Adolescent girls' and young mothers' knowledge and use of antenatal care in the Ahafo Region, Ghana: A cross-sectional study.

BACKGROUND:  Antenatal care (ANC) is crucial to reducing maternal and neonatal deaths, but few studies examined adolescent girls' and young women's ANC utilisation and knowledge in Ghana. AIM:  To assess adolescents' and young mothers' knowledge of ANC, utilisation and factors influencing its use in Ghana. SETTING:  Tano North Municipality, Ahafo Region. METHODS:  This community-based, cross-sectional study involved 440 adolescent and young mothers (between 10 and 24 years). A structured questionnaire was employed to collect data face-to-face. Descriptive and statistical analyses were performed, and p  0.05 was considered statistically significant. RESULTS:  Of the 440 respondents, most were aged 20-24 years (61.2%), married (30.0%), Christians (78.2%), completed junior high school (JHS) (47.8%) and traders (38.9%). Postnatal mothers were 71.6% (315), and all had utilised ANC services. Antenatal care knowledge was good among 75% (330) respondents, with no significant variation by age. Religion influenced knowledge, with Muslims having lower knowledge. Antenatal care utilisation was high ( 50%) among those aged 15-19 years, married, Christians, JHS graduates and traders. Age, marital status and employment type significantly influenced ANC utilisation. Individuals in the age group 15-19 years and married women demonstrated higher odds of utilising ANC services. Casual workers and unemployed respondents were found to have lower odds of utilising ANC services compared to traders. CONCLUSION:  Age, marital status, and employment type influenced ANC utilisation in the Ahafo Region. Adolescent mothers under 15 years had lower rates, requiring targeted interventions to improve pregnancy outcomes.Contribution: This study highlights the knowledge and factors influencing ANC use in Ahafo Region and adds to the existing research evidence on ANC.

Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence.

BACKGROUND: Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps. METHODS: The review employed the Arksey and O'Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings. RESULTS: After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies (n = 15; 75%) from South Africa (n = 11; 55%), and involved women (n = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries. CONCLUSION: This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review.

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Women's perceptions with use of Implanon® contraceptive device at a primary healthcare facility in KwaZulu-Natal.

Background: Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim: The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting: This study was conducted at a selected primary health care (PHC) facility in KwaZulu-Natal. Methods: A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results: Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion: Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions: This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.

Mapping global evidence on injuries/trauma due to sexual and gender-based violence for research prioritisation and development of guidelines to mitigate their impact: a scoping review protocol.

BACKGROUND: The World Health Organization recognises injuries as a growing global public health problem. While there are several causes of injuries and trauma, relevant research is mostly centred on road traffic accidents, burns, and drowning with less focus on violence-related injuries/trauma such as sexual and gender-based violence (SGBV). To identify priority research topics, prioritisation, and development of practice guidelines to mitigate the impact of injuries/trauma resulting from SGBV, this systematic scoping review will aim to map and describe the range of research relating to injuries/trauma due to SGBV in the global context. METHODS: A scoping review guided by Arksey and O'Malley's methodological framework will be conducted. Literature relating to injuries/trauma and SGBV will be searched in PubMed, SCOPUS, and PsycINFO, CINAHL, Web of Science, Google Scholar, Trip, guideline repositories, websites, and reference list of included articles. This study will include evidence sources focused on the epidemiological burden, guidelines for out-of-hospital and in-hospital care of victims, barriers or facilitators to reporting and obtaining healthcare, and approaches for mitigating injuries/trauma due to SGBV. The search will be limited to publications within 10 years (2012 to 2023). Two authors will apply the eligibility criteria to identify potentially relevant citations. The data will be extracted in duplicate and methodological quality assessed using varied tools (Mixed Method Quality Appraisal Tool; and Appraisal of Guidelines, Research and Evaluation instrument). The study will be reported in keeping with the Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. DISCUSSION: The scoping review will highlight existing literature on injuries/trauma due to SGBV and identify gaps to facilitate research prioritisation, development of guidelines, and resource allocation to alleviate the impact of injuries/trauma resulting from SGBV. This study's findings will be disseminated via a series of meetings with key stakeholders (local and international) in the field of healthcare, policy, social welfare, GBV interest groups, and others. Also, the final scoping review results will be presented at relevant workshops, meetings, and conferences. Moreover, this study's findings will be disseminated via journal publications and policy briefs.

