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hcare workers should be carefully monitored to keep it moderate and ensure sufficient recovery. Sufficient control of the epidemic to keep the burden of the healthcare system low is vital for healthcare workers' well-being. Int J Occup Med Environ Health. 2022;35(6)708-18.No abstract available.The health crises related to climate change in African countries are predicted to get worse and more prevalent. The response to catastrophic events such as cyclones, flooding and landslides must be rapid and well-coordinated. Slower adverse events such as droughts, heat stress and food insecurity must similarly be anticipated, planned for and resourced. There are lessons to be learnt by the health system following the crisis created by Cyclone Idai in Zimbabwe during March 2019, which required a massive humanitarian response to mitigate the impact of torrential rainfall on lives and livelihoods. Several researchers and organisations documented the emergency response in detail. They reported that the government response was hampered by a lack of preparedness, poor planning, inadequate resource mobilisation and weak coordination. Rural communities did not access the early warning cyclone alerts disseminated through television, print and social media, nor did they appreciate the seriousness of events until it was too late. Primary health care (PHC) teams are familiar and trusted by the communities they serve and have a critical role in raising public awareness and in documenting the evolving impact of climate change, using established health indicators and local narratives. PHC leaders and providers have the knowledge and skills to mediate between government bodies, international agencies, other stakeholders and communities on the predicted impact of climate change on health outcomes, highlighting the vulnerability of disadvantaged and impoverished groups. They are also able to work with community leaders, using indigenous knowledge on weather patterns, to build local engagement in protection plans.Contribution This article describes the role health professionals and civil society can play in educating the public on the dangers faced in the near future as a result of climate change and actions that can be taken to become more resilient and to mitigate this impact.Chakama is an area of 46 small villages in Kilifi County, Kenya. Climate change has led to more frequent and longer periods of drought in this semi-arid region as well as locust invasions. This has led to a lack of water, with many rivers drying up and poor water quality as a result of pollution of the remaining river water. The lack of water and locust invasion have led to a failure of the crops and loss of livestock. Many pastoralists and farmers have lost their livelihood. Wild animals from local nature reserves have also come into conflict with the community over water scarcity. Many families have migrated in search of water and income. The health effects are seen in the rising number of people suffering from malnutrition and gastroenteritis as well as in terms of mental health problems. Primary health care services are not always available, and the quality of such services is poor. Facilities and healthcare workers also struggle to be resilient in the face of the same environmental challenges. Local nongovernment organisations are attempting to assist through health and social services, community engagement and multisectoral action.

South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Q-VD-Oph Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery.

This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention.

Nqamakwe, a rural community in the Eastern Cape province of South Africa.

This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed ation.

The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities.

This study compared the prevalence of PND and associated factors among women attending postnatal services facilities.

The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa.

A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children's characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine assindicates the need for routine screening and targeted interventions in both urban and rural settings.Contribution The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.

The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings.Contribution The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.

Therapeutic choices of hypertensive and diabetics in rural areas A mixed study in two health zones in the East of the Democratic Republic of Congo.

One third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare.

In this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions.

The study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC.

A mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis.

Out of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics.

To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

Globally, the public health importance of mental health has gained significant attention in recent years. In Africa, many traditional belief systems impact the perceptions, attitude and management of mental illness. Women are usually the primary caregivers of mentally ill persons, but they have lower mental health literacy.

To assess rural women's knowledge, perceptions and attitudes regarding mental illnesses and the role of traditional beliefs in their management.

Epe Local Government Area of Lagos State, Nigeria.

This was a cross-sectional study with a total of 295 rural women recruited through a multistage sampling method. A pretested interviewer-administered questionnaire was used to collect data. Summary and inferential statistics were measured using Epi Info version 7. The level of significance was predetermined at 5%.

A total of 253 questionnaires were adequately filled and analysed. Overall, just over one-third (35%) of respondents had good knowledge and only 26% had positive attitudes towards mental health and illness. About 45% reported that mental illness should first be treated in 'the traditional way', whilst 47% felt that there was no need for collaboration between orthodox and unorthodox healthcare for mental illness. Sociodemographic variables were significantly associated with knowledge (educational level p = 0.001) and attitude (marital status p = 0.001 and ethnicity p = 0.001).

Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.

Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.

The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane's Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response.

To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.

Three community-based COSUP sites in Mamelodi (Tshwane, South Africa).

A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data.

Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eighncreased access to opioid agonists for those who need them, in primary care settings.

Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.Contribution This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.