Challenges regarding the implementation of cervical cancer screening guidelines in Limpopo province, South Africa.

BACKGROUND:  The World Health Organization's (WHO) call to eliminate cervical cancer is essential in improving structures and processes at primary healthcare facilities by galvanising change in providing cervical cancer screening services. AIM:  The main objective of this study was to explore challenges affecting the implementation of cervical cancer screening guidelines in selected districts in Limpopo Province. SETTING:  The study was carried out at primary health care services (PHCs) in Vhembe and Mopani districts, Limpopo province. METHODS:  Qualitative non-experimental research design of an exploratory, descriptive and contextual nature of a qualitative paradigm to understand cervical cancer screening programme challenges from healthcare professionals' perspectives. The study population comprised two males and 16 female professional registered nurses working in Limpopo province's PHC services. The sample size was 18 professional nurses. A face-to-face interview guided by unstructured questionnaires was undertaken to elicit information regarding the implementation of cervical cancer screening services. Captured data were analysed using Tesch's open-coding method. RESULTS:  The study revealed that the cervical cancer guidelines were not effectively implemented as there were contradictions and gaps when applying the guidelines about the management of HIV and AIDS, age restrictions and gestation. Furthermore, structural factors contributed to the inadequacy rate and failure to reach the set targets. CONCLUSION:  Primary health care is an essential health care and human right; therefore, the government should ensure that guidelines and policies are supported financially and that professional nurses are capacitated for the efficient implementation of services.Contribution: Addressing the inequalities in the implementation of social policies for the prevention of cervical cancer prevention and improving the nurses' knowledge and practice behaviour regarding cervical cancer prevention are imperative.

Challenges regarding sexual health communication with secondary school learners in Limpopo Province: Parents views.

BACKGROUND: A conversation about sexuality is most likely to encourage healthy and positive sexual practices while reducing risky sexual behaviour among adolescents. Traditionally, sexuality is discussed in hushed tones in proverbs and is reserved for adults. On the other hand, adolescents require to be well informed about their sexuality to assist them to make informed decisions about their sexual behaviour. AIM: The study determined parents' views regarding challenges of sexual health communication among secondary school learners in Limpopo Province. METHOD: A qualitative, exploratory-descriptive, and contextual approach was employed for the study. Fifty-six parents were purposively select, resulting in five focus group discussions that had 8-12 members. One central question was asked, and based on the participants' responses, probing questions asked followed. Data were analyzed using thematic analysis. Trustworthiness and ethical considerations were ensured. RESULTS: Three themes, that is communication concerns, role shifting in imparting sexuality education and poor parent-child relationships and eight sub-themes emerged from the data. CONCLUSION: Study identified that communication concerns influence parent-child dialogue on sexuality education. Therefore, there is a need to address factors hindering communication like cultural barriers, role shifting in imparting sexuality education, poor parent-child relationships. This study suggests that parents be empowered in dealing with children's sexuality.

Challenges on sexual health communication with secondary school learners, Limpopo province

A conversation about sexuality is most likely to encourage healthy and positive sexual practices while reducing risky sexual behaviour among adolescents. Traditionally, sexuality is discussed in hushed tones in proverbs and is reserved for adults. On the other hand, adolescents must be well informed about their sexuality to assist them to make informed decisions about their sexual behaviour.Objectives: The study determined parents' views regarding challenges of sexual health communication among secondary school learners in the Limpopo province.Method: A qualitative, exploratory-descriptive and contextual approach was employed for the study. Fifty-six parents were purposively selected, resulting in five focus group discussions that had 8­12 members. One central question was asked, and based on the participants' responses, probing questions followed. Data were analysed using thematic analysis. Trustworthiness and ethical considerations were ensured.Results: Three themes, namely communication concerns, role shifting in imparting sexuality education and poor parent­child relationships, and eight subthemes emerged from the data.Conclusion: This study identified that communication concerns influence parent­child dialogue on sexuality education. Therefore, there is a need to address factors hindering communication such as cultural barriers, role shifting in imparting sexuality education and poor parent­child relationships. This study suggests that parents should be empowered in dealing with children's sexuality.Contribution: Parents should be equipped with reproductive knowledge to enable them to talk freely about sexuality with their children. This should be complemented with broader programmes aimed at promoting sexual health education within the traditional family institution

Occupational health and safety hazards among solid waste handlers at a selected municipality South Africa.

