Summaryobjective To identify factors causing delayed diagnosis and treatment for tuberculosis in high tuberculosis (TB) ⁄ HIV burden African countries.methods We searched Ovid Medline, CINAHL, PsychInfo, Scopus and Sabinet-South African journals and reference lists, Google, Google Scholar and Google SA for reports in English, ‡1992, of original data from sub-Saharan countries on patient or system delay in TB diagnosis or treatment with populations ‡15 years old. Two reviewers extracted data independently for each study. We categorized independent variables as predisposing, enabling or reinforcing (PRECEDE model). Meta-analysis was conducted for factors associated with delay in ‡2 studies.results Of 20 eligible studies, 12 assessed both sources of delay; 1, system delay; and 7, patient delay only. Most were cross-sectional surveys (k = 13) with samples of consecutive patients (k = 13) and bivariate analyses (k = 11). Starting and endpoints for patient delay were consistent, but not system delay. Patient characteristics were studied frequently; HIV stigma and enabling factors were studied infrequently, although the last were most often associated with delay. Consulting traditional healers first -usually by rural residents -consistently led to patient delay; OR = 3.45 (1.91-6.21). Travel time for the return visit was consistently associated with system delay OR = 1.87 (1.378-2.531).conclusions We recommend partnerships with traditional healers and research emphasizing HIV and system factors, standard definitions of delay and qualitative and cohort studies to identify enabling and reinforcing factors related to delay.keywords tuberculosis, sub-Saharan Africa, health care-seeking behaviour, delivery of health care

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Unplanned teenage pregnancy constitutes an important health problem, whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP) services is increasing. The purpose of this study was to assess the knowledge, attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province, South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls, the sample consisting of 273 girls in Grades 10-12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However, most did not have knowledge of the emergency contraceptive, intra-uterine device and female condom. Pressure from male partners, fear of parental reaction to the use of contraceptives, reluctance to use contraceptives, poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health.

Background: The term ‘menopause’ is derived from the Greek words men (month) and pausis (a cessation, a pause). It is a direct description of the psychological and physical events in women where menstruation ceases to occur. It is the time in a woman’s life when she has experienced her last menstrual bleed. Menopause is not a disease per se but a condition associated with hormonal changes where oestrogen diminishes to a low level, causing aging-related health problems. Objectives: The purpose of this study was to explore perceptions of menopause and aging amongst women in rural villages of Vhembe District in Limpopo Province, South Africa.Method: The study was qualitative and explorative, using phenomenological approach. Purposive sampling was used to select the four villages and to select the focus groups. Sample size was determined by data saturation.Results: The study findings were that participants in the villages associated cessation of menstruation to aging rather than menopause. Once menstruation stopped, one was regarded as old.Conclusion: The conclusions of the study were that (1) menopausal issues should be emphasised and receive priority from puberty at the girls initiation schools, high schools, churches, other community resources and health care services so that when women reach menopause, (2) they should accept and be able to effectively cope with menopause and aging. (3) Emphasis should also be placed on menopause as the aspect of human aging. Agtergrond: Die term ‘menopouse’ is afgelei van die Griekse woorde menos (maand) en pausis (onderbreking/pouse, einde) en is ’n direkte beskrywing van die psigologiese en fisiese gebeure in vroue waar menstruasie ophou voorkom. Dit is die tyd in ’n vrou se lewe wanneer die laaste menstruele bloeding ervaar word. Menopouse is nie ’n siekte per se nie, maar ’n toestand wat geassosieer word met hormonale veranderings waar estrogen afneem tot ’n vlak wat gesondheidsverwante probleme veroorsaak.Doelstelling: Die doel van die studie was om persepsies ten opsigte van menopause en veroudering onder landelike vroue in die Vhembe-distrik in Limpopo Provinsie, Suid-Afrika, te verken.Metode: Die studie was kwalitatief en verkennend, met ’n fenomenologiese benadering. Doelgerigte steekproefneming is gebruik om die vier dorpies en deelnemers van die fokusgroepe te selekteer. Die steekproefgrootte is bepaal deur dataversadiging.Resultate: Die bevindings was dat die deelnemers die einde van menstruasie aan ouderdom, en nie aan menopause nie, toeskryf. Wanneer menstruasie stop, word ’n vrou dus as oud beskou.Gevolgtrekkings: Aanbevelings was dat (1) menopausale onderwerpe reeds beklemtoon behoort te word vanaf puberteit in inisiasieskole, hoërskole, kerke en gemeenskappe en gesondheidsdienste sodat, wanneer menopouse bereik word, (2) vroue dit kan aanvaar en positief ervaar. (3) Klem behoort ook op menopause as ’n menslike aspek van veroudering gelê te word.

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The aim of the study was to determine the factors that influence the uptake of contraception services by adolescents in the Vhembe district of Limpopo Province, South Africa. A qualitative research method which is explorative, descriptive and contextual in nature was used to investigate the phenomenon from the adolescents’ perspective. The target population comprised of adolescents residing in one of the six villages of Vhembe District. Data was collected through six focus group discussions until data saturation was achieved. Data was analysed using an open coding method. The findings revealed that adolescents are aware of the availability of contraceptive services. However, they lack a comprehensive knowledge about contraception and contraceptives, which led to negative attitudes towards using the services. Cultural health beliefs and attitudes were also identified as a barrier to the uptake and use of contraceptives. Recommendations were made on interventions to increase the uptake of contraception services amongst adolescents.Die doel met die studie was om te bepaal watter faktore beïnvloed adolessente in die Vembe distrik van Limpopo Provinsie, Suid Afrika se besluit om voorbehoedmiddels te gebruik. ’n Kwalitatiewe navorsingsmetode wat eksploratief, beskrywend en kontekstueel van aard is, is gebruik om die fenomeen vanuit die perspektief van die adolessent te ondersoek. Data is ingewin deur ses fokusgroepbesprekings todat ’n punt van dataversadiging bereik is. Data is met behulp van oop kodeering geanaliseer. Bevindinge het getoon dat die adolessente wel bewus is van die beskikbaarheid van voorbehoeddienste, alhoewel hulle kennis van voorbehoeding en voorbehoedmiddels gebrekkig is, en dit het tot ’n negatiewe houding jeens die gebruik van die dienste gelei. Kulturele en kulturele gesondheidsgelowe gelowe en houdings is ook geidentifiseer as ’n hindernis tot die gebruik van voorbehoedmiddels. Aanbevelings is gemaak ten opsigte van intervensies om die gebruik van voorbehoeddienste onder adolessente te bevorder.

BackgroundLimpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing a directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours.AimTo apply a Community-Based Participatory Research (CBPR) approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme.SettingThis study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts.MethodsThe community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants.ResultsA total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour.ConclusionJoint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community.

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