BACKGROUND:In October 2003 South Africa embarked on a program of folic acid fortification of staple foods. We measured the change in prevalence of NTDs before and after fortification and assessed the cost benefit of this primary health care intervention. METHODS: Since the beginning of 2002 an ecological study was conducted among 12 public hospitals in four provinces of South Africa. NTDs as well as other birth defect rates were reported before and after fortification. Mortality data were also collected from two independent sources. RESULTS: This study shows a significant decline in the prevalence of NTDs following folic acid fortification in South Africa. A decline of 30.5% was observed, from 1.41 to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49-0.98; p = .0379). The cost benefit ratio in averting NTDs was 46 to 1. Spina bifida showed a significant decline of 41.6% compared to 10.9% for anencephaly. Additionally, oro-facial clefts showed no significant decline (5.7%). An independent perinatal mortality surveillance system also shows a significant decline (65.9%) in NTD perinatal deaths, and in NTD infant mortality (38.8%). CONCLUSIONS: The decrease in NTD rates postfortification is consistent with decreases observed in other countries that have fortified their food supplies. This is the first time this has been observed in a predominantly African population. The economic benefit flowing from the prevention of NTDs greatly exceeds the costs of implementing folic acid fortification.

BackgroundMajor health sector reform and the need for baseline measures of performance to determine impact.AimBaseline audit of primary healthcare (PHC) performance.SettingCape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.MethodThe South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.ResultsData from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.ConclusionGaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.

BackgroundCervical cancer is the most common cancer among women in Kenya. However, only 3% of women are routinely screened. This study aimed to assess women’s knowledge and attitudes towards cervical cancer and cervical cancer screening in Kenya’s Isiolo and Tharaka Nithi counties.MethodsA cross-sectional survey was conducted between January and March 2017. Using a multistage cluster sampling methodology, 451 women 18 years of age and older participated in the study. Interviewers administered a 35-item questionnaire collecting demographic information, knowledge of risk factors and attitudes towards cervical cancer and cervical cancer screening. Bivariate and multivariate analyses of cervical cancer knowledge and demographic characteristics were conducted.ResultsThe response rate for the study was 98% (451/460). Two-thirds of the study participants originated from Tharaka Nithi county (n = 318). Respondents reported a median age of 32; 70.5% were married; and 35.0% had primary education. Eighty percent of the participants were aware of cervical cancer, 25.6% of whom had previously undergone a cervical screening examination, and 44.4% had above-average knowledge of risk factors of cervical cancer. Knowledge of cervical cancer risk factors was significantly associated with employment status (adjusted odds ratio = 1.6; 95% CI: 1.0–2.6) and county of origin (adjusted odds ratio = 2.8; 95% CI: 1.6–5.0). Almost all (89.2%) of those who had heard of cervical cancer categorised it as “scary”. There was a marginal significant difference in the overall attitude assessment score towards cervical cancer between participants from Isiolo and Tharaka Nithi counties; the mean (SD) score was 2.13 (0.34) and 2.20 (0.30) respectively. The score was comparatively higher among participants residing in Tharaka Nithi (95% CI: 0.002–0.146; p = 0.043).ConclusionsInterventions to increase cervical cancer knowledge are needed in Isiolo and Tharaka Nithi counties, Kenya. Additional research is needed to further understand and assess the effectiveness of different strategies to improve attitudes regarding cervical cancer in order to increase the uptake of screening services, particularly among less-educated women and those in hard-to-reach areas.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4642-9) contains supplementary material, which is available to authorized users.

BackgroundBreast cancer and cervical cancer are the two leading cancers among women in Ethiopia. This study investigated knowledge and attitudes related to these two types of cancer among women in 4 zones of Ethiopia. This is the first study employing a validated questionnaire to investigate knowledge and attitudes relating to breast and cervical cancer in Ethiopia.MethodsA community based cross-sectional study was conducted from September to November 2015 in the North Shewa zone (Amhara region), Gamo Gofa zone (Southern Nations, Nationalities and Peoples’ region) and zones 1 and 3 (Afar region) of Ethiopia. A total of 799 women aged 18 years and older participated in the survey. Multiple logistic regression analysis was used to investigate the association of possible predictors with breast and cervical cancer knowledge.ResultsA total of 799 women aged 18 years and older participated in the survey. Of the women interviewed, 63.0% had heard of breast cancer and 42.2% had heard of cervical cancer. Among those who had heard of breast cancer, 21.3% (107/503) had heard of breast cancer screening and 1.4% of women aged 40 years and older had undergone at least one breast screening examination. Fewer than half of the participants provided the correct response to questions related to risk factors for breast and cervical cancer. Among those who had heard of cervical cancer, 41.5% (140/337) had heard of cervical cancer screening and 3.3% had undergone at least one cervical cancer screening examination. Women with primary and higher levels of education were more likely to have heard of breast cancers (OR = 3.0; 95% CI: 2.1–4.2; p < 0.001) and cervical cancer (OR = 1.9; 95% CI: 1.4–2.6; p < 0.001). From the overall attitude score, the majority of the women were found to have negative attitudes towards breast cancer (67.4%) and cervical cancer (70.6%).ConclusionsThis study found that the overall knowledge of risk factors for breast cancer and cervical cancer among women was low. Lack of cancer awareness, and lack of education in general, are the most potent barriers to access and care, and should be addressed through multi-faceted strategies including peer-education, mass media and other community-based interventions.

BackgroundMeasuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the content and cross-cultural validity for wider use in South Africa (SA).AimThis study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform.SettingPublic sector primary care clinics, users, practitioners and managers in urban and rural districts in the Western Cape Province.MethodsFace value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version – ZA PCAT.ResultsAll original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans.ConclusionThe PCAT is a valid measure of primary care performance in SA. The PHC team domain is an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource- constrained environment.

BackgroundResearch consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility.AimTo improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC).SettingDu Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS).MethodsA cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance.ResultsThe ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers.ConclusionKnowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Background: Cancer has remained one of the leading causes of death worldwide. In Lesotho, breast and cervical cancers contribute about 43% of all the cancer cases annually.Aim: This study is aimed at comparing knowledge, attitudes, and practices between breast and cervical cancers among females in Maseru.Settings: This study consists of women residing in five study sites which have clinics that offer cervical and breast cancer-screening services.Methods: A cross-sectional study was conducted in June 2021 in Maseru, the Capital city of Lesotho. The participants were interviewed using a pre-tested questionnaire, through which their knowledge, practices about, and attitudes towards breast and cervical cancers were assessed.Results: A total of 228 women aged 15–75 years participated in the study and the majority were aged 30 years and above. Of the women interviewed for cervical cancer, 89.5% had heard of it, 11.8% had heard of its screening, and 7.4% had at least one examination. Similarly, for breast cancer, 77.6% of women who had heard of it, 72.9% had heard of screening, and 40.1% of women did at least one examination.Conclusion: The majority of women were more knowledgeable about cervical cancer than breast cancer. However, more women had heard about breast cancer screening than cervical cancer screening. Therefore, there is a need for awareness campaigns related to cervical cancers’ screening.Contribution: There is an urgent need to intensify awareness about cervical and breast cancer screening and availability of services at the nearby clinics.

There is little debate as to the harmful effects of cigarette smoking on health. Most health workers advise their patients to cease the practice. The impact of the advice is however diluted if it is seen to be ignored by the professionals themselves. As nurses play an increasing role in all levels of health care a survey was undertaken to investigate the smoking habits of two groups of nurses - those operating within the community and those working in institutions