Background: Solid waste management is one of the most dangerous occupations in the world because of its potential harm from the waste to the environment and the public. Therefore, the protection of human health and the environment is a challenge that all countries are facing. Aim: The study explored occupational health and safety hazards among waste handlers at a selected municipality in Limpopo Province. Setting: The study was conducted in one municipality in the Vhembe District. Methods: The study used a qualitative, explorative and contextual design to explore occupational health and safety hazards among participants. Participants were sampled using purposive sampling. Data were collected through in-depth individual interviews that lasted between 40 min and 45 min. The sampled size comprised 18 participants and was determined by data saturation. Tesch's open coding was used to analyse data, where the main theme, categories and sub-categories emerged. Results: The findings revealed the main theme, namely municipal waste handlers experience occupational health and safety hazards. Four categories emerged from the main theme, namely physical, psychosocial, biological and chemical hazards. The categories were further divided into sub-categories such as exposure to extreme weather conditions and musculoskeletal injuries. Conclusion: Solid waste handlers experienced preventable physical and chemical occupational health and safety hazards that are inherent to their job. It is recommended that workers be provided with adequate suitable protective equipment to reduce the level of occupational health hazards. Contribution: The findings in this study will help in closing the gaps by the municipality for failing to prioritise working conditions for municipality waste handlers.

Support model for nurses caring for people living with HIV and AIDS in the Limpopo province, South Africa.

BACKGROUND: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) caregiving has created a foundation for stress and burnout amongst nurses as they are burdened by the increased workload of HIV and AIDS care. OBJECTIVES: This study aimed to develop a support model for nurses caring for people living with HIV and AIDS (PLWH). METHOD: The study employed concept analysis and the identified concept of interest within the caring context of HIV and AIDS was conceptualised using six elements of practice-oriented theory, namely, the context, agent, recipient, dynamic, procedure and purpose. RESULTS: The framework consisted of six components: health service and legislative (context); nursing service managers (agents); nurses (recipients); decreasing power imbalance, participative and transformational leadership and trust (dynamics); initiation of support process through teamwork and mutual goal-setting, implementation and sustenance through reflections, monitoring and evaluation (process) and empowered nurses (outcome). CONCLUSION: Poor organisational support deteriorates the quality of nurses' lives on a personal level and imposes a direct economic cost on the employer by decreasing overall nursing workforce productivity. The conceptual framework could be a guide to support nurses in healthcare services regarding the management of HIV and AIDS in the workplace.

Managers' support on implementation of maternal guidelines, Limpopo province, South Africa.

BACKGROUND: The report of Saving Mothers indicated a decline of maternal mortality from 12.8% to 12.5% last triennium of 2017. This shows that regardless of availability of national maternal health guidelines, midwives and managers, 25% of maternal deaths were caused by preventable and avoidable factors. As such, support provided by managers is vital in promoting the utilisation of maternal guidelines. OBJECTIVES: The objective was to determine the support offered by managers to midwives during the implementation of maternal health guidelines. METHOD: The study design was cross-sectional descriptive in a quantitative domain. Simple random sampling was used to select 58 operational managers and two maternal managers. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences version 23. Descriptive statistics provided by Microsoft Excel in the form of charts was used to describe data. Pearson's correlation test was used to describe relationships amongst variables. RESULTS: The results revealed that 83.3% respondents indicated a shortage of staff to attend pregnant women. Fifty-six per cent of managers indicated that shortage of material resources contributed to substandard implementation of maternal guidelines. Supervision and monitoring of implementation of maternal guidelines was difficult as indicated by 53.3%, and 63.3% indicated lack of supervision. CONCLUSION: Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on implementation of maternal guidelines. Capacity building was offered; however, shortage of resources led to poor implementation of maternal guidelines by midwives.

How do family members perceive re-integration of male state patients into their families in South Africa? A qualitative analysis.

BACKGROUND: State patients are admitted to a psychiatric hospital after being declared as such by the magistrate courts as a result of not found fit to stand trial for the offence they had committed. After successful rehabilitation of state patients at the psychiatric hospital, they need to be re-integrated into their families. Family members' perceptions regarding re-integration of male state patients are not largely explored in the scientific body of knowledge. AIM: The aim of the study was to determine the perceptions of family members regarding reintegration of male state patients into their families. SETTING: This study was conducted in Vhembe District of Limpopo province, South Africa. METHOD: A qualitative approach using explorative, descriptive and contextual designs was adopted. In-depth interviews were conducted with 10 family members who were purposefully sampled, and data were thematically analysed using Tech Open Coding method. RESULTS: Three themes emerged, namely, family members understand re-integration; family members' expectations from a mental healthcare user; and threat to re-integration as perceived by family members. CONCLUSION: Data revealed that family members have varied perceptions regarding re-integration. These perceptions were based on the behaviour displayed or an offence committed by the mental healthcare user before admission and how participants experienced it. The study recommends that an investigation is to be conducted on the kind of support family members need regarding re-integration of state patients into their families.

Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa.

BACKGROUND: Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained. AIM: This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa. SETTING: The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured. METHODS: This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch's method of data analysis was used. Ethical considerations were adhered to. RESULTS: Patients' care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and 'use once' pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist. CONCLUSION: Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.

Caring for Tuberculosis Patients: Understanding the Plight of Nurses at a Regional Hospital in Limpopo Province, South Africa.

Tuberculosis (TB) is a disease which is caused by a relatively large, non-motile, rod-shaped pathogen called Mycobacterium tuberculosis. TB is a major cause of illness and death worldwide, especially in Asia and Africa. Despite the fact that TB is a curable illness, the tragedy is that TB remains the biggest killer in the world as a single pathogen. The aim of this study was to determine the experiences of nurses caring for TB patients at a regional hospital in Limpopo Province, South Africa. Qualitative, exploratory, and descriptive designs were used. A non-probability purposive sampling method was used to select the participants. The personal experiences of six nurses with more than five years' experience caring for TB patients at a regional hospital were explored, and it was guided by data saturation. Data were collected through in-depth individual interviews. Data were analyzed using Colaizzi's method. Trustworthiness was ensured and ethical considerations were observed in this study. The research findings revealed six major themes from the raw data: challenges of the working environment, problems impacting on the quality of nursing care, fear, anxiety, stress and risk of contracting infection, nurses' perceptions towards patients, support structure available in the hospital, and support needs for the nurses. Therefore, there is an urgent need to address the challenges experienced by nurses caring for communicable diseases through provision of a positive practice work environment.

Managing hypertensive disorders during pregnancy in low resource settings.

Background: Maternal deaths caused by hypertensive disorders are preventable. The purpose was to assess midwives' perceived knowledge and skills on the implementation of maternal health guidelines when managing hypertensive disorders during pregnancy. Methods: Quantitative, cross-sectional method was used. Population comprised of 200 midwives. Data was collected through self-report questionnaires and analysed through Statistical Package for Social Sciences 24. Results: Midwives (63.5%) possessed knowledge and skills of implementing maternal guidelines. While 77.5% experienced shortage of human and material resources. Non-compliance to ambulance services led to delayed initiation of treatment. Recommendations: Continuous in-service training and education must be conducted. More resources to be provided to implement guidelines accurately.

Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa.

BACKGROUND:  Providing optimal care to critically ill patients poses challenges in resource-poor settings because of the lack of equipment, inadequately trained personnel and limited infrastructure. OBJECTIVES:  This study explored challenges experienced by health care professionals working in resource-poor intensive care units. METHOD:  A qualitative, explorative, descriptive design was used. The population comprised nurses and doctors working in an intensive care unit of one hospital in the Limpopo province of South Africa. A purposive sample was selected and 17 semi-structured interviews were conducted. Data were analysed using Tesch's method. Ethical considerations were adhered to. RESULTS:  Participants experienced challenges related to provision of suboptimal patient care, the challenge of non-adherence to protocols and/or instructions and the challenge of practising beyond the scope of practice. CONCLUSION:  Lack of resources resulted in providing suboptimal intensive patient care. Patients were prone to infections and their safety might be compromised.

