Browsing by Author "Charumbira, Maria Yvonne"
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- ItemFalls in people living with HIV : a scoping review(BMJ Open, 2020-11) Charumbira, Maria Yvonne; Berner, Karina; Louw, Quinette AbegailObjectives: Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. Methods: A scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done. Results: Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. Conclusion More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.
- ItemPhysiotherapists awareness of bone demineralisation and falls risk in people living with HIV and their perceptions about fall risks management(Stellenbosch : Stellenbosch University, 2020-03) Charumbira, Maria Yvonne; Louw, Quinette A.; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY : Background: Sub-Saharan Africa has the greatest disease burden due to HIV globally. Improved access to better antiretroviral regimens has increased numbers and longevity of people living with HIV (PLWH). However, recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss at younger-than-expected ages in PLWH. The benefits of anti-retroviral drugs may be overshadowed if PLWH suffer from excess morbidity such as falls, fractures and functional impairments. Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim: This research aimed to describe the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. It further aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions about current falls prevention in the care of PLWH in selected regions of sub-Saharan Africa. Method: The research consisted of a scoping review and a primary study. The scoping review included peer-reviewed studies (excluding narrative reviews) available in English with any information referring to falls in PLWH. Any data regarding bone demineralisation in these studies were also extracted. The results were used to explain concepts arising from the qualitative study. In the primary study, an interpretative exploratory qualitative research method with a phenomenological approach was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. Results: The scoping review identified 14 studies on falls in PLWH, with all but one study published in high income countries (HIC). Prevalence of falls in PLWH approximated that of seronegative counterparts, but the studies were mostly in middle-aged to older adults in whom geriatric syndromes may already be prevalent. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention as perceived by the physiotherapists were sub-optimal and lacked a patient-centred approach. Conclusion: Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH. More awareness also needs to be created among other healthcare professionals and PLWH. Meanwhile, research on falls in younger PLWH and in sub-Saharan Africa, where HIV is most prevalent and where more robust clades exist, is needed. Relevant stakeholders including governments and PLWH themselves require concerted efforts in addressing health system challenges affecting the implementation of falls prevention services to PLWH at primary care level.
- ItemTowards strengthening of rehabilitation at primary care : exploring the needs and perspectives regarding rehabilitation services in two South African and Zimbabwean settings(Stellenbosch : Stellenbosch University, 2024-03) Charumbira, Maria Yvonne; Louw, Quinette; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Introduction: There is an escalating demand for rehabilitation as a health strategy globally. The growing burden of health-related disability, particularly pronounced in low-and-middle-income countries (such as South Africa and Zimbabwe) will strain the already-compromised health systems. This juxtaposition of growing functioning problems and reportedly poor rehabilitation, notably at primary care, signifies an important gap towards strengthening of rehabilitation services. Detailed contextual information regarding the patients’ rehabilitation needs is required to inform the development of targeted strategies. Aim: The overall aim of the study was to explore the type and impact of functioning problems in adults, the associated rehabilitation service needs, and strategies to strengthen primary care rehabilitation in low-resource contexts. Research setting: The research was conducted across10 systematically selected primary health care facilities in two districts of the Eastern Cape, South Africa (Amathole and Buffalo City), and two districts in Manicaland, Zimbabwe (Mutare Urban and Makoni). Methodology: The research encompassed three interrelated studies: Study 1: A scoping review synthesized the status of peer-reviewed literature on functioning problems linked to health conditions contributing significantly to adult disability in South Africa and Zimbabwe. The problems were mapped to the International Classification of Functioning, Disability and Health framework. A web-based application, Rehab4all, was developed to facilitate this review. Study 2: A qualitative, descriptive study obtained diverse perspectives from 43 purposefully selected adult patients regarding the perceived impact of their functioning problems on their life roles and suggestions on how rehabilitation services can be improved. Study 3: A qualitative, descriptive study gained insights from 37 primary care providers on current rehabilitation service delivery and innovative ways of enhancing primary care rehabilitation. Results: A 130 distinct functioning problems were identified from 282 studies. There was a huge lack of evidence on health-related functioning problems among Zimbabwean adult populations. In South Africa, the top 20 functioning problems, with prevalence ranging from 15 – 70.6%, were predominantly related to mobility, pain, and mental health. The South African and Zimbabwean primary health care facilities were ill-equipped to address the wide array of prevalent functioning problems, as rehabilitation services are inadequate, inappropriate, or absent. A complex network of intertwined factors resulted in sub-optimal provision, access to, and utilization of rehabilitation. These factors included patients’ and providers’ lack of interest, awareness, knowledge, and skills regarding rehabilitation, compounded by lack of resources and high levels of undesirable social determinants of health. To improve the current situation, patients and providers recommended multifactorial strategies including education, skills training, community engagement and financial investment to ensure adequate supplies, infrastructure, and human resource capacity. Conclusion: Patients attending primary health care in South Africa and Zimbabwe have a high but under-recognised need for rehabilitation. The primary health care system falls short in its ability to identify, manage, and support the rehabilitation needs of people with functioning problems. Individuals’ participation in society is further hampered by the lack of development and integration of other government sectors. Achieving transformation in primary care rehabilitation within these countries will require an all- sector and society approach. This involves collaboration and coordination across various sectors and engaging the broader community in rehabilitation service development.