South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde[JOURNAL]
Sun
200 papers
Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection.
Swart M
S Afr Med J · 2026 Apr · PMID 42246846 · Publisher ↗
Abstract loading — click title to view on PubMed.
Opportunities for health system strengthening to reduce preventable trauma deaths in the Western Cape Province, South Africa: Findings from an expert panel review.
Dixon J, De Vries S, Bhaumik S … +11 more , Dymond C, Ross M, Finn J, Geduld H, Steyn E, Lategan H, Hodsdon L, Verster J, Mukonkole S, Doubell K, Mould-Millman NK
S Afr Med J · 2026 Apr · PMID 42246845 · Publisher ↗
BACKGROUND: Injuries are a leading cause of death and disability worldwide, and disproportionately affect young persons (aged 15 - 49 years) residing in low- and middle-income countries. Panel reviews of trauma deaths ar...
BACKGROUND: Injuries are a leading cause of death and disability worldwide, and disproportionately affect young persons (aged 15 - 49 years) residing in low- and middle-income countries. Panel reviews of trauma deaths are an effective way to identify areas for improvement within a health system. OBJECTIVES: To assess the preventability of trauma deaths that had contact with the health system, and the associated panellists' recommendations for improvements. METHODS: A comprehensive review of injury-related deaths identified by an epidemiological study was conducted in the Western Cape Province of South Africa in April 2022. Panellists identified contributing factors and opportunities for improvement for each case. Investigators assigned a thematic code to each opportunity for improvement, and codes were categorised and mapped into a matrix organised according to the applicable level of the health system and the descriptive category for improvement. RESULTS: Twenty-three multidisciplinary expert panellists reviewed 90 injury deaths that occurred in 2021. The largest proportion of deaths was from firearms (30%), and 41 (45%) of the 90 cases were found to be preventable or potentially preventable. The median time from injury to death was 41.4 hours for rural injuries, compared with 12.9 hours for urban injuries. CONCLUSION: Key recommendations from the panel included training in basic trauma resuscitation, and increased access to patient monitoring, operating theatres, radiology and intensive care beds. Panellists further recommended implementation of injury primary prevention strategies in the community.
A new perspective to aid in MMed research report completion: The effort-time trajectory model.
Nel G, Ruder T, Kauchali S
S Afr Med J · 2026 Apr · PMID 42246844 · Publisher ↗
BACKGROUND: Since 2011, the Health Professions Council of South Africa has required all specialist trainees to complete a Master of Medicine (MMed) research report, a requirement intended to strengthen the production of...
BACKGROUND: Since 2011, the Health Professions Council of South Africa has required all specialist trainees to complete a Master of Medicine (MMed) research report, a requirement intended to strengthen the production of relevant local research. However, evidence shows that this expectation substantially increases trainee workload, contributes to delays in specialist registration and may impede clinical skills development. SA studies report that registrars frequently lack the time and support needed to complete research tasks, with many exceeding the nominal training period. These challenges mirror international experiences where integrating research into busy clinical programmes remains difficult. OBJECTIVE: To introduce and describe the effort-time trajectory model as an innovative conceptual framework to support MMed trainees in planning and completing their research reports. METHODS: We describe the effort-time trajectory model, originally developed by Nel, which complements existing scheduling-based research support models by explicitly incorporating anticipated cognitive effort. Drawing on educational theory, particularly cognitive load theory, the model conceptualises research progression as a dynamic trajectory of both practical and cognitive effort over time. RESULTS: The model highlights predictable peaks - such as protocol development, data analysis and final writing - and lulls, such as routine data collection. Mapping these fluctuations enables early identification of periods where trainees are most vulnerable to overload and where targeted supervisory or institutional support may have the greatest impact. CONCLUSION: The effort-time trajectory model provides a more holistic lens for supporting MMed research training by accounting for both temporal and cognitive demands. Its application may reduce last-minute workload surges, improve research completion timelines and support more sustainable integration of research within specialist training programmes.
A turn for the worse: The impact of deteriorating healthcare spending in South Africa.
Bhorat A, Nel D, Cairncross L … +1 more , Visser M
S Afr Med J · 2026 Apr · PMID 42246843 · Publisher ↗
The November 2023/2024 national health budget cuts represent the largest reduction in public health expenditure in South Africa's post-apartheid history. This article critically examines the implications of these budget...
