Browsing by Author "Isaacs, Abdul-Aziez"

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    Antibiotic prescribing practice and adherence to IMCI guidelines among CNPs in children younger than 5 years withrespiratory tract infections at Crossroads clinic, Cape Town,South Africa: retrospective audit
    (2023) Machina, Baba; Isaacs, Abdul-Aziez
    Background. Antibiotic use is especially high among children globally. In South Africa (SA), children under 5 years (U5) are typically prescribed an appreciable number of antibiotics in primary health care (PHC). There have been several published studies on antibiotic prescribing practice among Health Care Workers (HCWs) in PHC in low-resource setting. However, no published study has been reported on antibiotic prescribing practice among clinical nurse practitioners (CNPs) in PHC low-resource setting in Cape Town. Antimicrobial Stewardship Programme (ASP) in PHC has strengthened the use of evidence-based guidelines to support appropriate antimicrobial prescribing; however, adherence to these guidelines seems to be low. Objective. To assess antibiotic prescribing practices amongst CNPs and adherence to Integrated Management of Childhood Illnesses (IMCI) guidelines for U5 children with respiratory tract infections (RTIs), as well as to make recommendations with the aim to promote appropriate antibiotic prescribing at PHC Level. Methods. This is a retrospective audit that included folder review of children U5 with RTIs for which antibiotic was prescribed by CNPs for the period July 2021 to December 2021 at Crossroads community day clinic (CDC). Data was obtained on site by sequential non-random sampling of patient folders from medical records in the baby clinic admission book, with a total sample size of 120. This study determined the appropriateness or otherwise of antibiotics prescribed to U5 children by CNPs, and additionally makes recommendations to mitigate the effect of rising prevalence of antimicrobial resistance (AMR) in PHC setting. Results. A total of 120 folders included in this study were audited. Of the 120 folders analyzed, (60%) (n=72) did not adhere to guidelines. Guidelines were adhered to in only (40%) (n=48). Of those non adherent to the guidelines, (18.05%) (13/72) had no diagnosis documented in patient folder, (31.94%) (23/72) had incorrect dose prescribed, (40.27%) (29/72) had no weight documented, (18.05%) (13/72) had no allergies documented; duration of antibiotic prescribed not documented in (9.72%) (7/72), the antibiotic prescribed was different from what was recommended in the IMCI guidelines in (6.94%) (5/72) and only (6.94%) (5/72) were non adherent owing to frequency of antibiotic prescribed per day not documented. Adherence variation was observed between the 3 antibiotics, with significantly higher adherence to guidelines for prescriptions containing Amoxicillin (53.53%) (53/99) than other antibiotics. Adherence to guidelines also differed by diagnosis, prescriptions for pneumonia was more likely to adhere to guideline (55.00%) (33/60) than other RTIs. A strong association was observed between weight documented and adherence to guidelines. 51.64% (47/91) of the prescriptions in which weight was done adhered to guidelines. When weight was done, the prescriptions were more likely to be correct, Fishers exact test = 0.000 (P<0.05). Conclusions. In a resource-limited environment, CNPs play a pivotal role in order to meet community healthcare needs. This study gives insight into antibiotic prescribing practices amongst CNPs and it demonstrated low adherence to IMCI guidelines. Focus should be directed towards CNPs prescribing adherence with aim of improving appropriate antibiotic use and the fight against AMR in PHC in low-resource setting in Cape Town. Future clinical research in this setting should explore qualitative research approach including interviewing both CNPs and caregivers to assess their knowledge and understanding of prescribing guidelines and antibiotic use respectively. The views and expertise of stakeholders should be incorporated to shape policies in the fight against AMR in PHC.
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    Open Access
    Breastfeeding knowledge, attitudes and practices among adolescent teenage mothers at Crossroads, Western Cape, South Africa
    (2023) Ashwehdi, Ahmad; Isaacs, Abdul-Aziez
    Background: Breastfeeding is important in supporting the normal growth and development of infants and young children. Evidence shows that breastfeeding is protective against infectious diseases such as upper and lower respiratory tract infections, gastrointestinal illnesses, and otitis media, during the infant period. South Africa has a low exclusive breastfeeding rate. Exclusive breastfeeding for the first six months is the best start for health and development. Adolescent pregnancy is detrimental to the health of mother and child and is a common public health problem worldwide. The identification of factors that promote or inhibit breastfeeding behavior is vitally important for the design of evidence-based policies and interventions. Despite the available knowledge of benefits of breastfeeding, this has not translated into practice in South Africa. Objective: This study aimed to investigate breastfeeding knowledge, attitudes, and practices among adolescent mothers at Crossroads, Western Cape, South Africa. Study- Design and Methods: An analytical cross-sectional study was conducted with 77 mothers aged between 16 and 19 years old, attending Crossroads Community Day Centre located in Mitchell's Plain sub-district, Western Cape. A skilled research assistant performed an in-person meeting with each mother in either English or isiXhosa. Closed-ended questions were used to gather information on socio-demographic characteristics, breastfeeding knowledge, attitudes, and practices. Results: The study analyzed the breastfeeding practices and knowledge of 77 mothers, all of whom reported initiating breastfeeding. However, 31.5% reported discontinuation at the time of the interview. Almost sixty percent of the mothers in this study were unemployed. Most of mothers reported that healthcare workers emphasized the importance of breastfeeding and educated them on appropriate breastfeeding practices. However, only 52.8% of mothers practiced exclusive breastfeeding. Most mothers recognized the benefits of breastfeeding for their babies, including reduced respiratory infections (72.6%), increased intelligence (86.7%), and protection from allergies (94.8%). They also acknowledged benefits for themselves, such as preventing breast Breastfeeding knowledge, attitudes and practices among adolescent mothers at Crossroads, Western Cape, South Africa engorgement (79.5%) and lowering the risk of breast cancer (50.0%). However, many mothers were unaware of the benefits of breastfeeding for child spacing (65.5%), and 56.8% of mothers lacked knowledge on breastfeeding and pre-pregnancy weight. The study found a statistically significant difference in mean knowledge scores for breastfeeding benefits to the baby and the mother. Conclusion: The importance of breastfeeding in babies' lives has been established. However, in low-income communities such as Crossroads, knowledge of the benefits of breastfeeding was variable, and the majority did not practice exclusive breastfeeding. it is important to implement promotional and educational programs in these communities to increase awareness of the vital role of breastfeeding in ensuring optimal development of children.