African Journal of Primary Health Care and Family Medicine

The efficacy of treatment for clients with diabetes is highly dependent on the individual's ability to manage the disease. Several constraints, such as poverty, illiteracy and insufficient resources (finances and specialised healthcare professionals), especially communities of low socio-economic status, could influence clients' ability to manage their disease.The main aim of this study was to outline the obstacles encountered by individuals with type 2 diabetes mellitus from an urban community with regard to management of their disease.The study was conducted at a primary health care facility in the Western Cape, South Africa.Ethical clearance was obtained from all relevant authorities. Eight (8) conveniently selected clients with type 2 diabetes mellitus per participating community healthcare centre (six approved centres in total) were invited to take part in focus group discussions. Twenty six clients, 15 females and 11 males, with a mean age of 58.92 years (SD = 7.33), agreed to participate. Audiotaped data were transcribed verbatim followed by content analysis and identification of themes.Themes that emerged were challenges with: a healthy eating plan, physical activity, financial constraints, other people's understanding of the disease, and service received at the community healthcare centre. Verbatim quotes were used to exemplify the themes.Clients with type 2 diabetes mellitus experienced several challenges in the management of their disease. These challenges should be addressed to assist with better glycaemic control and to curb the emergence of diabetic complications and their attendant cost implications.

Tania Steyl

Julie Phillips

African Journal of Primary Health Care & Family Medicine

Management of type 2 diabetes mellitus: Adherence challenges in environments of low socio-economic status

The primary care clinician faces many challenges and is often left to manage complex pathology because of resource constraints at higher levels of care. One of these complex conditions is the perioperative management of antithrombotic medication. This narrative review is focused on helping the clinician navigate the complex path and multiple guidelines related to the perioperative use of antithrombotic medication. Perioperative antithrombotic guidelines (American College of Chest Physicians, European Society of Regional Anaesthesia, and American Society of Regional Anesthesia) and relevant publications were identified by a PubMed search using the terms perioperative AND anticoagulants OR antithrombotics AND guideline. Issues relevant to clinical practice were identified, and attempts were made to explain any ambiguity that arose. Adhering to basic pharmacological principles and evidence-based guidelines allows for the safe usage of antithrombotics. Knowing when to stop, continue, bridge and restart antithrombotic medication prevents perioperative morbidity and mortality. Stopping antithrombotic medication too early can lead to thromboembolic complications associated with their primary disease process. Not stopping antithrombotic medication or stopping it too late can potentially cause life-threatening bleeding, haematomas and increased transfusion requirements.

Daniël J. Laäs

Mergan Naidoo

Perioperative antithrombotic medication: An approach for the primary care clinician

围手术期抗血栓药物：初级保健临床医生的方法

Family medicine has not received appropriate attention in the sub-Saharan African context. In particular, family medicine is rarely recognised as a medical speciality and most African countries are silent on the role of family medicine in their health systems. There is, however, an emerging interest in developing family medicine as a key component of primary healthcare. Postgraduate training in family medicine is progressing and many countries have already established specific training programmes. In addition, there have been attempts to define the importance of family medicine, which, we expect, this short report contributes to. Interviews were conducted with physicians, partners and beneficiaries of two international development projects funded by the Canadian government. The one project supports training of health professionals and the other education of healthy women and girls in the community. The objective was to document the strengthening of primary healthcare through the creation and adaptation of a new family and community medicine postgraduate medical programme (which includes both family and community medicine) emphasising field training, immersion in local communities and interdisciplinary collaboration. This article underlines the importance of family medicine in Mali by documenting how what is now termed family and community medicine can promote community-orientated health services. To do so, we use the examples of initiatives and actions done through two international health development projects.

Mahamane M. Maïga

Gabriel Blouin Genest

François Couturier

Sarah Stecko

Michèle Rietmann

Mamadou B. Coulibaly

Drissa M. Sidibé

Fatoumata Dicko

The contribution of family medicine to community-orientated health services in Mali: A short report

