Febisola I. Ajudua

Background: South Africa introduced a 6-month rotation in family medicine (FM) as part of the 2-year internship. This necessitated a restructuring of the traditional hospital rotations. It is not known if the new rotation is meeting the goals set by the Health Professions Council of South Africa. The aim was to evaluate the new FM rotation for medical interns in South Africa. Methods: A descriptive cross-sectional survey of 260 interns, 74 supervisors across 34 intern programmes in all provinces of South Africa in 2025. Quantitative data were collected using a validated questionnaire, distributed using Redcap, and analysed descriptively in the Statistical Package for the Social Sciences. Results: Most interns ‘strongly agreed’ that they learnt how to refer patients (57.8%), how to manage people with chronic conditions (55.7%), and to take greater responsibility for clinical decision-making (53.9%). Most interns also ‘agreed’ that they learnt to coordinate care between the district and referral hospitals (72.8%), to consider the patient’s perspective (70.5%) and context (67.8%), to manage undifferentiated conditions (68.3%) and to rationalise prescribing (62.7%). Most interns reported little exposure to palliative care (58.2%), community-based services (56.0%) and quality improvement (50.2%). A substantial proportion reported little exposure to public health medicine (42.2%), continuity of care (26.2%) and forensic medicine (24.4%). Conclusion: The intern rotation in FM is fulfilling its promise in developing junior doctors who are fit for purpose and better able to cope with the community service year, with some specific areas for improvement. Contribution: The findings confirm the value of the rotation and should guide quality improvement.

Vaping is the inhaling of aerosolised heated liquids in e-cigarettes. It is now known that vaping is not as harmless as was previously described in the mid-2000s when the devices were introduced into the markets across Europe and America. The e-liquids are made of flavourings or psychoactive substances and may or may not contain nicotine. Research shows that these devices and the e-liquids have the potential for causing harm to humans. Although they were marketed originally to assist with breaking addiction to cigarette smoking and tobacco harm reduction, evidence suggests they are not entirely harmless. This continuing medical education article focuses on what is known and what remains unknown about e-cigarettes. Contribution: This CPD article shows that a lot remains unknown about e-cigarettes and their long-term effects on human health. Also, very little is known about the effect of second-hand exposure to the e-cigarette exhaled aerosol residue. In high-income countries, they are used commonly among adolescents and young adults. In recent years, research in South Africa shows an increasing pattern of use among adolescents and young adults. This raises concerns for potential health risks for this population and the need for research that describes the effectiveness of these devices in tobacco harm reduction and the potential risks of exposure in adolescents and young adults.

Shock is a clinical state where oxygen demand in the cells exceeds supply due to hypoperfusion. Early recognition of the patient with shock and a clear understanding of the possible underlying pathologies causing the shocked state aid in providing adequate interventions to mitigate the patient’s outcome and reduce the chances of morbidity and mortality. This article highlights the management of undifferentiated shock as it usually presents in primary care. It also provides information on the four main types of shock and provides a brief overview of the common underlying pathologies associated with each and highlights useful investigations that aid with early recognition and focused interventions to reverse shock. Contribution: This CPD article highlights important information for clinicians in the early identification of shock and immediate interventions in management of the shocked patient.

Background: Chronic pain is a major global health challenge that impairs quality of life through physical disability, psychological distress, and socioeconomic burden. Despite its prevalence, limited research examines its multidimensional impact in South African primary healthcare. This study evaluated the quality of life and factors influencing chronic pain in patients attending a primary healthcare clinic in Gqeberha, South Africa. Methods: A cross-sectional study was conducted among 208 adults with chronic pain attending Walmer 14th Avenue Clinic. Data were collected using the Brief Pain Inventory, capturing demographics, pain severity, interference, relief, and management. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed using SPSS v29. Results: Participants had a mean age of 50.2 years; most were female (71.6%). Back pain was most common (43.8%), while pelvic/groin pain was most severe. Pain relief was inadequate in 74% of participants, with 15.9% reporting none. Sleep was the most affected quality-of-life domain (72% interference). Predictors of higher pain interference included pain severity (p < 0.001), pain relief (p = 0.003), marital status (p = 0.004), and employment status (p = 0.005). Disease-specific treatments and adjuvant therapies provided better relief than paracetamol, nonsteroidal anti-inflammatory drugs, or opioids. Conclusion: Severe pain and inadequate relief are prevalent in primary healthcare. Improving access to adjuvant and disease-specific therapies, as well as addressing socioeconomic factors, is thus essential for enhanced patient outcomes. Contribution: This study highlights the interplay between chronic pain, sociodemographic factors, and quality of life in South African primary care and underscores the need for tailored, multimodal, resource-sensitive pain management strategies to inform policy.

