Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa
Thandiwe Wendy Mkhwanazi,
Perpetua Modjadji,
Kabelo Mokgalaboni
et al.
Abstract:The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic an… Show more
“…This paper provides further evidence that age, obesity, being formerly married and sex are associated with multimorbidity in South Africa (Alaba & Chola, 2013; Mkhwanazi et al, 2023; Weimann et al, 2016). However, surprisingly no associations were identified with health behaviours such as smoking, drinking and dietary health.…”
Section: Discussionmentioning
confidence: 52%
“…The lowest estimate of multimorbidity prevalence, from the South Africa National Income Dynamic Surveys 2012, utilised only four conditions of which three were self-reported (Weimann et al, 2016). Whilst, in certain groups such as the older, rural, and black population from the HAALSI study and in a survey of chronic patients attending health facilities in Tshwane prevalence of multimorbidity was especially high (70.9% and 98%, respectively) (Mkhwanazi et al, 2023; Wade et al, 2021).…”
Multimorbidity in Sub-Saharan Africa is under researched and includes distinct disease combinations to those seen in high income countries. The aim of this study was to determine the prevalence and distribution of multimorbidity in South Africa, as well as the associated individual, area-level and contextual factors. Multilevel logistic regression analyses were conducted on nationally representative 2016 South Africa Demographic Health Survey Data. The sample included 5,342 individuals (level 1) who completed the Adult Health questionnaire living in 691 neighbourhoods (level 2) from nine provinces (level 3). Multimorbidity was present in 44.6% of the study population and ranged from 36.8% in Gauteng to 52.8% in Eastern Cape. Individuals who were older, women, formerly married, black, obese, consumed a medium amount of sugary drinks, received education to primary or secondary school level or exposed to smoke at work had an increased risk of multimorbidity. Province level factors including poverty, rurality and unemployment, as well as neighbourhood level poverty were associated with multimorbidity. Some evidence of residual multimorbidity clustering was observed at the neighbourhood but not province level. Therefore, strategies that aim to tackle multimorbidity should address the risk factors identified and the wider determinants of health within neighbourhoods.
“…This paper provides further evidence that age, obesity, being formerly married and sex are associated with multimorbidity in South Africa (Alaba & Chola, 2013; Mkhwanazi et al, 2023; Weimann et al, 2016). However, surprisingly no associations were identified with health behaviours such as smoking, drinking and dietary health.…”
Section: Discussionmentioning
confidence: 52%
“…The lowest estimate of multimorbidity prevalence, from the South Africa National Income Dynamic Surveys 2012, utilised only four conditions of which three were self-reported (Weimann et al, 2016). Whilst, in certain groups such as the older, rural, and black population from the HAALSI study and in a survey of chronic patients attending health facilities in Tshwane prevalence of multimorbidity was especially high (70.9% and 98%, respectively) (Mkhwanazi et al, 2023; Wade et al, 2021).…”
Multimorbidity in Sub-Saharan Africa is under researched and includes distinct disease combinations to those seen in high income countries. The aim of this study was to determine the prevalence and distribution of multimorbidity in South Africa, as well as the associated individual, area-level and contextual factors. Multilevel logistic regression analyses were conducted on nationally representative 2016 South Africa Demographic Health Survey Data. The sample included 5,342 individuals (level 1) who completed the Adult Health questionnaire living in 691 neighbourhoods (level 2) from nine provinces (level 3). Multimorbidity was present in 44.6% of the study population and ranged from 36.8% in Gauteng to 52.8% in Eastern Cape. Individuals who were older, women, formerly married, black, obese, consumed a medium amount of sugary drinks, received education to primary or secondary school level or exposed to smoke at work had an increased risk of multimorbidity. Province level factors including poverty, rurality and unemployment, as well as neighbourhood level poverty were associated with multimorbidity. Some evidence of residual multimorbidity clustering was observed at the neighbourhood but not province level. Therefore, strategies that aim to tackle multimorbidity should address the risk factors identified and the wider determinants of health within neighbourhoods.
“…In South Africa, a country characterized by a burden of diseases [26,27], AYPWDs remain marginalized in various dimensions of their lives and are less likely to receive sexual and reproductive healthcare. This is despite the country having a progressive and liberal sexual and reproductive health policy framework, with the constitution being clear on equal access to services and opportunities [28,29].…”
Despite South Africa having a progressive and liberal sexual and reproductive health (SRH) policy framework, adolescents and young people with disabilities (AYPWDs) are less likely to receive sexual and reproductive healthcare, being consequently predisposed to a long-term detrimental impact on their health. Our study explored the barriers to accessing sexual and reproductive health services (SRHSs) in clinics among AYPWDs in Mpumalanga, South Africa. We conducted a descriptive qualitative study with twenty-seven AYPWDs in four focus group discussions using semi-structured interviews, audiotaped and transcribed verbatim, and then applied a thematic analysis of the data. Employing a socio-ecological model, the findings show a poor socioeconomic status, lack of information on SRH, and the attitudes of AYPWDs as barriers at the individual level, hindering AYPWDs from accessing SRHSs in clinics. AYPWDs also faced difficulties to talk about SRH with parents, a lack of support to seek SRHSs, improper care from family/parents, and negative attitudes of friends, at the interpersonal level. They further expressed barriers at the community/societal level as negative attitudes of non-disabled community members and poor infrastructure for wheelchair use. At the organization level, their access to SRHSs was negatively affected by HCWs’ maltreatment, described in the forms of negative attitudes, being judgmental using verbal abuse, discrimination, and bullying. Furthermore, AYPWDs described difficulties in communication with HCWs, as well as violating their confidentiality and misconceived ideas on their sexuality. Intensified efforts to strengthen public health strategies are needed to improve access to SRHSs by AYPWDs in South Africa, as well as enhancing the proficiency and communication skills of HCWs and educating AYPWDs, parents, and non-disabled community members on SRH.
“…Prior to the COVID-19 era [30], HCWs were already strained psychologically and physically, while the health system of South Africa was already burdened with the convergence of non-communicable diseases (NCDs) such as diabetes, hypertension, and communicable diseases (CDs) such as HIV and TB [40,41]. The pandemic worsened the pre-existing challenges in health service delivery, especially in the public sector [42,43].…”
As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs’ family members tested positive while some died due to COVID-19 infection. Informed by the workers’ wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics.
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