Geographic availability of and physical accessibility to tuberculosis diagnostic tests in Ghana: a cross-sectional survey.

BACKGROUND: In Ghana, tuberculosis (TB) case detection is low (< 34%). Existing scientific evidence suggest access to TB diagnostic tests play an essential role in TB case detection, yet little has been scientifically documented on it in Ghana. This study, therefore, sought to map TB diagnosis sites, and describe the geographic availability and physical accessibility to TB diagnosis in six regions of Ghana to inform scale-up and future placement of TB diagnostic tests. METHODS: We assembled the geolocation and attribute data of all health facilities offering TB diagnosis in Upper West Region (UWR), Upper East Region (UER), Ahafo, North-East, Northern, and Savannah regions. QGIS was employed to estimate the distance and travel time to TB diagnosis sites within regions. Travel time estimates were based on assumed motorised tricycle speed of 20 km (km)/hour. RESULTS: Of the total 1584 health facilities in the six regions, 86 (5.4%) facilities were providing TB diagnostic testing services. This 86 TB diagnosis sites comprised 56 (65%) microscopy sites, 23 (27%) both microscopy and GeneXpert sites, and 7 (8%) GeneXpert only sites (8%). Of the 86 diagnosis sites, 40 (46%) were in the UER, follow by Northern Region with 16 (19%), 12 (14%) in UWR, 9 (10%) in Ahafo Region, 5 (6%) in North East, and 4 (5%) in Savannah Region. The overall estimated mean distance and travel time to the nearest TB diagnosis site was 23.3 ± 13.8 km and 67.6 ± 42.6 min respectively. Savannah Region recorded the longest estimated mean distance and travel time with 36.1 ± 14.6 km and 108.3 ± 43.9 min, whilst UER recorded the shortest with 10.2 ± 5.8 km and 29.1 ± 17.4 min. Based on a 10 km buffer of settlement areas, an estimated 75 additional TB diagnosis sites will be needed to improve access to TB diagnosis services across the six regions. CONCLUSION: This study highlights limited availability of TB diagnosis sites and poor physical accessibility to TB diagnosis sites across five out of the six regions. Targeted implementation of additional TB diagnosis sites is needed to reduce travel distances to ≤ 10 km.

Women's perceptions with use of Implanon® contraceptive device at a primary healthcare facility in KwaZulu-Natal

Background: Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim: The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting: This study was conducted at a selected primary health care (PHC) facility in KwaZuluNatal. Methods: A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results: Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion: Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions: This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.

Adolescent on the bridge: Transitioning adolescents living with HIV to an adult clinic, in Ghana, to go or not to go?

BACKGROUND: Children survive into adult life with Human Immunodeficiency Virus (HIV), which previously would have been lethal in early childhood. METHODS: The study aimed to describe the current transitional process for Adolescents Living with HIV (ALHIV) in a resource-limited setting in Ashanti Region, Ghana. The study was an explorative study that used an interpretive paradigm. A semi-structured interview guide was used to interview ALHIV, selected by purposive sampling. The study was conducted at a tertiary hospital in Kumasi. Data were analysed using thematic analysis. RESULTS: Transitioning of ALHIV was done without any guide; the themes generated were on the process of transition in which they used age (13 and above) and disclosure as the criterion to move ALHIV to the adult clinic. Most adolescents complained about being stigmatised, the attitude of staff, interruption of school and separation anxiety as experiences they went through during the transitioning process. On improving transition, ALHIV felt sexual and reproductive health services, information on treatment, privacy, and support were necessary transition components. CONCLUSION: The use of age and disclosure of status as a criterion for transitioning ALHIV affects moving and retaining this age group in HIV management programs in the adult clinics. There is, therefore, an urgent need for a guideline as the current transition process defeats the purpose of providing adolescents with age-specific care in the Adult Clinic.