马里家庭医学对社区导向型卫生服务的贡献：简报

Background: For continuity and quality of care, accurate record-keeping is crucial. Complete care is facilitated by completing a child’s Road to Health Booklet (RTHB) as well as prompt interpretation and appropriate action. This could result in a decrease in child morbidity and mortality.Aim: The study was aimed at assessing the completeness of the RTHB of children younger than 5 years.Setting: Temba Community Health Centre (CHC), Tshwane District, South Africa.Methods: A cross-sectional study was conducted using a data collection sheet adopted from previous studies.Results: Children less than 1-year-old accounted for 70.2% of the 255 RTHBs. The mean ± s.d. age was 11.5 ±10.76 months. The study finding showed no section was 100% fully completed. Of the 255 records studied, 38 (14.9%) human immunodeficiency virus (HIV)-exposed babies were recorded at birth, 39.5% were negative at 6 weeks and 60.5% were not recorded. Ninety-one (35.7%) children were unexposed. The HIV status of 126 (49.4%) children was not recorded. Sixty-six per cent (66%) of recorded maternal syphilis was negative. Immunisations, weight-for-age, neonatal information, and details of the family and child were fully completed in 80% of the booklets. Developmental screening was 17.2% completed, and oral health was 1.6% partially completed. The overall completeness was 40.3%.Conclusion: The completeness of RTHBs was found to be suboptimal.Contribution: The present study’s findings should serve as a reminder that healthcare practitioners must complete RTHBs in their totality in order to improve continuity and care quality, as the results indicated that RTHB completion was below ideal.

Pfunzo Machimana

Suzan L.N. Nyalunga

Edith N. Madela-Mntla

Doudou K. Nzaumvila

An audit of completeness of Road to Health Booklet at a community health centre in South Africa

南非社区卫生中心《健康之路手册》完整性的审计

Background: Village health workers (VHWs), popularly known as community health workers (CHWs) in some contexts and settings, should effectively complement health care providers in primary health care (PHC) delivery in Zimbabwe. However, they continue to offer services that do not address current and emerging health issues.Aim: This study aims to review the literature and develop a conceptual framework to improve the effectiveness and efficiency of VHWs in service delivery.Method: Rodgers’ evolutionary framework was used to analyse the concept of ‘strategies for effective and efficient delivery of PHC by VHWs’. Articles and reports published in English from 2010 to 2022 in peer-reviewed journals from the PUBMED, EBSCO, ScienceDirect and Google Scholar databases were reviewed.Results: After screening and removal of duplicates a total of 52 articles and two reports were reviewed to identify antecedents, attributes and consequences of strategies to improve PHC services by village health workers. The antecedents included an enabling work environment, community participation, motivation, incentives, integration of community health into national health systems, and information and communication technology. The attributes consisted of ongoing training and skills development, mutual respect and trust, enhanced contact between VHWs and communities and supportive supervision. The consequences were equitable access to and improved quality of PHC service delivery.Conclusion: The concept of PHC service delivery by VHWs has evolved from health promotion to curative care through task shifting and is now an integral part of the health system. A supportive and enabling work environment, anchored in community participation, empowers VHWs to deliver equitable services effectively and efficiently.Contribution: The development of strategies for improving VHW service delivery and a conceptual framework informed by findings from the reviewed literature.

Ofhani Munyai

Azwinndini G. Mudau

Ntsieni S. Mashau

Strategies for effective and efficient delivery of primary health care by village health workers: A scoping review using the Rodgers’ Evolutionary Concept Analysis Framework

基于罗杰斯进化概念分析框架的村卫生工作者有效高效提供初级卫生保健策略：范围综述

Background: Oral pre-exposure prophylaxis (PrEP) uses antiretroviral medication to reduce HIV risk in HIV-negative individuals. Despite its effectiveness, global uptake faces policy and accessibility challenges. In Eswatini, PrEP introduction in 2017 showed promise despite stigma and COVID-19 disruptions.Aim: This study compared PrEP uptake and retention during and after COVID-19.Setting and Methods: An analytical cross-sectional study was conducted among clients accessing HIV testing services in selected Eswatini facilities. Data from the HIV testing register, PrEP register, and Client Management Information System (CMIS) were analysed. Uptake, retention, and client outcomes were measured during COVID-19 (March 2020–March 2021) and post-COVID-19 (April 2021–April 2022).Results: Of 5286 clients, 45% (n = 2380) initiated PrEP during COVID-19, while 55% (n = 2906) initiated post-pandemic. Facility 3 had the highest initiations during COVID-19 (844), while Facility 5 had the lowest (7). Retention was lower among clients aged 15–29 years. Females initially showed higher retention odds (odds ratio [OR]: 1.50), but this was insignificant after adjusting for confounders. Clients initiated post-COVID-19 had higher retention odds (OR: 2.96).Conclusion: COVID-19 impacted PrEP uptake in Eswatini, emphasising the need for flexible healthcare delivery. Targeted campaigns and tailored interventions are crucial for sustaining HIV prevention efforts and addressing demographic shifts.Contribution: This study highlights the importance of responsive healthcare systems and tailored approaches to maintaining HIV prevention during public health crises.