Knowledge and Attitudes of Women towards Human Papilloma Virus and HPV Vaccine in Thulamela Municipality of Vhembe District in Limpopo Province, South Africa.

Human papillomavirus (HPV) is the most common sexually transmitted viral infection. HPV can cause cervical cancer and other cancers of the genitals, neck and throat. Two HPV vaccines are available, Cervarix and Gardasil, which are the first vaccines directed at the prevention of cervical cancer. The purpose of the study was to assess the knowledge of human papilloma virus and HPV vaccine among rural women in Vhembe district in Limpopo Province. A quantitative descriptive approach was adopted. The quantitative design enabled the discovery of more information by means of direct questioning of a sample of women 30years and older. A convenience sampling was used to select 1546 respondents. Data was analysed using the Statistical Package for Social Sciences. The findings revealed that (97.8%) of women lacked knowledge about Human Papilloma Virus and HPV vaccine and were also not aware of the transmission methods of HPV virus. Furthermore (94.3%) were not aware who was eligible for HPV vaccine and the age range for vaccination and (92.1%) displayed negative attitudes to the use of vaccines if given a pamphlet to let their daughters be immunized. The awareness on human papilloma virus and HPV vaccine among women in Vhembe district is limited. There is a need to educate and promote awareness on cervical cancer screening methods among women to reduce the burden of morbidity and mortality.

Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe.

BACKGROUND: Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. PURPOSE: The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. METHODS: The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15-29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. RESULTS: Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). CONCLUSION: Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.

Knowledge, attitudes and practices regarding cervical cancer prevention at Thulamela Municipality of Vhembe District in Limpopo Province.

BACKGROUND: Cervical cancer is a widespread and often fatal disease that affected 1 million women globally in 2005. Not only is it the second most common cancer in women but it was also the second leading cause of cancer deaths, accounting for over 250 000 in 2006. PURPOSE: The purpose of the study was to assess the knowledge, attitudes and practices regarding cervical cancer prevention among rural women in Vhembe District in Limpopo Province. METHODOLOGY: A quantitative descriptive approach was adopted. The quantitative design enabled the discovery of more information by means of direct questioning of a sample of women aged 30 years and older. A convenience sampling was used to select the respondents. Data were analysed using the Statistical Package for Social Sciences. Measures to ensure ethical issues were adhered to. RESULTS: The findings revealed that women lacked knowledge about cervical cancer and preventive methods, and displayed positive attitudes to the use of services if made available as health workers did not adequately inform them about the availability of the services. CONCLUSION: The awareness of cervical cancer among women in Vhembe District is limited. There is a need to educate and promote awareness of cervical cancer among women to reduce the burden of morbidity and mortality.

Knowledge, attitudes and practices toward breast cancer screening in a rural South African community.

OBJECTIVES: The study assessed the knowledge, attitudes and breast cancer screening practices amongst women aged 30-65 years residing in a rural South African community. METHOD: A quantitative, descriptive cross-sectional design was used and a systematic sampling technique was employed to select 150 participants. The questionnaire was pretested for validity and consistency. Ethical considerations were adhered to in protecting the rights of participants. Thereafter, data were collected and analysed descriptively using the Predictive Analytics Software program. RESULTS: Findings revealed that the level of knowledge about breast cancer of women in Makwarani Community was relatively low. The attitude toward breast cancer was negative whereas the majority of women had never performed breast cancer diagnostic methods. CONCLUSION: Health education on breast cancer screening practices is lacking and the knowledge deficit can contribute negatively to early detection of breast cancer and compound late detection. Based on the findings, community-based intervention was recommended in order to bridge the knowledge gap.

Home-based carers' perceptions of health promotion on sexual health communication in Vhembe District.

BACKGROUND: The introduction of home-based care in rural communities in the 1980s contributed immensely toward the upliftment of the personal and environmental health of communities. Women's groups provided health promotion skills and health education to communities and made a difference in health-related behaviour change. OBJECTIVE: The purpose of the study was to explore and describe the home-based carers' perception regarding health promotion concerning sexual health communication in Vhembe district, in the context of HIV, amongst communities still rooted in their culture. METHOD: A qualitative, explorative and descriptive design was used in order to understand home-based carers' perceptions regarding health promotion on sexual health communication amongst rural communities which may adversely impact on health promotion practices. The population were home-based organisations in Vhembe. The sample was purposive and randomly selected and data were gathered through semi-structured face-to-face interviews and focus groups which determined data saturation. Open coding was used for analysis of data. RESULTS: The results indicated that sexual communication was absent in most relationships and was not seen as necessary amongst married couples. Socioeconomic conditions, power inequity and emotional dependence had a negative impact on decision making and sexual communication. CONCLUSION: This study, therefore, recommends that educational and outreach efforts should focus on motivating change by improving the knowledge base of home-based carers. Since they are health promoters, they should be able to change the perceptions of the communities toward sexually-transmitted infections and HIV by promoting sexual health communication.

Menstrual knowledge and practices of female adolescents in Vhembe district, Limpopo Province, South Africa.

BACKGROUND: Although sexual issues are openly discussed in the media, sexuality and reproductive functions are treated as taboo. Menstruation is a normal physiologic process, but carries various meanings within cultures and is rarely discussed amongst families and communities. PURPOSE: This study sought to assess the knowledge and practices of secondary school girls towards menstruation in the Thulamela municipality of Limpopo Province, South Africa. METHODS: A quantitative descriptive study design was used and respondents were selected by means of convenience sampling from a population of secondary school girls. The sample consisted of 273 secondary school girls doing Grades 10-12. A self-administered questionnaire was used to collect data, which was analysed by computing frequencies and percentages using the Statistical Package for Social Sciences (SPSS version 12). FINDINGS: The findings revealed that respondents experienced menarche at 13 years and that menstruation is a monthly bleeding (80%) that happens to every female; it is a sign of adulthood (91%). 15% reported that it is the removal of dirt from the stomach and abdomen, 67% indicated the source of menstruation being the uterus, 65% the vagina and 13% from the abdomen. 73% reported having fear and anxiety at the first experience of bleeding and that they could not maintain adequate hygienic practices due to a lack of privacy and sanitary towels. CONCLUSION: Interventions are needed to increase girls' opportunities to discuss menstruation and access information from adults including mothers, parents and guardians. School-based sexuality education should be comprehensive, begin early and be regularly repeated.

Factors Influencing the Uptake of Contraception Services by Vatsonga Adolescents in Rural Communities of Vhembe District in Limpopo Province; South Africa

The aim of the study was to determine the factors that influence the uptake of contraception services by adolescents in the Vhembe district of Limpopo Province; South Africa. A qualitative research method which is explorative; descriptive and contextual in nature was used to investigate the phenomenon from the adolescents' perspective. The target population comprised of adolescents residing in one of the six villages of Vhembe District. Data was collected through six focus group discussions until data saturation was achieved. Data was analysed using an open coding method. The findings revealed that adolescents are aware of the availability of contraceptive services. However; they lack a comprehensive knowledge about contraception and contraceptives; which led to negative attitudes towards using the services. Cultural health beliefs and attitudes were also identified as a barrier to the uptake and use of contraceptives. Recommendations were made on interventions to increase the uptake of contraception services amongst adolescents

Knowledge, attitudes and practice of secondary school girls towards contraception in Limpopo Province.

Unplanned teenage pregnancy constitutes an important health problem, whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP) services is increasing. The purpose of this study was to assess the knowledge, attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province, South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls, the sample consisting of 273 girls in Grades 10-12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However, most did not have knowledge of the emergency contraceptive, intra-uterine device and female condom. Pressure from male partners, fear of parental reaction to the use of contraceptives, reluctance to use contraceptives, poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health. 

Knowledge; Attitudes and Practice of Secondary School Girls towards Contraception in Limpopo Province

Unplanned teenage pregnancy constitutes an important health problem; whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP) services is increasing. The purpose of this study was to assess the knowledge; attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province; South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls; the sample consisting of 273 girls in Grades 10-12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However; most did not have knowledge of the emergency contraceptive; intra-uterine device and female condom. Pressure from male partners; fear of parental reaction to the use of contraceptives; reluctance to use contraceptives; poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health