, Fabaceae, Lamiaceae, Malvaceae, Myrtaceae, Poaceae, Rosaceae and Solanaceae. More than a third of the useful plants (37.6%) documented in this study are exotic to South Africa. About three quarters of the documented species (74.4%) were collected from the wild, while 20.8% were cultivated and 4.8% were spontaneous. Majority of the species (62.4%) were used as herbal medicines, followed by food plants (30.4%), ethnoveterinary medicine (18.4%), construction timber and thatching (11.2%). Other minor plant use categories (1-5%) included firewood, browse, live fence, ornamentals, brooms and crafts. CONCLUSION: This study demonstrated that local people in the Eastern Cape province harbour important information on local vegetation that provides people with food, fuel and medicines, as well as materials for construction and the manufacturing of crafts and many other products. This study also demonstrated the dynamism of traditional ecological knowledge, practices and beliefs of local people demonstrated by the incorporation of exotic plants in their diets and indigenous pharmacopoeia.

A survey of plants responsible for causing irritant contact dermatitis in the Amathole district, Eastern Cape, South Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Potentially harmful plants grow almost everywhere, hence, it is not practical to eradicate them all. However, a basic understanding of adverse cutaneous reactions and the common plants that cause each type can enable vulnerable individuals to discover the source of their dermatitis and thus prevent re-exposure. The aim of this study therefore, was to document the plants responsible for irritant contact dermatitis (ICD) in the Eastern Cape, along with their respective irritants and clinical presentations. MATERIALS AND METHODS: Study participants (161) in 12 locations were selected by convenient sampling with particular focus on local people who regularly interact with plants or plant products. Interview questions were focused on the local names of plants that contain irritating chemicals and physical characteristics that cause ICD. RESULTS: Forty four plant species distributed in 24 families and 34 genera were reported as causative agents of irritant contact dermatitis. Herbs constituted 67.35%, trees 24.49% and shrubs 8.16%. Mechanical ICD was reported to be caused by 23 species, closely followed by chemical ICD (20 species) and mechanico-chemical ICD (6 species). Species with the highest frequency of citations were Allium cepa, Acacia karroo, Capsicum annuum, Citrus limon and Zea mays. The most representative families were Euphorbiaceae (for chemical ICD), Urticaceae (for mechanico-chemical ICD), Fabaceae and Rutaceae for mechanical ICD. Most of the classes of chemical compounds identified as being responsible for chemical ICD were restricted to plants of specific genera such as the diterpenes in Euphorbia spp., disulphides in Allium spp., terpenes in Citrus spp. and isothiocyanates in Brassica spp. Thorns and hairs were reported for causing Mechanical ICD in 6 plant species each, including widely cultivated plants such as Acacia karoo and Citrus reticulata. CONCLUSION: Irritant contact dermatitis is a common cutaneous disorder in individuals exposed to plants in the Eastern Cape, especially among workers of the food and flower industries. Health practitioners should therefore consider the possible work-related causes of dermatitis, especially in cases associated with a clear history of symptoms.

Ethnobotanical survey of medicinal plants used in the management of skin disorders among the Xhosa communities of the Amathole District, Eastern Cape, South Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Skin diseases have been of major concern recently due to the association of skin opportunistic infections and HIV/AIDS, are usually the first sign of HIV infection and conversion to AIDS. More than 90% of HIV-infected individuals develop skin and mucosal complications at some stage during the disease. Although classical medicine is undoubtedly addressing these diseases, the people of the Eastern Cape, South Africa still depend, to a large extent on traditional herbal medicine for the treatment of various diseases. The current study was undertaken to investigate the local peoples characterisation of skin diseases/disorders and to document the medicinal plants used for various skin disorders among the Xhosa-speaking communities of the Amathole District, Eastern Cape. MATERIALS AND METHODS: Information was obtained by interviewing 54 respondents in 7 locations. Collection of the reported medicinal plants from the wild was assisted by the informants and identification of the collected plants specimens was done with the help of floristic works of South Africa. Quantitative methods including the use-value and the informant consensus factor (ICF) were computed for determining the relative importance of species known locally and the homogeneity of the informants׳ knowledge respectively. RESULTS: Twenty five skin disorders, classified under 5 categories are being treated with the listed medicinal plants in the study area. The highest ICF (0.45) was linked to bacteria-related skin disorders. This category comprised of 57 use citations, 3 skin disorders; with sore throat being the most frequently mentioned (4.2%). In this study, 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae and Asteraceae with 6 species each, followed by Fabaceae, Poaceae and Rutaceae (5 species each). The leaves were the most frequently used plant part, followed by the bark (10%) and fruits (7%). Administration of the different plant parts was mostly topical (77%) on the affected area. CONCLUSION: A total of twenty five skin disorders/conditions, classified under 5 categories are being treated with the listed medicinal plants in the study area. 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae, Asteraceae, Fabaceae, Poaceae, Rutaceae and Euphorbiaceae. Majority of the plant species were herbs and the leaves were the most frequently used, mostly applied topically as a paste, powder or sap on the affected skin area.

Use of traditional and complementary health practices in prenatal, delivery and postnatal care in the context of HIV transmission from mother to child (PMTCT) in the Eastern Cape, South Africa.

The aim of this study was as part of a baseline assessment in PMTCT in the traditional health sector: a) to determine the views of women who have used the services of traditional practitioners before, during and/or after pregnancy, and b) to conduct formative research with traditional health practitioners (THPs), i.e. herbalists, diviners and traditional birth attendants (TBAs) on HIV, pregnancy care, delivery and infant care. The sample included a) 181 postnatal care clients with a child less than 12 months interviewed at postnatal clinic visits from 20 primary care clinics in the Kouga Local Service Area (LSA), Cacadu district, Eastern Cape, and b) 54 traditional birth attendants (TBAs) and 47 herbalists and/or diviners were interviewed from Kouga LSA. Results showed that THP (in particular TBAs and to a certain extend herbalists/diviners) play a significant role in pregnancy and postnatal care, and also with the assistance of delivery. Certain HIV risk practices were reported on the practice of TBAs. THPs also seem to have some role in infant feeding and family planning. THPs should be trained in optimising their services in pregnancy and postnatal care, and preparation for health facility delivery. In addition, they should be trained on HIV risk practices, HIV/AIDS, HIV prevention including PMTCT, infant feeding and family planning.

Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa.

Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses.

Barriers to accessing PMTCT services in a rural area of South Africa.

Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups.