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

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

Cervical cancer screening by visual inspection and HPV testing in Eswatini.

In 2009, visual inspection with acetic acid (VIA) followed by cryotherapy (VIA-and-cryotherapy), was introduced into the Eswatini cervical cancer prevention programme. We present screening results of 654 women attending VIA-and-cryotherapy who participated in a sexually transmitted infections prevalence study, at which samples for HPV DNA testing and liquid-based cytology (LBC) were also collected. VIA positives (VIA+) ineligible for cryotherapy, suspected cancers and women with high-grade squamous intraepithelial or worse lesions (HSIL+) on LBC were referred for diagnosis and treatment. Women with negative VIA who were HPV positive (HPV+) and those VIA+ treated with cryotherapy were recalled for another VIA one-year later. The positivity rates of VIA, HPV, atypical squamous cells of undetermined significance or worse cytology abnormalities (LBC ASCUS+) and low-grade squamous intraepithelial or worse lesions (LBC LSIL+) were 9.7%, 42.6%, 13.2% and 5.3%, respectively. HPV testing detected 29 of 31 LSIL+ (93.6%, 95%CI: 78.6-99.2) while VIA only detected 11 (35.6%, 95%CI: 19.2-54.6). The HIV prevalence was 43% (95%CI: 39.2-46.9). HIV positives were at increased risk of being VIA+ (age-adjusted odds ratio: 2.5, 95%CI: 1.5-4.3), HPV+ (3.7, 2.6-5.3) and having LSIL+ (16.3, 4.9-54.8). The ineligibility rates for cryotherapy were 38% (24 of 63 VIA+), and 46% among HIV positives (18 of 39 VIA+). HPV testing was substantially more sensitive than VIA, thus, HPV followed by ablative treatment may be more effective. However, the high ineligibility for cryotherapy highlights the need for improving the assessment of eligibility for ablative treatment and for strengthening colposcopy, particularly in populations with high HIV prevalence.

The economic burden of prostate cancer in Eswatini.

BACKGROUND: Prostate cancer is the fifth cause of cancer mortality among men worldwide. However, there is limited data on costs associated with prostate cancer in low- and middle-income countries particularly in the sub-Saharan region. From a societal perspective, this study aims to estimate the cost of prostate cancer in Eswatini. METHODS: This prevalence-based cost-of-illness study used diagnosis specific data from national registries to estimate costs associated to prostate cancer during 2018. The prevalence-based approach was used employing both top down and bottom up costing approaches. Costs data included health care utilization, transport, sick leave days and premature death. RESULTS: The total annual cost of prostate cancer was $6.2 million (ranging between $ 4.7 million and 7.8 million estimated with lower and upper bounds). Average cost-per patient for radiotherapy, chemotherapy and other non-medical direct costs (transport and lodging) were the highest cost drivers recording $16,648, $7,498 and $5,959 respectively whilst indirect costs including productive loss due to sick leave and pre-mature mortality was estimated at $58,320 and $113,760 respectively. Cost of managing prostate cancer increased with advanced disease and costs were highest for prostate cancer stages III and IV recording $1.1million, $1.9million respectively. CONCLUSIONS: Prostate cancer is a public health concern in Eswatini, and it imposes significant economic burden to the society. This finding point areas for policy makers to perform cost containment regarding therapeutic procedures for prostate cancer and the need for strategies to increase efficiencies in the health care systems for increased value for health care services.

Knowledge, attitude and practice towards cervical cancer prevention among mothers of girls aged between 9 and 14 years: a cross sectional survey in Zimbabwe.

BACKGROUND: Cervical cancer (CC) morbidity and mortality is still high in developing countries like Zimbabwe. Treatment for CC is out of reach for many women, hence the need to maximise on prevention which mainly includes screening and administering human papillomavirus (HPV) vaccine. Knowledge about CC prevention is a prerequisite for utilisation of all the available options for CC prevention, yet little is known about its levels and the corresponding attitudes and practices on cancer prevention methods within the society. METHODS: A cross sectional survey was done to assess knowledge, attitude and practice (KAP) on CC prevention among mothers of girls aged between 9 and 14 years in Zimbabwe as well as factors explaining the KAP. Four hundred and six mothers participate. Descriptive and inferential statistics (binary logistic regression and Chi-Square test of association) were applied to determine participant characteristics with KAP using STATA version 16 software. FINDINGS: Overall KAP of cervical cancer prevention is in a poor state. The knowledge was poor with 24% being able to say CC is caused by HPV; the attitude is negative with 58% being of the opinion that CC is caused by witchcraft and it is a death sentence, while the bad practices of relying only on traditional means were being practiced. Factors associated with knowledge are: not having medical aid (odds: 0.17, 95%CI: 0.05-0.59, p = 0.005) and high levels of education (secondary level odds: 4.20; 95%CI: 2.25-7.84 p < 0.001 and tertiary odds: 7.75; 95%CI: 2.04-29.45, p-value: 0.003 compared to primary education). Attitude towards CC management was driven by levels of education (secondary level odds: 0.39, 95%CI: 0.20-0.78, p = 0.007 and tertiary odds: 0.12, 95%CI: 0.04-0.33, p < 0.001), the same factor increases odds of good practice (secondary odds: 3.78, 95%CI: 1.99-7.18, p < 0.001 and tertiary odds: 3.78, 95%CI: 1.99-7.18, p < 0.001). On the other hand, HPV vaccine knowledge was also very moderate (with majority of mothers not knowing the right age of vaccination; vaccine acceptability was high (90%), but uptake was very low (8% had their daughter vaccinated). CONCLUSION: KAP about CC prevention was poor with factors necessary for improvement of KAP identified as education, medical insurance coverage. Making health education easily accessible in schools, primary health facilities and various media platforms will help to address the myths on causes of CC and how it can be treated. Health education and availability of free screening services and free vaccine will improve CC prevention out outcomes.

Health systems influence on the pathways of care for lung cancer in low- and middle-income countries: a scoping review.

BACKGROUND: Globally, lung cancer is the most common cancer and cause of cancer-related deaths, responsible for nearly one in five deaths. Many health systems in low- and middle-income countries, including sub-Saharan Africa have weak organizational structure, which results in delayed lead time for lung cancer patient care continuum from diagnosis to palliative care. AIM: To map evidence on the health systems issues impacting on the delays in timely lung cancer care continuum from diagnosis to palliative care in LMICs, including sub-Saharan Africa. METHODS: A scoping review was performed following the method of Arksey and O'Malley. Systematic searches were performed using EBSCOhost platform, a keyword search from the following electronic databases were conducted: PubMed/MEDLINE, Google Scholar, Science Direct, World Health Organization (WHO) library, and grey literature. The screening was guided by the inclusion and exclusion criteria. The quality of the included studies was determined by Mixed Method Appraisal Tool (MMAT). RESULTS: A total of 2886 articles were screened, and 236 met the eligibility criteria for this scoping review study. Furthermore, 155 articles were also excluded following abstract screening. Eighty-one articles were selected for full-article screening by two researchers with 10 being selected for independent detailed data extraction for synthesis. These studies were also subjected to methodological quality assessment. All included studies were conducted in LMICs mostly Asia, the Middle East, and Latin America and published between January 2008 and June 2018. The ten included studies described at least one interval in lung cancer care. CONCLUSIONS: Reducing wait time across this care continuum is needed to improve easy access to healthcare, quality care, survival and patient outcomes, as many patients still face longer wait times for diagnosis and treatment of lung cancer than recommended in several healthcare settings. A multidisciplinary team approach will help to reduce wait time and ensure that all patients receive appropriate care. Interventions are needed to address delays in lung cancer care in LMICs. Health-care providers at all levels of care should be educated and equipped with skills to identify lung cancer symptoms and perform or refer for appropriate diagnostic tests.

Patterns, trends, and factors associated with contraceptive use among adolescent girls in Zambia (1996 to 2014): a multilevel analysis.

BACKGROUND: Despite high levels of pregnancy and childbearing among adolescents in Africa, contraceptive use remains low. Examining variations in contraceptive use among adolescent girls is vital for informing programs to improve contraceptive utilisation among this segment of the population. This study aimed to examine the patterns, trends, and factors associated with contraceptive use among adolescents in Zambia over the period 1996-2014. METHODS: The study involved an analysis of data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys focusing on adolescent girls aged 15-19 years. Analysis entailed descriptive statistics and estimation of multilevel logistic regression models examining variations in contraceptive use among adolescent girls over time. Estimates with p-values less than 0.05 were considered statistically significant. RESULTS: Results showed that contraceptive use remains low and ranged from 7.6% in 1996 to 10.9% in 2013/14, reflecting a change of 3.3 percentage points over 18 years. Over the 18 years, contraceptive use was significantly associated with age, level of education, and marital status. Older adolescent girls and those with higher levels of education were significantly more likely to use contraception compared to younger ones and those with lower levels of education. Although initially significant (AOR 0.556, 95% CI 0.317, 0.974 in 1996), rural-urban differences disappeared between 2001/2 and 2007 but re-emerged in 2013/14 (AOR 0.654, 95% CI 0.499, 0.859). Across all survey years, adolescents who were married or living with a partner were significantly more likely to use contraceptives compared to those who were not married. CONCLUSIONS: The findings suggest the need for targeted interventions to improve contraceptive use among sexually active adolescent girls in the country in general, and those who are disadvantaged in particular.

Lung cancer awareness and palliative care interventions implemented in low-and middle-income countries: a scoping review.

BACKGROUND: Lung cancer is the most diagnosed cancer worldwide. In low- and middle-income countries (LMICs), lung cancer is often diagnosed at a late stage due to poor knowledge and awareness of its signs and symptoms. Increasing lung cancer awareness is likely to reduce the diagnosis and treatment delays. The implementation of early palliative care has also been reported to improve a patient's quality of life, and even survival. The aim of this scoping review was to map evidence on lung cancer awareness and palliative care interventions implemented in sub-Saharan Africa (SSA) and other LMICs. METHODS: This scoping review was guided by Arksey and O'Malley's framework. Databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, World Health Organization (WHO) library and grey literature were used to perform systematic searches of relevant articles. The methodological quality assessment of included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVivo version 10 software was used to perform the thematic content analysis of the included studies. RESULTS: A total number of screened articles was 2886, with 236 meeting the eligibility criteria and 167 further excluded following abstract screening. Sixty-nine (69) articles qualified for full-article screening and 9 were selected for detailed data extraction and methodological quality assessment. Of the included nine studies, eight described at least one lung cancer warning signs and symptoms, while one described the effectiveness of palliative care for lung cancer. Eight articles recognized the level of lung cancer knowledge, risk factors awareness of warning signs and symptoms in LMICs, mostly Africa and Asia. CONCLUSIONS: Most of the participants were aware of tobacco use as the major risk factor for lung cancer but lacked knowledge on the other pre-disposing risk factors. Evidence on palliative care is scarce, therefore, awareness interventions packaged with evidence on the value of timely access to palliative care services in improving the quality of life of the lung cancer patients and their families, are required.

Facilitating factors and barriers to accessibility and utilization of kangaroo mother care service among parents of low birth weight infants in Mangochi District, Malawi: a qualitative study.

BACKGROUND: Kangaroo Mother Care (KMC) is one of the interventions widely used in low-income countries to manage Low Birth Weight Infants (LBWIs), a global leading cause of neonatal and child mortality. LBWI largely contributes to neonatal mortality in Malawi despite the country strengthening and implementing KMC, nationwide, to enhance the survival of LBWIs. This qualitative study aimed to assess the facilitating factors and barriers to accessibility and utilization of KMC service by the parent of low birth weight infants (PLBWIs) in Mangochi District, Malawi. METHODS: Two focused group discussions assessed factors facilitating and hindering the accessibility and utilization of KMC service were conducted in April 2018 that reached out to (N = 12) participants; (n:6) PLBWI practicing KMC at Mangochi district hospital (MDH) referred from four health facilities and (n:6) high-risk pregnant mothers (HRPMs) visiting antenatal care (ANC) clinic at MDH. The availability of KMC at MDH was assessed using KMC availability checklist. The study used purposive, convenient and simple random sampling to identify eligible participants. Thematic analysis was used to analyze the findings. RESULTS: Sixteen themes emerged on facilitating factors and barriers to accessibility and utilization of KMC service by the PLBWIs. The identified themes included; availability of KMC providers, social factor (social support and maternal love), timing of KMC information, knowledge on KMC, health linkage systems, recognition of LBWIs, safety on the use of KMC, preference of LBWI's care practice, lived experience on KMC practice, KMC expert clients, perceived causes of LBWI births, cultural/traditional factors, religious beliefs, health-seeking behavior, women empowerment and quality of care. CONCLUSIONS: Although KMC was available in some of the health facilities, integration of KMC messages in ANC guidelines, community awareness and in sensitization of any health intervention may enhance KMC accessibility and utilization by the targeted population.

Evidence on the prevalence, incidence, mortality and trends of human papilloma virus-associated cancers in sub-Saharan Africa: systematic scoping review.

BACKGROUND: Human papilloma virus (HPV) associated cervical cancer remains a global concern particular, in Sub-Saharan Africa (SSA) where the impact is felt most. Evidence show that many other cancers such as vaginal, anal, oropharyngeal, penile are because of persistent infection with HPV especially, high-risk types. AIM: We mapped evidence on the incidence, prevalence, mortality, and the trends of human papillomavirus-related cancers in SSA. METHODS: A comprehensive literature search was conducted from several databases including PubMed, Google scholar, Science Direct, and CINAHL and MEDLINE via EBSCOhost as well as World Health Organization website for grey literature. Studies reporting HPV-related cancers in SSA outcomes including prevalence, incidence, mortality, and trends were included in this study. The risk of bias of the included studies were assessed using the mixed methods appraisal tool version 2011. We employed PRISMA (preferred reporting items for systematic reviews and meta-analyses) to report the search results. Thematic analysis used to reveal the emerging themes from the included studies. RESULTS: Seventy-four (74) studies were retrieved at full article screening, eight of them (six reviews, and two quantitative study) were eligible for data extraction. The degree of agreement between the two independent reviewers following full article screening, was 86.49% agreement versus 64.57% likely by chance which constituted moderate to significant agreement (Kappa statistic = 0.62, p-value< 0.05). Of the eight included studies, four (50%) studies generalized about SSA with no country of interest; two (25%) studies were conducted in Nigeria; one (12.5%) reported about Uganda, Zambia, Guinea, Malawi Tanzania, Mali, Mozambique, Zimbabwe; and one (12.5%) reported about Ethiopia, Senegal, Zimbabwe and Uganda. These eight included studies reported evidence on more than one outcome of interest. Four studies reported about the prevalence of HPV-related cancers, seven studies reported about the incidence, four studies reported about mortality, and four studies reported about the trends of HPV-related cancers. CONCLUSION: This study observation highlighted a gap of knowledge regarding the epidemiological data on the recent HPV prevalence in SSA, which will have a potential impact in determining the distribution of HPV on different body sites (cervix, penis, vagina, vulva, anus and oropharynx). Ongoing research projects are recommended in SSA to enhance the value of HPV, and HPV-associated cancers epidemiological data to inform strategies or/and policies on prevention, diagnosis, and treatment of HPV-related conditions.

Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates.

BACKGROUND: The scarcity of country data (e.g. a cancer registry) for the burden of cervical cancer (CC) in low-income countries (LCIs) such as Swaziland remains a huge challenge. Such data are critical to inform local decision-making regarding resource allocation [1]. We aimed to estimate likely cervical cancer incidence in Swaziland using three different methodologies (triangulation), to help better inform local policy guidance regarding likely higher "true" burden and increased resource allocation required for treatment, cervical cancer screening and HPV vaccine implementation. METHODS: Three methods were applied to estimate CC incidence, namely: 1) application of age-specific CC incidence rates for Southern African region from GLOBOCAN 2012 extrapolated to the 2014 Swaziland female population; 2) a linear regression based model with transformed age-standardised CC incidence against hr-HPV (with and without HIV as a covariate) prevalence among women with normal cervical cytology; and 3) a mathematical model, using a natural history approach based on parameter estimates from various available literature and local survey estimates. We then triangulated estimates and uncertainty from the three models to estimate the most likely CC incidence rate for Swaziland in 2015. RESULTS: The projected incidence estimates for models 1-3 were 69.4 (95% CI: 66.7-72.1), 62.6 per 100,000 (95%CI: 53.7-71.8) and 44.6 per 100,000 (41.5 to 52.1) respectively. Model 2 with HIV prevalence as covariate estimated a higher CC incidence rate estimate of 101.1 per 100,000 (95%CI: 90.3-112.2). The triangulated ('averaged') age-standardized CC incidence based across the 3 models for 2015 was estimated at 69.4 per 100,000 (95% CI: 63.0-77.1) in Swaziland. CONCLUSION: It is widely accepted that cancer incidence (and in this case CC) is underestimated in settings with poor and lacking registry data. Our findings suggest that the projected burden of CC is higher than that suggested from other sources. Local health policy decisions and decision-makers need to re-assess resource allocation to prevent and treat CC effectively, which is likely to persist given the very high burden of hr-HPV within the country.

Mapping evidence on the distribution of uterine fibroids in sub-Saharan Africa: A scoping review protocol.

BACKGROUND: Uterine fibroids are the most common pelvic benign tumours found in reproductive-aged women and may affect up to 70% of all women by menopause. Uterine fibroids place a heavy burden on women and society resulting in poor quality of life, impaired self-image, and impaired social, sexual, emotional, and physical well-being of affected individuals. AIM: This study aims to map the evidence on the burden of uterine fibroids in Sub-Saharan Africa; uterine fibroids' burden by age, uterine fibroids' geographic burden, uterine fibroids' cost estimation and reported experiences among women diagnosed with uterine fibroids. SETTING: Articles will be selected from countries within Sub-Saharan Africa. METHODS AND ANALYSIS: This scoping review will be guided by the Arksey & O'Malley framework, enhanced by Levac et al (2010). The following electronic databases will be searched; PubMed, EBSCOhost (Cumulated Index to Nursing and Allied Health Literature and Health Source), Medical Literature Analysis and Retrieval System Online, Cochrane Library, Scopus, Web of Science, Africa Journal Online, and Google Scholar. The Population Concept and Context (PCC) framework will be used and the PRISMA flow diagram will also be used to show the literature search and selection of studies. Descriptive data analysis will be used; results will be presented in themes, narrative summaries, tables, and charts. DISCUSSION: The study anticipates finding relevant literature on the distribution of uterine fibroids, the burden of uterine fibroids in terms of geographic distribution, age distribution, and cost approximation related to the disease. This will assist in identifying research gaps to guide future research contribute to the body of scientific knowledge and develop preventative strategies for the disease.

Sustainable solutions to barriers of point-of-care diagnostic testing services in health facilities without laboratories in the bono region, Ghana: a qualitative study.

BACKGROUND: A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery. METHODS: A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively. RESULTS: Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders. CONCLUSIONS: This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings.

Knowledge and management of female genital schistosomiasis in sub-Saharan Africa: A scoping review protocol.

Background: Approximately 20 to 120 million women of reproductive age worldwide are thought to be affected by female genital schistosomiasis (FGS). It is a preventable manifestation of schistosomiasis in adolescent girls and women, which remains underreported, underdiagnosed, or misdiagnosed, and largely untreated. Objective: This study aimed to map evidence on the knowledge and management of FGS from 1950 to 2022 in sub-Saharan Africa. Method: The Arksey and O'Malley and Levac et al. framework suggestions and a guideline from Joanna Briggs Institute will be employed. Search for literature will be in PubMed, Scopus, Cochrane, Web of Science, MEDLINE via PubMed, and Google Scholar from 1950 to 2022 for useful published research articles using key phrases or search terms and grey literature with limitations for studies conducted in sub-Saharan Africa. Two reviewers will screen the articles. Kappa coefficients by Cohen statistics will be computed for inter-screener agreement, and the selected articles will be evaluated using Mixed Method Appraisal Tool (MMAT). Results: The researchers will map and explore the evidence of the knowledge and management of FGS in the subregion. The years of publications, countries of study, and settings will be reported, and the identified research gaps will be reported. Conclusion: The researchers anticipate that this study will determine and map the evidence on the knowledge and management of FGS in sub-Saharan Africa; identify knowledge and management gaps, and direct future research. Contribution: This study will add to the literature on FGS and direct future research regarding the knowledge and management of FGS.

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

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

Pre- and post-intervention survey on lung cancer awareness among adults in selected communities in KwaZulu-Natal, South Africa: A quasi-experimental study.

Background: Lung cancer remains the number one cause of cancer mortality estimated at 1.8 million deaths. There are limited studies in resource poor countries regarding knowledge, attitudes and practices towards lung cancer. Objective: This study aimed to assess the effects of a lung cancer awareness intervention in selected communities in KwaZulu- Natal, South Africa. Materials and Methods: A quasi-experimental study design was conducted in the selected communities in KwaZulu-Natal. A community intervention was administered in the communities after a baseline survey. The intervention effects were assessed a month after implementation. Results: There were statistical differences in the mean age (p<0.001) and proportion of males and females (p<0.001) at baseline and post-intervention. There were no differences in terms of smoking status (p=0.958), however, there was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). The mean knowledge score increased from 41.8% (95% CI 35.7 - 47.9) at baseline to 59.9 (95% CI 53.8 - 66.0) post-intervention (p<0.001). The proportion of participants who were aware that lung cancer can be detected early increased from 46.5% (95% CI 39.1 - 53.9) at baseline to 81.1% (95% CI 71.7 - 87.9) post-intervention (p<0.001). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on the level of lung cancer knowledge in the selected communities (p<0.001). Conclusions: Interventions increasing the recognition of signs and symptoms, focusing on the importance of early detection and health seeking behaviour (including screening), smoking cessation, and addressing the perceived health system barriers are required.

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

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

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

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

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

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

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

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

Facilitators and barriers to in vitro diagnostics implementation in resource-limited settings: A scoping review.

BACKGROUND: The World Health Organization (WHO) developed the model list of essential in vitro diagnostics (EDL) to guide countries to develop and update point-of-care (POC) per their disease priorities. The EDL includes POC diagnostic tests for use in health facilities without laboratories; however, their implementation might face several challenges in low- and middle-income countries (LMICs). AIM: To identify facilitators and barriers to POC testing service implementations in the primary health care facilities in the LMICs. SETTING: Low- and middle-income countries. METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. A comprehensive keyword search for literature was conducted in Google Scholar, EBSCOhost, PubMed, Web of Science and ScienceDirect using the Boolean terms ('AND' and 'OR'), as well as Medical Subject Headings. The study considered published articles in the English language from 2016 to 2021 and was limited to qualitative, quantitative and mixed-method studies. Two reviewers independently screened the articles at the abstract and full-text screening phases guided by the eligibility criteria. Data were analysed qualitatively and quantitatively. RESULTS: Of the 57 studies identified through literature searches, 16 met this study's eligibility criteria. Of the 16 studies, 7 reported on both facilitators and barriers; and the remainder reported on only barriers to POC test implementation such as inadequate funding, insufficient human resource, stigmatisation, et cetera. CONCLUSION: The study demonstrated a wide research gap in facilitators and barriers, especially in the general POC diagnostic test for use in health facilities without laboratories in the LMICs. Extensive research in POC testing service is recommended to improve service delivery.Contribution: This study's findings contribute to a few works of literature on existing evidence of POC testing.