Background: South Africa is a high tuberculosis (TB)-burden country with the worst multidrug-resistant TB (MDRTB) epidemic in Sub-Saharan Africa. The recommendations of the World Health Organization (WHO) in high TB-burden settings are to institute processes for identifying patients with active TB and to improve social support. The community-oriented primary care (COPC) model relies on the community health workers’ (CHW) every encounter in the community as an opportunity to screen for TB symptoms. This study aimed to evaluate the implementation of active surveillance for TB in a CHW team. Methods: This was a quality improvement project (QIP) focused on the implementation of TB screening in the community-based services at a primary care facility in the Nelson Mandela Bay Health District (NMBHD). Results: The baseline audit revealed one team was available in the facility even though it serviced two and a half municipal wards. The team comprised an outreach team leader and three CHWs. There were no records of community-based TB screenings done. The midway audit showed a remarkable rise in clients screened in the community. There was a failed attempt to introduce the use of mHealth technology to the team. The audit at the end of the QIP showed a continuing lack of adequate records of activities in the community. Conclusion: The CHWs in this study, although capable and motivated, lacked opportunity to perform adequate community-based TB screening because of the lack of supportive supervision, inadequate recordkeeping, and a district managerial team that focused on the practice population rather than the population at risk. Contribution: We recommend a continuing QIP and a re-education of health care providers about community-based health services.

Primary care researchers often turn to qualitative methodologies to explore people’s perspectives and experiences. Phenomenology is appropriate when the focus is on lived experiences, rather than ideas, beliefs, opinions or perceptions. Phenomenology has its roots in German philosophy and the social sciences, and doctoral students as well as researchers in the health sciences may struggle to understand the paradigm and apply it practically. This article attempts to make sense of the paradigm and two of its key threads, namely descriptive and interpretive phenomenology. The key principles of both approaches and the practical methodological steps are outlined. In addition, examples are given, and the two approaches are compared. Finally, the article discusses trustworthiness and quality criteria in phenomenology.

Background: South Africa is a tuberculosis (TB) high-burden country. In the Eastern Cape (EC), community health worker (CHW) teams implement active surveillance for TB to curb spread in disadvantaged communities. However, achieving the goals of the End-TB strategy require coordinated efforts that implement policy and strengthen health systems. Aim: This survey described views of healthcare workers (HCWs) in primary care facilities on factors that influence implementation of active surveillance for TB. Setting: This survey was conducted across two districts, among healthcare workers working in TB rooms at primary health facilities. Method: A cross-sectional survey of HCW in the EC. Results: The survey included 37 clinics in the OR Tambo Health District (ORTHD) and 44 clinics in the Nelson Mandela Bay Health District (NMBHD). Routine screening at primary care facilities (88.2%) and contact tracing initiatives (80.8%) were the common modes of TB screening. Tuberculosis screening services in the community were only provided by CHWs in 67.3% of instances. Although CHWs were adequately trained and motivated; the lack of transport, limited availability of outreach team leaders (OTLs) and poor security limited implementation of TB screening services in the community. Comparison between both districts revealed TB screening was limited by lack of transport in the rural district and poor security in the urban context. Community engagement provided a platform for improving acceptability. Conclusion: Community-based TB screening was limited. Inadequate coordination of services between stakeholders in the community has limited reach. Further research should describe that coordinating resource allocation and community empowerment could improve the implementation of active surveillance for TB. Contribution: This study highlights the views of TB room HCWs who believe the opportunity for community-level TB screening is improved with effective leadership and community engagement for acceptability of these services.

Background: The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors.Methods: This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.ti software.Results: The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB.Conclusion: Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.

The achievement of the World Health Organization’s END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health.