Exploring health provider's knowledge on the home-based maternal and neonatal health care package in Rwanda.

BACKGROUND: Rwanda implemented post-natal care home visits by maternal community health workers (M-CHWs) in charge of maternal and newborn health care in 2010 as a component of a home-based maternal and neonatal health care package (HB-MNHCP), this being a complementary strategy to facility-based postnatal care to improve survival. The country has not met its Sustainable Development Goal (SDG) 3 target of less than 70 maternal mortalities per 100,000 live births and less than 12 neonatal deaths per 1,000 live births. This study therefore aimed to establish the knowledge of the health providers, providing HB-MNHC services as part of their antenatal, delivery and postnatal care program, specifically the M-CHWs services. METHODS: The cross-sectional descriptive study included 79 purposively sampled health care providers who were directly involved in the various components of the HB-MNHCP, namely: professional nurses, midwives, M-CHW, social workers, supervisors and data managers. The Kibogora, Muhima and Nyamata District Hospitals and two rural, semi-urban and urban health facility were included. Data was collected using questionnaires from April to July 2018. This study followed the STROBE checklist form: Cross -sectional studies. RESULTS: Overall, 88.6% (n=70/79) of participants knew about the M-CHW three home visits scheduled during pregnancy, 73.4% (n=58/79) about the three postnatal home visits after birth when the weight was normal, and 64.6% (n=51/79) about the five PNC home visits for low birth weights. Most (97.5%, n=77/79) knew that the mother and newborn should be screened during the same M-CHW home visits, and 87.2% (n= 68/79) were aware of the seven postnatal core competencies of delivering key maternal and newborn interventions during PNC home visits. CONCLUSIONS: There were varying levels of knowledge among the HB-MNHCP staff, indicating the need for ongoing monitoring and training to ensure that the correct information is provided to the mothers throughout the antenatal and postnatal periods. While most of the M-CHWs appear to have had the correct knowledge, their executing of some activities needs to be monitored to ensure that they provide the required services, as this is an important step in lowering the maternal and infant mortality and enabling Rwanda to meet its SDG 3. Home visits by the M-CHWs could increase referrals and reduce maternal and newborn mortality.

A qualitative study to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a novel virus that has rapidly spread across countries globally, and has been declared a pandemic by the World Health Organization (WHO). In South Africa, more that 1 million cases have been confirmed since case zero was detected in March 2020. South Africa is currently leading in the sub-Saharan African region in terms of COVID-19-related mortality and morbidity rates. AIM: The aim of this study was to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa. SETTING: The study was conducted at two selected primary health care facilities (a community health centre and satellite clinic) within a low-income rural context in KwaZulu-Natal, South Africa. METHODS: A qualitative study was conducted to explore and describe perceptions and understanding of primary health care practitioners regarding the COVID-19 pandemic in KwaZulu-Natal (KZN), South Africa. Data were collected from a purposive sample of 15 participants at two different clinics situated in rural KZN, South Africa. Participants comprised of nurses, physiotherapists, pharmacists, community care givers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. An audiotape was used to collect data, which were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis. RESULTS: Participants reported pre-pandemic and pandemic perceptions of fear, denial, expectancy and a perceived poor preparation for the COVID-19 outbreak. The findings also revealed participants' misperceptions regarding the nature of the COVID-19 pandemic and unrealistic expectations of occupational compensations for working during the outbreak. CONCLUSION: The findings of this study suggest that primary health care practitioners generally have negative perceptions and understanding regarding the pandemic because of misinformation obtained from social media. Interventions to support health care practitioners are necessary to mitigate the potentially negative implications of health practitioners' misconceptions on service delivery and their mental health.

The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa.

