John V. Ndimande

The efficacy of a brief intervention to reduce alcohol misuse in patients with HIV in South Africa: study protocol for a randomized controlled trial

BackgroundAlcohol abuse comes with risks for increased morbidity and mortality among patients with HIV. This study aims to determine the prevalence of alcohol use and other risk factors in a sample of primary care patients with HIV in South Africa and to assess a brief intervention to reduce the use of alcohol in this group.Methods/DesignA single-blinded randomized controlled trial is designed to determine the efficacy of a brief intervention to reduce hazardous alcohol use in patients with HIV. The study will be carried out on out-patients with HIV in two primary healthcare HIV clinics near Pretoria, South Africa. Alcohol use will be assessed with the Alcohol Use Disorder Identification Test questionnaire. Other data that will be collected relate to health-related quality of life, depression, sexual behavior, internalized AIDS stigma, HIV-related information and adherence to antiretroviral therapy (self-reported 7-day recall of missed doses, Visual Analog Scale and pill count). The intervention consists of a brief counseling session to reduce alcohol risk; the control group receives a health education leaflet.DiscussionThe findings will be important in the public health setting. If the intervention proves to be efficient, it could potentially be incorporated into the HIV care policy of the Ministry of Health.Trial registrationPan African Clinical trial Registry: PACTR201202000355384

Reasons for non-compliance among patients with hypertension at Vanga Hospital, Bandundu Province, Democratic Republic of Congo: A qualitative study

ABSTRACT Background Hypertension is a serious public health challenge in both economically developing and developed countries. Patients on outpatient medication for hypertension at Vanga Hospital in the Democratic Republic of Congo (DRC) often present with uncontrolled hypertension and some with hypertension emergencies. On enquiry, the problem appeared to revolve around compliance. Method The study was a qualitative, descriptive study using the focus group interview technique for data collection. Subjects were purposely selected. Interviews were conducted from 23 March to 19 July 2006. Three focus groups were formed: The first was heterogeneous in terms of gender (five males and three females), the second homogeneous (six males) and the last also homogeneous (six females). The group members varied with respect to characteristics such as place of residence, occupation and educational standard. The data collected were analysed using the thematic analysis method within grounded theory. Results Five themes emerged as possible explanations for non-compliance: Side effects discouraged patients from taking medication; patients took medication only when they experienced perceived symptoms of hypertension; poor knowledge of the disease and the medication used; lack of support by family members; and difficulty in obtaining antihypertensive medication. Conclusion Side effects of the medication, lack of information and support, difficulty in obtaining the medication and the fact that the disease is mainly silent played a major role in the poor adherence to hypertension medication. Sustained health promotion and education should be undertaken at all levels of patient contact to ensure good compliance.

Knowledge and attitude of schoolgirls about illegal abortions in Goma, Democratic Republic of Congo

ABSTRACT Background Adolescent sexual activity, early pregnancy, induced abortion and the increase in HIV infection have become major concerns in sub-Saharan Africa and understanding adolescent sexual behaviour remains a challenge. In the Democratic Republic of Congo (DRC), the practice of illegal abortions is prevalent among school-going adolescent girls with unplanned pregnancies. Assessing their attitude and knowledge on the subject could be a starting point from which to address the problem. Objectives To determine the knowledge of schoolgirls in Goma, DRC about the health consequences of illegal abortions and to assess their attitude towards these abortions. Method A descriptive cross-sectional study was conducted among a randomly selected sample of 328 high school girls aged 16 to 20 years. A pre-tested, self-administered questionnaire was used for data collection. Nine out of 55 (11 public and 44 private) secondary schools were randomly selected for inclusion in the study. The Epi-Info 2000 computer program was used for data capturing and analysis. Results The different sources of information were the radio (66.2%, 217), friends (31.7%, 104), parents (1.5%, 5), and the church (0.5%, 2). The health consequences of illegal abortion mentioned were death, infertility, infection and bleeding. Of the participants, 9.8% (32) had committed an abortion before and 46% (151) knew where to obtain it; 76.2% (250) of participants were against illegal abortion, while 23.8% (78) supported it. Conclusion Girls in secondary school in Goma had good knowledge of the illegal abortion practice and its consequences. A fifth of them were in support of the procedure. The DRC government may need to consider legalising abortion to secure a healthy future for affected girls.

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity. Objectives To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods This was a qualitative arm of a larger study, titled ‘Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa’, conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity. Data were analysed thematically. Results Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be ‘too busy’, aloof, non-communicators and sometimes uncertain about patients’ conditions. Some inpatients had unquestioning trust in healthcare practitioners, whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion The reasons for not seeking clarity were based on patients’ experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.

An exploration of the reasons women give for choosing legal termination of pregnancy at Soshanguve Community Health Centre, Pretoria, South Africa

Background: Termination of pregnancy (TOP) is one of the most commonly performed gynaecological procedures in the world and was legalised in South Africa in 1996 with the passing of the Choice on Termination of Pregnancy Act, 1996 (Act No. 29 of 1996). Utilisation of the TOP service increased significantly after the promulgation of the Act, to the extent that 7% of pregnant women in South Africa chose to terminate their pregnancies legally in 2012. Worldwide, women most commonly state their reasons for choosing TOP as a desire to stop or postpone childbearing. Although several international studies have been done in this regard, the reasons for women requesting legalised TOP in South Africa have not been explored in depth. Methods: A qualitative study using the case-study approach and involving one-on-one open interviews with participants was done at the TOP Clinic at Soshanguve Clinic 3 with the aim of gaining more insight into this issue. Results: The following themes emerged from the interviews: formal education not completed, financial difficulties, contraceptive failure, wrong timing, reasons relating to the existing family; and problems relating to the partner. Conclusion: This study also gave insight into the complex personal and social contexts within which women make the decision to terminate their pregnancy, and the thoughtfulness with which they make their decisions.