How do South African policies address provision of contraception among adolescents?

BACKGROUND:  The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). AIM:  We examined how national policies address access and provision of contraception to adolescents in South Africa. SETTING:  South African national policies. METHODS:  We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. RESULTS:  We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. CONCLUSION:  With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution: This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Provider perspectives on adolescent access to contraception in South Africa.

BACKGROUND:  Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM:  This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING:  This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS:  Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS:  Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION:  Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.

Caregivers' health-seeking behaviour for children participating in an integrated school health programme in KwaZulu-Natal, South Africa.

BACKGROUND: Caregivers are active members of the healthcare team, and the uniqueness of their role in caring for a sick child is holistic, as no other healthcare team member is consistently aware of all the facets of the child's life. The integrated school health programme (ISHP) aims to improve access to healthcare services and promote equity for school-going children by delivering comprehensive healthcare services. However, not much attention has been paid to understanding caregivers' health-seeking experiences within the context of the ISHP. AIM: This study sought to understand caregivers' health-seeking behaviour for their children participating in the ISHP. SETTING: Three low-resource communities were chosen within the eThekwini District of the KwaZulu-Natal province, South Africa. METHODS: This study utilised a qualitative research design. We recruited 17 caregivers using purposive sampling. Semistructured interviews were conducted, and the data were analysed using thematic analysis. RESULTS: Caregivers explored multiple means of care, ranging from managing the children's health conditions based on previous experiences to visiting traditional healers and administering traditional medicines. Caregivers delayed health seeking due to low literacy levels and financial barriers. CONCLUSION: Although ISHP has expanded its coverage and the range of services provided, the study suggests the need to implement interventions focused on providing support to caregivers of sick children within the ISHP context.Contribution: The findings of the study highlight the need to develop potential schemes to address transportation barriers to accessing healthcare services for school-going children.

Values of COVID-19 Self-Testing among Urban and Rural South Africans: A Cross-Sectional Survey.

Self-testing for COVID-19 may be a preferable strategy for identifying SARS-CoV-2 infection among populations in low- and middle-income settings. To determine South Africans' values related to COVID-19 self-testing should it become widely available, a cross-sectional survey was administered in Durban, KwaZulu-Natal Province and the King Sabata Dalindyebo sub-district of the Eastern Cape. A 35-question survey was administered to 531 participants (268 female) in one urban and one rural setting of South Africa. Survey participants were randomly selected by household in the rural setting, while in the urban setting participants were approached in randomly selected public places. The survey assessed participants' likelihood of using and willingness to pay for a COVID-19 self-test and actions they would take following a COVID-19 self-test. The results were analysed using descriptive statistics and bivariate and multivariate regression. Overall, 93.03% of participants supported COVID-19 self-testing, 61.62% of participants were willing to pay for self-testing, and 90.15% indicated they would communicate their results if they tested positive. Rural participants were more positively associated with each of these outcomes compared with urban-based participants. Should they test positive, most participants said they would: go in-person to a health facility for counselling (76.45%), self-isolate (95.85%), notify close contacts (97.74%), and inform their employer (95.14%). COVID-19 self-testing was a preferable option for most participants, although this varied with setting and demographic characteristics. Self-testing may overcome barriers to care for South Africans, but to achieve this, policies for self-testing and delivery methods must not exacerbate individuals' underlying economic vulnerabilities.

Identifying multilevel and multisectoral strategies to develop a Theory of Change for improving child and adolescent mental health services in a case-study district in South Africa.

BACKGROUND: The lack of child and adolescent mental health (CAMH) policies and implementation plans constitute major barriers to CAMH services in low resource settings. Engaging with on-the-ground stakeholders to identify possible contextually appropriate strategies for developing a CAMH collaborative system and inform CAMH plans and policies is important to ensure that resultant policies and plans are feasible and appropriate. Together with key stakeholders across multiple sectors, this study aims to (i) co-identify causal factors and potential strategies to overcome bottlenecks in one district in SA as a case study; and (ii) Co-develop a Theory of Change (ToC) for increasing access to CAMH services within the resource constraints of a remote resource-scarce district as a case study. METHODS: A participatory workshop was held with key stakeholders (n = 40) from the Departments of Health (DoH), Basic Education (DBE), and Social Development (DSD) and three community-based organisations offering CAMH services in the district. The stakeholders identified context-specific causal factors and possible strategies to address the bottlenecks in the workshop. All the factors identified in the workshop were compared and consolidated. A ToC map was developed based on the data obtained from the workshop. The ToC was further refined by conducting a follow-up virtual workshop with stakeholders (n = 15). RESULTS: Mapping out the strategies identified in the workshop facilitated the development of a ToC model for the resource-scarce context. Key multilevel and multisectoral task-sharing strategies emerged in support of the development of a collaborative system of care that includes the development of (i) community awareness programs and user-friendly CAMH psychoeducation and screening tools to strengthen mental health literacy and facilitate early identification at the community level; (ii) an intersectoral working group to facilitate intersectoral collaboration (iii) a functional district CAMH referral system, (iv) youth-friendly CAMH care packages. CONCLUSIONS: In scarce-resource contexts, it is feasible to work collaboratively with key stakeholders across multiple sectors to identify feasible multilevel and multisectoral strategies that can be used to develop a ToC for improved access to CAMH services within a task-sharing approach.

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).