Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal,South Africa

Abstract

Purpose: The purpose of this study was to describe the experiences of people living with HIV (PLHIV) who had undergone a physiotherapy-led rehabilitation programme, with the aim of informing and improving future rehabilitation. Methods: The study population included patients living with HIV who were referred for physiotherapy rehabilitation at a public-funded KwaZulu-Natal hospital. Eight participants were considered for final analysis in the study. A qualitative research design was adopted using in-depth interviews to explore their experiences of their rehabilitation programme. Additionally all eligible participants were requested to complete the World Health Organisation Disability Assessment Schedule. Results: Participants presented varying activity-related challenges with mobility, self-care and life activities being the most severely affected areas. Participants showed little understanding of their health conditions, prescribed medication and in some cases therapy. HIV and disability impacted their daily lives, adversely affecting work and domestic activities. Although participants reflected positively on the rehabilitation experience they faced a number of barriers to accessing continued rehabilitation. Conclusion: PLHIV who experience disability are affected in major life areas but the current model of delivering rehabilitation provides a number of barriers to patients. A more accessible approach of delivering HIV-care and rehabilitation needs to be developed.

• Implications for Rehabilitation

• Physiotherapists and other rehabilitation professionals, particularly those working in the South African public sector, need to consider developing and implementing home-based rehabilitation interventions for patients living with HIV and disability. This will counter some of the barriers these patients face in accessing hospital-based therapy.

• With the increasing incidence of HIV-related disabilities as PLHIV live longer lives, rehabilitation professionals working with this patient population should keep up to date with recent literature and practical training courses related to the disease and its management.

     

Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

AIM: This paper is a report of a study to determine the aetiological distribution of sexually transmitted infections and prevalence of human immunodeficiency virus infection in selected primary health care clinic attendees. BACKGROUND: South Africa has a high prevalence of human immunodeficiency virus and other sexually transmitted infections. Sexually transmitted infections are managed syndromically in the public sector as part of the essential nurse-driven primary care services provided at no cost to the client. METHOD: This cross-sectional study was conducted in a rural community in South Africa between September and November 2002. A total of 277 consenting women were recruited. Vulvo-vaginal swabs were collected for screening for Neisseriae gonorrheae, Chlamydia trachomatis and Trichomonas vaginalis using DNA amplification methods and Gram stain with Nugent's score for the diagnosis of bacterial vaginosis. Seroprevalence of syphilis and human immunodeficiency virus infection were determined. FINDINGS: The overall prevalence of human immunodeficiency virus in the study was 43.7% (95% confidence interval 37.6-50.0) with the prevalence in family planning clinic attendees 45.5% (95% confidence interval 38.9-52.3) and antenatal clinic attendees 33.3% (95% confidence interval 19.6-50.3). The prevalence of sexually transmitted infections amongst both the antenatal clinic and family planning attendees accounted for at least 70% of cases. Fifty per cent of women had one recognized sexually transmitted infection with 17.9% of the family planning and 14.5% of the antenatal clinic attendees having infections from two recognized pathogens. All infections were asymptomatic. CONCLUSION: Nurse-driven antenatal and family planning services provide a useful opportunity for integrating reproductive health services, human immunodeficiency virus voluntary counselling and testing and treatment of sexually transmitted infections.     

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS‐related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross‐sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in‐depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0·05), but less HIV/AIDS training when compared to PHC nurses (P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0·01) and training (P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.     

对农村老年糖尿病患者实施饮食管理的方法与效果

目的探讨农村老年糖尿病患者饮食管理的有效方法。方法选择100例农村老年糖尿病患者按随机数字表法分为对照组和观察组,各50例。对照组给予常规护理及健康教育,观察组在此基础上实施个性化饮食管理,包括分层次健康教育及“一对一”的饮食指导,设计并实施饮食治疗卡,同时强化家庭成员的支持、出院后随访等。结果经过6个月的观察,观察组的血糖控制指标和饮食治疗依从性明显优于对照组（P〈0．01）。结论个性化饮食管理能控制患者的血糖、提高饮食治疗依从性。     

农村地区癫痫苯巴比妥治疗管理效果评价

目的评价农村地区癫痫苯巴比妥治疗管理的效果。方法在河北省沧州市沧县、献县和肃宁县,对惊厥性癫痫患者进行免费苯巴比妥治疗和随访管理,评价分析药物疗效及不良反应、患者的依从性等指标。结果2007年6月至2008年7月,入组治疗患者共有1243例,男665例（53．5％）、女578例（46．5％）,年龄2～80岁,平均（37．9±15．5）岁。患者入组前有314例（25．3％）在正规治疗,治疗缺口74．7％（929／1243）。在入组治疗随访期间,有130例先后退组、8例死亡,患者总失访率11．1％（138／1243）。130例患者退组原因：疗效差47例（36．2％）、不能耐受药物不良反应39例（30．0％）、依从性差37例（28．5％）、其他7例（5．3％）;患者死因构成：心脑血管疾病4例（50．0％）、车祸1例（12．5％）、不明原因3例（37．5％）。在治疗管理的前3个月,1243例患者中不良反应发生126例（10．1%）,其中轻度103例（8．3％）、中重度23例（1．8％）,主要症状为困倦或嗜睡、头晕、头痛等,随着服药时间延长,药物不良反应发生率降低。经过近4个月的治疗和管理,患者平均发作频率由入组前的1．63次／月下降到0．34次／月。结论开展苯巴比妥治疗管理,对提高农村癫痫的控制水平是有效、经济、安全和适用的。     

