Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in p...Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in primary health care settings in a rural, high HIV prevalence area in South Africa. Methods: As part of a larger intervention (“Amagugu” Intervention) health staff in nine primary health care clinics were trained in a child-friendliness approach. 281 enrolled mothers were invited to attend clinic with their primary school-aged children and assessed childfriendliness via structured questionnaires administered by independent assessors;a sub-group also participated in in-depth interviews. Post intervention, focus groups were conducted with 87 primary health staff to determine their experiences of providing child-friendly services. Results: Mothers rated 65% of clerks and 70% of nurses as “very friendly”. Qualitative data showed that heavy clinical loads, limited human resources and inadequate infrastructure were perceived as barriers to child-friendliness, while good clinic leadership and appropriate resources facilitated child-friendliness. Post intervention most health workers reported that child-friendly health promotion activities were rewarding. Conclusions: Providing child-friendliness training and support to primary health care facilities in low-resource settings is feasible, acceptable and yielded encouraging results.展开更多
Background: Despite public perception to the contrary, pregnancy does not offer a protective effect for suicide ideation. In low and middle income countries (LMIC) multiple concurrent risk factors including unplanned ...Background: Despite public perception to the contrary, pregnancy does not offer a protective effect for suicide ideation. In low and middle income countries (LMIC) multiple concurrent risk factors including unplanned pregnancies, testing for HIV, intimate partner violence and depression may increase suicide risk among pregnant women. We examine suicide ideation among women attending routine antenatal care in rural South Africa. Method: A consecutive series of 109 women in the second half of pregnancy were enrolled in a cross-sectional study at a large primary health care facility in a rural area of KwaZulu-Natal with high HIV prevalence. Using a mixed-methods approach, women were assessed using the Major Depression Section of the Structured Clinical Interview for Depression (SCID) for DSM-IV diagnosis;qualitative interview data were collected on women’s experiences of suicide ideation and plans. Women were assessed two weeks after routine HIV testing as part of Prevention of Mother-to-Child Transmission (PMTCT) screening. Results: Both HIV-positive (49/109) and HIV-negative (60/109) women were assessed. Depression was high (51/109, 46.7%) and equally common amongst HIV-positive and negative women. Suicide ideation was high (30/109, 27.5%) with thoughts of self harm closely linked to suicide plans. Age, previous history of depression and current depression were significantly associated with suicide ideation. Close to equal numbers of HIV-positive and negative women were suicidal. Suicide methods were frequently violent and most women cited family and partnership conflict related to an unplanned pregnancy or their newly HIV-positive status as triggers to their suicide ideation. Conclusions: Rates of suicide ideation among pregnant women testing for HIV are high. Testing HIV-positive causes considerable distress, and among HIV-negative women unplanned and unwanted pregnancies are important risk factors for suicide ideation. Pregnancy brings women into increased contact with the health services with important opportunities for prevention and intervention.展开更多
文摘Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in primary health care settings in a rural, high HIV prevalence area in South Africa. Methods: As part of a larger intervention (“Amagugu” Intervention) health staff in nine primary health care clinics were trained in a child-friendliness approach. 281 enrolled mothers were invited to attend clinic with their primary school-aged children and assessed childfriendliness via structured questionnaires administered by independent assessors;a sub-group also participated in in-depth interviews. Post intervention, focus groups were conducted with 87 primary health staff to determine their experiences of providing child-friendly services. Results: Mothers rated 65% of clerks and 70% of nurses as “very friendly”. Qualitative data showed that heavy clinical loads, limited human resources and inadequate infrastructure were perceived as barriers to child-friendliness, while good clinic leadership and appropriate resources facilitated child-friendliness. Post intervention most health workers reported that child-friendly health promotion activities were rewarding. Conclusions: Providing child-friendliness training and support to primary health care facilities in low-resource settings is feasible, acceptable and yielded encouraging results.
文摘Background: Despite public perception to the contrary, pregnancy does not offer a protective effect for suicide ideation. In low and middle income countries (LMIC) multiple concurrent risk factors including unplanned pregnancies, testing for HIV, intimate partner violence and depression may increase suicide risk among pregnant women. We examine suicide ideation among women attending routine antenatal care in rural South Africa. Method: A consecutive series of 109 women in the second half of pregnancy were enrolled in a cross-sectional study at a large primary health care facility in a rural area of KwaZulu-Natal with high HIV prevalence. Using a mixed-methods approach, women were assessed using the Major Depression Section of the Structured Clinical Interview for Depression (SCID) for DSM-IV diagnosis;qualitative interview data were collected on women’s experiences of suicide ideation and plans. Women were assessed two weeks after routine HIV testing as part of Prevention of Mother-to-Child Transmission (PMTCT) screening. Results: Both HIV-positive (49/109) and HIV-negative (60/109) women were assessed. Depression was high (51/109, 46.7%) and equally common amongst HIV-positive and negative women. Suicide ideation was high (30/109, 27.5%) with thoughts of self harm closely linked to suicide plans. Age, previous history of depression and current depression were significantly associated with suicide ideation. Close to equal numbers of HIV-positive and negative women were suicidal. Suicide methods were frequently violent and most women cited family and partnership conflict related to an unplanned pregnancy or their newly HIV-positive status as triggers to their suicide ideation. Conclusions: Rates of suicide ideation among pregnant women testing for HIV are high. Testing HIV-positive causes considerable distress, and among HIV-negative women unplanned and unwanted pregnancies are important risk factors for suicide ideation. Pregnancy brings women into increased contact with the health services with important opportunities for prevention and intervention.