Musa B. Ginindza

Nondumiso Ncube

Renier Coetzee

COVID-19 impact on HIV PrEP uptake and retention at selected health facilities in Eswatini

COVID-19对埃斯瓦蒂尼选定医疗机构中HIV暴露前预防（PrEP）接受和保持的影响

This Therapeutic Letter considers the evidence for inhaled corticosteroids (ICS) as a treatment for Chronic Obstructive Pulmonary Disease (COPD). Drug therapy aims to alleviate symptoms, enhance functional capacity and prevent exacerbations, but has not consistently shown to reduce mortality or improve quality of life based on randomised trials.Inhaled corticosteroids have shown limited benefits for COPD symptoms and exacerbations but increased risks of serious harms. Guidelines recommend limiting ICS to severe COPD and only for repeated exacerbations. Studies show withdrawing ICS can be done safely for stable COPD patients with infrequent exacerbations, especially those with lower eosinophil counts. Provincial, national and international guidelines now recommend limiting ICS prescriptions to severe COPD stages. Long-term ICS use may lead to serious side effects, including pneumonia and fractures. Initial COPD therapy should focus on short-acting bronchodilators, not ICS. Adding long-acting bronchodilators is recommended before considering ICS because of limited benefits and risks of serious harms. For persistent symptoms, long-acting muscarinic antagonists (LAMA) or long-acting beta2 agonists (LABA) are recommended, with the addition of ICS reserved for those with repeated exacerbations and severe COPD. Deprescribing ICS can be considered in clinically stable patients, particularly for those with infrequent exacerbations and mild COPD. When applicable, tapering ICS over several months is advised for patients with elevated eosinophil counts. Overall, the risks of serious harms from ICS typically outweigh their limited benefits for mild COPD patients in primary care.

Benji Heran

Thomas L. Perry

Ken Bassett

Minimising inhaled corticosteroids for COPD

最小化吸入性糖皮质激素在COPD中的应用

In older adults with type 2 diabetes (T2DM), tight glycaemic control (HbA1c 7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycaemia, which may cause falls, confusion and hospitalisations. This Therapeutic Letter evaluates the risks of tight glycaemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidity and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycaemia and improving patient-centred care through relaxed HbA1c targets. Large randomised controlled trials show that intensive glycaemic control (HbA1c ≤ 7%) does not reduce cardiovascular risk, but increases hypoglycaemia and mortality, particularly in older adults. Instead, glycaemic targets should be adjusted based on the patient’s overall health and life expectancy. Deprescribing may be considered, starting with drugs most likely to cause hypoglycaemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualised treatment plans are essential.

Wade Thompson

Minimising harms of tight glycaemic control in older patients with type 2 diabetes

尽量减少老年2型糖尿病患者严格血糖控制的危害

Abbreviation	Afr. J. Prim. Health. Care. Fam. Med.
Journal Impact	1.23
Quartiles(Global)	PRIMARY HEALTH CARE(Q4)

ISSN	2071-2928, 2071-2936
h-index	31

Publication Information	Publisher: AOSIS (Pty) Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2009，Proportion of original research papers: 95.35%，Self Citation Rate:8.30%， Gold OA Rate: 96.34%
Journal Fees	$Details
Average review cycle	网友分享经验：15 Weeks

African Journal of Primary Health Care and Family Medicine

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Management of type 2 diabetes mellitus: Adherence challenges in environments of low socio-economic status

Perioperative antithrombotic medication: An approach for the primary care clinician

The contribution of family medicine to community-orientated health services in Mali: A short report

An audit of completeness of Road to Health Booklet at a community health centre in South Africa

Strategies for effective and efficient delivery of primary health care by village health workers: A scoping review using the Rodgers’ Evolutionary Concept Analysis Framework

COVID-19 impact on HIV PrEP uptake and retention at selected health facilities in Eswatini

An audit of completeness of Road to Health Booklet at a community health centre in South Africa

Strategies for effective and efficient delivery of primary health care by village health workers: A scoping review using the Rodgers’ Evolutionary Concept Analysis Framework

Minimising inhaled corticosteroids for COPD

Minimising harms of tight glycaemic control in older patients with type 2 diabetes