Family experiences of home caring for patients with HIV/AIDs in rural Limpopo Province, South Africa

The increasing rate of patients with HIV/AIDS brings a burden to the already weakened health care delivery systems in Limpopo Province, South Africa. Hospitals alone cannot deal with the needs of AIDS patients effectively; the patients are discharged to be cared for at home. A qualitative study was conducted to explore and describe the experiences of the family members that are caring for patients with HIV/AIDS at home. Interviews were conducted with 12 participants who were purposively selected as the caregivers of patients suffering from AIDS at home. Ethical measures were adhered to for the protection of the participants. The findings revealed that the family members experience negative feelings, characterized by sadness, pain, anger, depression, and frustration, as they care for their loved one within the context of extreme poverty. Quality care was compromised in situations where basic resources were not available. Guidelines to assist families in caring for their loved one with HIV/AIDS at home were developed.     

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

Abstract

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities.

Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling.

Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa.

• Implications for rehabilitation

• Persons with disabilities in rural South Africa have poorer reported health outcomes.

• Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa.

• Better access to health care for persons with disabilities is needed in rural South Africa.

     

Methamphetamine use and sexual risks for HIV infection in Cape Town,South Africa

Aims: The current study examined the use of methamphetamine (Meth) in relation to HIV risks in a South African community sample.

Design and setting: Street intercept methods were used to collect surveys of substance use and sexual behavior from 441 men and 521 women living in a racially mixed township in Cape Town South Africa.

Findings: Results showed that 78 (18%) men and 63 (12%) women had used Meth, and 49 (11%) men and 34 (6%) women ever had used Meth in the preceding 6 months. Other than alcohol, cannabis was the most commonly used drug followed by Meth. We found that Meth use was closely associated with other drug use, indicating a pattern of poly‐substance use among Meth users. Recent Meth use was associated with being male, engaging in unprotected intercourse and having multiple sex partners in the previous 6 months. Meth users also demonstrated greater condom use than non‐users, although less than half of all intercourse occasions among Meth users were condom protected.

Conclusions: Meth is used by a substantial number of people in one area of South Africa and the close association of Meth and sexual risk practices raises concern that Meth could fuel the spread of HIV infection in new South African sub‐populations.     

Identification of perceived barriers of pain management in Iranian children: a qualitative study

Hospitalized children are often inadequately treated for their pain. Paediatric nurses experience these inadequacies more than other health-care team members. This research was an attempt in the form of a phenomenological study to reveal some major barriers in children pain management as the nurses had perceived. Sixteen nurses were interviewed in the medical, surgical and infectious paediatric wards of a hospital in Iran. Data analysis were based on Colaizzi method that surfaced three main themes in different areas namely: organizational barriers, limitations relating to child's characteristics and barriers relating to the nature of disease and its treatments. The study results have shown organizational limitations added to the lack of authority for administering some medical intervention, inadequate equipment and utilities and unavailability of opioids as the main pain controlling and restricting factors. Additional factors that relate to the child specifications like age, temperament, behaviour, expression and gender affect the assessment and treatment of pain. The results revealed identified barriers in real context. It seems that some guidelines are needed to achieve optimal pain management.     

Effect of Tepid Sponge on changes in body temperature in children under five who have fever in Dr. Achmad Mochtar Bukittinggi Hospital

Objective

The purpose of the study was to determine the effect of Tepid Sponge on changes in body temperature in children aged under five who had a fever in Dr. Achmad Mochtar Bukittinggi Hospital.

贫困地区农村HIV/AIDS综合预防管理及健康教育的模式研究

目的 探讨综合预防管理及健康教育网络模式对贫困地区农村居民艾滋病知识、态度及行为的影响.方法 采用类实验性研究,建立由县、乡、村、家庭4级网络为纵向结构,不同人群为横向结构,家庭为基本单位,妇女及青少年为重点人群的HIV/AIDS综合预防管理及健康教育网络模式,进行为期1年的干预.应用艾滋病知识、态度及行为问卷进行干预...     

农村群体糖尿病流行病学调查中的组织管理方法与体会

目的探讨农村群体糖尿病流行病学调查工作中的组织管理与质量控制方法,为更好地开展农村群体健康服务提供科学依据。方法采取对医务人员进行专题培训,调查前对村民进行健康教育,科学合理布局和控制调查的现场,通过耐心详细的问卷调查,对被调查村民进行心理疏导。结果完成了对10500名35岁及以上农村居民的糖尿病流行病学调查,完善各项体检并完整收回问卷调查表9871份,有效回收率达94．01％。结论科学的组织管理能保障农村群体流行病学调查的顺利实施。