Langalibalele H. Mabuza

Non-adherence to diet and exercise recommendations amongst patients with type 2 diabetes mellitus attending Extension II Clinic in Botswana

Abstract Background Patients diagnosed with type 2 diabetes mellitus in Extension II Clinic in Botswana have difficulty in adhering to the lifestyle modifications recommended by health care practitioners. Poor adherence to lifestyle recommendations leads to poor control of the condition and consequently to complications. Objectives The aim of the study was to determine reasons for poor adherence to lifestyle recommendations amongst the patients. The objectives were to determine: reasons for poor adherence to dietary requirements, exercise recommendations, the support they had in adhering to the recommendations, and their understanding of the role of dietary and exercise requirements in the management of their condition. Method This was a cross-sectional descriptive study. The sample comprised of 105 participants. Data on participants’ baseline characteristics and adherence to dietary and exercise habits were analysed using the SPSS 14.0 version. Results The sample of 104 participants comprised of 61 (58.7%) women. The rates of non-adherence to diet and exercise were 37% and 52% respectively. The main reasons for non-adherence to diet were: poor self-discipline (63.4%); lack of information (33.3%) and the tendency to eat out (31.7%). The main reasons for non-adherence to exercise were: lack of information (65.7%); the perception that exercise exacerbated their illness (57.6%) and lack of an exercise partner (24.0%). Conclusion There was a relatively high rate of non-adherence to both diet and exercise recommendations by patients suffering from type 2 diabetes mellitus at Extension II Clinic, Botswana, with non-adherence to exercise recommendations more common.

Understanding participation in a hospital-based HIV support group in Limpopo Province, South Africa

Abstract Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV/AIDS, especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups. Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study. Results: The participants attended because they were referred by a health-care worker, wanted information, wanted emotional support, accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support, accepting ones HIV status, reducing stigma and isolation, increasing hope, forging new friendships, helping others, obtaining HIV-related information, developing strategies to change behaviour, gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group, long queues at the HIV clinic, concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict, burn-out and impractical protocols. Access to disability grants was also a concern. Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV/AIDS through offering structured emotional, informational, instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally, support group leaders should receive appropriate training and regular debriefing.

African Primary Care Research: Qualitative data analysis and writing results

Abstract This article is part of a series on African primary care research and gives practical guidance on qualitative data analysis and the presentation of qualitative findings. After an overview of qualitative methods and analytical approaches, the article focuses particularly on content analysis, using the framework method as an example. The steps of familiarisation, creating a thematic index, indexing, charting, interpretation and confirmation are described. Key concepts with regard to establishing the quality and trustworthiness of data analysis are described. Finally, an approach to the presentation of qualitative findings is given.

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.

African primary care research: performing surveys using questionnaires.

The aim of this article is to provide practical guidance on conducting surveys and the use of questionnaires for postgraduate students at a Masters level who are undertaking primary care research. The article is intended to assist with writing the methods section of the research proposal and thinking through the relevant issues that apply to sample size calculation, sampling strategy, design of a questionnaire and administration of a questionnaire. The article is part of a larger series on primary care research, with other articles in the series focusing on the structure of the research proposal and the literature review, as well as quantitative data analysis.

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 given by hypertensive patients for concurrently using traditional and Western medicine at Natalspruit Hospital in the Gauteng Province, South Africa

Abstract Background In 2007, a large number of hypertensive patients seen at Natalspruit Hospital had poor adherent to their anti-hypertension treatment which manifested itself through poor blood pressure control. On enquiry, they revealed that they were also taking traditional medicines. Objectives To explore the reasons given by hypertensive patients for concurrently using traditional and Western medicine. Methods A qualitative study was conducted amongst nine purposefully selected participants attending treatment at the hospital. Interviews were conducted in the Southern Sotho and IsiZulu languages and were audio-taped. The exploratory question was: ‘Would you tell us why you are taking traditional medicine together with the antihypertensive medicine your are receiving at this hospital?’ The transcribed and translated transcriptions were analysed using the ‘cut and paste’ method to identify themes. Results Themes that emerged were that traditional medicine was readily accessible; traditional healers displayed knowledge and confidence in their medicine; traditional medicine was perceived to counteract the side-effects of western medicine; the two streams were perceived to complement each other and both streams could lead to a ‘cure’. Patients were disappointed at the perceived bad attitude of the hospital staff. Conclusion The reasons given by hypertensive patients for their concurrent use of traditional and Western medicine centred around patients’ relatively favourable perception of traditional medicine and its practitioners. Western medicine health care practitioners should continue health education on antihypertensive medication in a manner acceptable to patients.

A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana

Background: Sustainable and aggressive population-based programmes on hypertension awareness, prevention, treatment and control are key to the successful control of this epidemic. The objective of the study was to determine to what extent hypertension and risk factors for its development were prevalent in the Kang village community in Botswana, and specifically to assess its prevalence in the adult population and its relationship with high blood pressure, anthropometric measures and lifestyle factors, i.e. diet and the use of tobacco products and alcohol. Method: A population-based cross-sectional study was conducted on 161 adult residents of Kang aged 18 years and older from November to December 2008. A questionnaire adapted from the World Health Organization stepwise approach to the surveillance of chronic disease was used for the data collection. Results: The prevalence of hypertension in the adult population of Kang was found to be 32% (95% confidence interval: 25-40). There was no significant sex difference in the prevalence rate in men (28%) versus women (34%), (p = 0.59). Hypertension was more prevalent in the overweight group than in the normal-weight group (p = 0.3), in the obese group than in the normal-weight group (p = 0.002), and in the obese group than in the overweight group (p = 0.04). Conclusion: This study showed that hypertension affected almost a third of the adult population of Kang, and was significantly associated with overweight and obesity.

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.

Why do women not return for CD4 count results at Embhuleni Hospital, Mpumalanga, South Africa?

Background According to the South African Policy and guidelines for the implementation of the PMTCT programme of 2008, all pregnant women who tested HIV-positive also had to have their CD4 count measured in order to inform the option of Prevention of Mother-to-Child Treatment (PMTCT): to be put on lifelong treatment or to be placed on temporary PMTCT. They were required to return for the results within two weeks, but some did not return, implying that they did not benefit from the programme. This study was conducted to establish their reasons for not returning. Objectives To explore the reasons given by women attending antenatal care for not returning for the results of their CD4 count done for PMTCT at Embhuleni Hospital and satellite clinics, Mpumalanga. Methods The study was a qualitative study using the free-attitude interview technique. Women who had not returned for their results were traced and interviewed on their reasons for not returning. Interviews were conducted in Siswati, audio-taped, transcribed verbatim and translated into English for analysis. Data saturation was reached by the eighth participant. A thematic analysis was conducted. Results The themes that emerged were: participants were not informed about the PMTCT process; poor service delivery from the healthcare practitioners; unprofessional healthcare practitioners’ conduct; shortages of medication in the healthcare facilities; fear of social stigma; and poor patient socioeconomic conditions. Conclusion The reasons for not returning were mainly based on participants’ experiences during consultations at the healthcare centres and their perceptions of the healthcare practitioners. Healthcare practitioners should adhere to the tenets of professionalism in order to address this problem.