Intimate partner violence has been recognised globally as a human rights violation. It is universally underdiagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool-short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool-short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool-short was shown to have a sensitivity of 45.2% and specificity of 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants' understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence. Improvement in the sensitivity of the Women Abuse Screening Tool-short in this setting may be achieved by lowering the threshold for a positive result.

Background: Interpersonal violence is a global health issue. More than 1.6 million people die annually as a result of violence. Injured survivors suffer from a range of physical, sexual, reproductive and mental health problems. The aim of this study is to describe the trends and profile of violence-related injuries from hospital records of an urban emergency department and crisis centre in South Africa. Methods: A descriptive study was conducted by reviewing patient files at Leratong Hospital. Relevant clinical information such as victim's age and gender; time, day of hospital attendance; nature of injury; presence/absence of alcohol; and nature of weapon was extracted. Results: Leratong Hospital manages many patients with injuries due to interpersonal violence throughout the year, with an increase in May, November and December. Higher numbers of patients present in the last week of the month, and on Saturdays and Sundays. Victims were predominantly male (64%), except for sexual assault where the victims were females. Females also suffered more blunt injuries than penetrating injuries. Blunt injuries were the most frequent type of injury although over the weekend males sustained more penetrating injuries than blunt injuries. Young males were the main victims of interpersonal violence. Conclusion: This study highlights a trend where young adults, especially males, are noted to be significantly affected by interpersonal violence.

Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and inadequate health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. Thematic analysis using a mixed deductive/inductive thematic approach was used. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient's TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients not following their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude.

Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and limited health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. We used thematic analysis with deductive and inductive approaches. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient’s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients did not follow their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care. Keywords: tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care

Background Optimized tuberculosis (TB) screening in high burden settings is essential for case finding. We evaluated digital chest x-ray with computer-aided detection (CAD) software (d-CXR) for identifying undiagnosed TB in three primary health clinics in South Africa. Methods The cross-sectional study consented adults who were sequentially screened for TB using the World Health Organization (WHO) four symptom questionnaire and d-CXR. Participants reporting ≥1 TB symptom and/or CAD score ≥60 (suggestive of TB) provided two spot sputum for Xpert MTB/RIF Ultra (Xpert Ultra) and liquid culture testing respectively. TB yield (proportion of screened tested positive) and number needed to test [NNT] (no of tests to identify one TB patient) were calculated. Risk factors for microbiologically confirmed or presumed (on radiological grounds) were determined. Results Among 3041 participants, 45% (1356/3,041) screened positive on either d-CXR or symptoms. TB yield was 2.3% (71/3041) using Xpert Ultra and 2.7% (82/3041) using Xpert Ultra plus culture. Modelled TB yield (identified by Xpert Ultra) by screening approach was: 1.9% (59/3041) for d-CXR alone, 2.0% (62/3041) for symptoms alone and 2.3% (71/3041) for both. The NNT was 9.7 for d-CXR, 17.8 for symptoms and 19.1 for d-CXR and/or symptom. Males, those with previous TB, untreated HIV or unknown HIV status, and acute illness were at higher risk of developing TB. Conclusion d-CXR screening identified a similar yield of undiagnosed TB compared to symptom-based screening, however required fewer diagnostic tests. Due to its objective nature, d-CXR screening may improve case detection in clinics.

Introduction: Intimate partner violence has been recognised globally as a human rights violation. It is universally under-diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool–short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool–short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool–short was shown to have a sensitivity of 45.2% and specificity of 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool–short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants’ understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence.  Improvement in the sensitivity of the Women Abuse Screening Tool–short in this setting may be achieved by lowering the threshold for a positive result.

KEYWORDS 2 tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care Abstract Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and limited health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU.Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. We used thematic analysis with deductive and inductive approaches.Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient's TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control.However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients did not follow their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude.Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care. Keywords: tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care Background:Tuberculosis (TB) remains the leading cause of death from a single infectious agent globally, ranking higher than HIV/AIDS and despite treatment being available (1). In 2018, South Africa ranked fourth "Unfortunately, people want to be treated by happy people, attitude. So an over worked person sometimes can you know show a bad attitude and that can, maybe he is having good intention, but the patient receives it differently and next time doesn't want to come back to the clinic, so those are some of the things that can make patients not to come" (#19). Discussion:This exploratory study highlighted the complex interplay of patients' beliefs, perceptions and health literacy regarding TB treatment adherence and how the perceived ineffective health service delivery colluded to hinder TB treatment completion. A prominent finding of this study ...

Background: Interpersonal violence is a global health issue. More than 1.6 million people die annually as a result of violence. Injured survivors suffer from a range of physical, sexual, reproductive and mental health problems. The aim of this study is to describe the trends and profile of violence-related injuries from hospital records of an urban emergency department and crisis centre in South Africa.Methods: A descriptive study was conducted by reviewing patient files at Leratong Hospital. Relevant clinical information such as victim’s age and gender; time, day of hospital attendance; nature of injury; presence/absence of alcohol; and nature of weapon was extracted.Results: Leratong Hospital manages many patients with injuries due to interpersonal violence throughout the year, with an increase in May, November and December. Higher numbers of patients present in the last week of the month, and on Saturdays and Sundays. Victims were predominantly male (64%), except for sexual assault where the victims were females. Females also suffered more blunt injuries than penetrating injuries. Blunt injuries were the most frequent type of injury although over the weekend males sustained more penetrating injuries than blunt injuries. Young males were the main victims of interpersonal violence.Conclusion: This study highlights a trend where young adults, especially males, are noted to be significantly affected by interpersonal violence.