BACKGROUND: KwaZulu-Natal (KZN) remains the epicentre of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa. The incidence of HIV infection in KZN necessitates cost-effective strategies to curb the spread of infection. Voluntary medical male circumcision (VMMC) has been adopted as an additional biomedical preventive strategy since 2010 in line with recommendations from the World Health Organization. Despite several attempts to scale-up VMMC to reach age specific targets to achieve immediate aversion of infections, the uptake of VMMC remains sub-optimal, particularly in KZN. The purpose of this study is to describe the processes that were followed in developing, describing and evaluating an explanatory model for VMMC in KZN, South Africa. METHODS: A qualitative theory-generative phenomenographic study design was used to analyse the qualitative differences in primary healthcare stakeholders' experiences, understanding and conceptions of VMMC in KZN, South Africa. The emerging results informed the development of the VMMC explanatory model for KZN, South Africa. The model development process followed four steps, namely (1) concept analysis, (2) construction of relational statements, (3) model description and (4) model evaluation. The criteria of relevance for the target audience - applicability, clarity, user friendliness and originality of work - were used to evaluate the model. RESULTS: The model's central premise is that the decision to undergo VMMC is shaped by a complex interplay of factors in the context or external environment of males (the extrinsic variable), which influences specific experiences, conceptions and understanding regarding VMMC (the influential/intrinsic variables). These collectively determine men's responses to VMMC (the outcome variable). CONCLUSION: The model describes the process by which contextual, extrinsic and intrinsic variables interact to determine an individual male's response to VMMC, thus providing a guide to primary healthcare providers on care, practice and policy interventions to support the uptake of VMMC in the rural primary healthcare context of KZN, South Africa.

Women's experiences on the use of Implanon as a contraceptive method in a selected primary healthcare facility in KwaZulu-Natal.

BACKGROUND: The South African department of health recently introduced subdermal Implanon contraceptive implant with the aim to reduce teenage pregnancy and maternal mortality. First used in all public healthcare facilities across the country since early 2014, this method of contraception has been described as highly effective. However, some women have reported unbearable side effects, forcing them to remove the contraceptive implant early before its expiry date. Negligible emphasis has been placed on staff training and development to equip the nurses with new protocol and policies on Implanon. OBJECTIVES: The objective of this study was to explore experiences of women using Implanon as method of contraception at a selected primary healthcare facility in KwaZulu-Natal province of South Africa. METHODS: A qualitative, descriptive and exploratory study design was used. A purposive sampling technique was used and a sample of seven women aged between 15 and 50 years was selected for this study. Semi-structured interviews were used in the data collection process. The Tesch's method for data coding and data analysis was utilised. Necessary ethical measures were taken to ensure that the study is trustworthy. The study was conducted at Community Health Centre, KwaZulu-Natal between June 2017 and December 2018. RESULTS: The findings showed that some participants were still willing to continue using this method of contraception regardless of the unwanted side effects. Major side effects reported were heavy menstrual bleeding, pain and discomfort, weight loss, insomnia and decreased sexual interest, which resulted in most participants stopping the use of Implanon. CONCLUSION: Most of the participants' experience unwanted side effects because of poor screening, counselling and support. There is a clear demand to develop a screening tool and facilitate training of healthcare workers when initiating the use of Implanon.

Healthcare providers' perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study.

BACKGROUND: There is compelling evidence that voluntary medical male circumcision (VMMC) reduces the chances of heterosexual transmission of HIV infection. Healthcare workers are among the key influencers in terms of the scale-up of VMMC as they are often involved in mobilisation for uptake. There is a paucity of qualitative research on healthcare workers' experiences, understanding and perceptions of VMMC; particularly in the South African rural primary healthcare context. This study was conducted to examine healthcare workers perceptions and understanding of VMMC in KwaZulu-Natal, South Africa. METHODS: The study employed a qualitative approach using a phenomenographic design. A purposive sample of 15 doctors, nurses and clinical associates working in 6 different rural clinics in KwaZulu-Natal, South Africa, were interviewed in English in-depth using a semi-structured interview schedule. The interviews were audio-recorded, and transcribed. The results were analysed thematically using phenomenographic data analysis procedures. RESULTS: Categories of description in participants' perceptions and understanding of VMMC emerged. The findings of this study revealed that healthcare workers perceptions and understanding of VMMC were predominantly influenced by the hegemonic religious and cultural norms associated with male circumcision in KwaZulu-Natal, South Africa. CONCLUSION: The findings of this study suggest that tailored training to address healthcare workers misperceptions and poor understanding of VMMC is necessary to ensure that they become effective custodians for VMMC implementation.

Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda.

BACKGROUND: While maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder's perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement. METHODS: The convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse. RESULTS: There was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities. CONCLUSION: The study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country's maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality.

Community- based maternal and newborn interventions in Africa: Systematic review.

AIM AND OBJECTIVES: This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. BACKGROUND: Most neonatal deaths (99%) occur in low- and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. METHODS: The review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. RESULTS: The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. CONCLUSION: The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. RELEVANT TO THE CLINICAL PRACTICE: Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa.

BACKGROUND: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. OBJECTIVES: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. METHODS: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. RESULT: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. CONCLUSION: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.

A road less travelled: Undergraduate midwifery students' experiences of a decentralised clinical training platform.

BACKGROUND: In South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. The expansion in student numbers has placed increased demands on overstretched educational institutions, and students are confronted with challenges of congestion in classrooms and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation. A solution is to utilise decentralised clinical training platforms (DCTPs) and allocate students in rural hospitals. AIM: To explore and describe undergraduate midwifery students' reflections of their DCTP experiences, in order to inform future practice of decentralisation in student training. SETTING: The study was conducted in the nursing discipline of an urban-based university in KwaZulu-Natal, South Africa, involving undergraduate midwifery students. The university had commenced a programme of allocating students to decentralised clinical sites. METHOD: Elo and Kyngäs' content analysis was used to analyse the experiences of DCTP by undergraduate midwifery students (n = 14) as expressed in a focus group (n = 11) and three individual interviews (n = 3). RESULTS: The following four categories emerged: Recognition as a team member, engaging support, win-win platform and juxtaposed challenges. CONCLUSION: In the presence of support and teamwork, rural settings can develop undergraduate student midwives, not only in the areas of midwifery competency but also in their personal capacity, and strengthen the responsiveness, preparedness and relevance of midwifery graduates.

Circumcised men's perceptions, understanding and experiences of voluntary medical male circumcision in KwaZulu-Natal, South Africa.

BACKGROUND: KwaZulu-Natal, South Africa, has rolled out voluntary medical male circumcision (VMMC) in response to recommendations that regions with a high human immunodeficiency virus (HIV) prevalence adopt VMMC as an additional HIV prevention strategy. There is a paucity of South African data on the motivators, barriers and experiences of adult male candidates regarding VMMC. This study was conducted to analyse circumcised men's perceptions, understanding and experiences of VMMC in KwaZulu-Natal, South Africa. METHODS: A qualitative phenomenographic design was used. Ethical clearance was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BE 627/18). Data were collected from 12 circumcised male candidates. Individual interviews were conducted and recorded by using an audiotape. Data were transcribed verbatim and analysed manually. RESULTS: Participants' perceptions regarding VMMC are health related and appear to be the motivators for the uptake of medical circumcision. Circumcised men in this study appeared to misunderstand VMMC in terms of healing and performance time and the nature of the procedure. Negative experiences in terms of quality of care received were reported. CONCLUSION: The study findings imply that practice interventions to promote demand generation for VMMC in KwaZulu-Natal, South Africa, should incorporate the perceptions and experiences of male candidates regarding the procedure. Tailored messaging to address misunderstanding related to the nature of VMMC should also be provided. Regular in-service training on standardised VMMC implementation practices should be provided to ensure the delivery of optimum quality VMMC services.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa.

BACKGROUND: Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention. AIM: To analyse health care workers' perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA. SETTING: The study took place at six different health districts and their six respective rural clinics in the KZN province of SA. METHODS: A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure. RESULTS: Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported. CONCLUSION: The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers' needs for training and preparation is crucial for successful implementation of VMMC.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

Background: Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention. Aim: To analyse health care workers' perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA. Setting: The study took place at six different health districts and their six respective rural clinics in the KZN province of SA. Methods: A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure. Results: Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported. Conclusion: The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers' needs for training and preparation is crucial for successful implementation of VMMC