The November 2023/2024 national health budget cuts represent the largest reduction in public health expenditure in South Africa's post-apartheid history. This article critically examines the implications of these budget cuts within the context of the country's post-apartheid health system reforms and macroeconomic strategies. Specifically, it documents the historical evolution of fiscal policies and health expenditure across three distinct periods: the 2008 - 2013 period, which witnessed a counter-cyclical fiscal strategy that improved healthcare access and began addressing apartheid-era disparities; the years 2013 - 2023, marked by economic and political instability, culminating in a national debt crisis exacerbated by COVID-19, which eroded health system resilience under fiscal consolidation policies; and the post-November 2023/2024 period, which represents a distinct threat to two decades of progress in health equity and outcomes under further fiscal consolidation measures. The article discusses the impact of these austerity measures on healthcare workers and patient populations and the implementation of the National Health Insurance, while exploring the ethical and legal implications. It concludes by proposing recommendations for system-wide reforms to mitigate the negative effects of these budget cuts and prevent systemic collapse.
Prevalence of alcohol use, associated risk factors, and the impact on the HIV care cascade among adolescent girls and young women in South Africa: Findings from the HERStory Study.
Tlali MR, Davies MA, Lombard C … +2 more , Mathews C, Parry CD
S Afr Med J · 2026 Apr · PMID 42246842 · Publisher ↗
BACKGROUND: High rates of hazardous and binge drinking patterns have been identified among adolescent girls and young women (AGYW) in South Africa. AGYW also bear the highest burden of HIV/AIDS in the country, placing th...
BACKGROUND: High rates of hazardous and binge drinking patterns have been identified among adolescent girls and young women (AGYW) in South Africa. AGYW also bear the highest burden of HIV/AIDS in the country, placing them at increased risk of negative outcomes for both HIV and alcohol. OBJECTIVES: To estimate the prevalence of alcohol use and describe the patterns of use for AGYW enrolled in the HERStory Study. Secondary aims included identifying covariates of alcohol consumption and examining the impact of alcohol use patterns on the HIV care continuum. METHODS: We included all 4 377 AGYW (aged 15 - 24 years) enrolled in the HERStory baseline survey from six high HIV-risk districts. Alcohol consumption was assessed using the abbreviated Alcohol Use Disorders Identification Test, the AUDIT-C screening tool, with a score of ≥2 indicating hazardous drinking, while binge drinking was defined as consuming ≥6 drinks on one occasion at least monthly. RESULTS: Among participants, the median (interquartile range) age was 19 (17 - 21) years; 57.2% attended school, 82% were of low socioeconomic status and 66.3% self-reported as HIV negative. The prevalence of alcohol use was 32.2% and was highest among women aged 20 - 24 years (36.1%) and among those living in the Cape Town and Tshwane districts (52.8% and 51.6%, respectively). Of the 1 394 participants who reported ever drinking, 50.6% reported hazardous drinking and 22.7% binge drinking. Hazardous drinking was associated with residence in Cape Town district (odds ratio (OR) 2.25) and absence from school (OR 1.42) in univariate analyses. The odds of binge drinking were 2 - 7 times greater in all districts compared with King Cetshwayo in univariate analyses, and remained significant in the multivariate analysis. No association was found between hazardous or binge drinking and HIV care outcomes. CONCLUSION: The prevalence of alcohol use was elevated in the population of young women aged 20 - 24 years. Hazardous and binge drinking patterns were common in most districts and among those not attending school. Efforts to address the risk of drinking in this age group could focus on increased screening of AGYW for alcohol use, and supporting school attendance and after-school activities.
Opportunities to expand delivery of prehospital tranexamic acid to bleeding trauma patients - findings from a prospective multicentre trauma study in the Western Cape Province, South Africa.
Abdullah N, Young J, Stassen W … +8 more , Wylie C, Lategan HJ, Oosthuizen G, De Vries S, Verster J, EpiC Study Site Collaborators, Dixon JM, Mould-Millman NK
S Afr Med J · 2026 Apr · PMID 42246841 · Publisher ↗
BACKGROUND: Traumatic haemorrhage is a leading cause of preventable injury-related deaths. Tranexamic acid (TXA) has demonstrated a 38% all-cause mortality reduction when administered to severe haemorrhagic shock patient...
BACKGROUND: Traumatic haemorrhage is a leading cause of preventable injury-related deaths. Tranexamic acid (TXA) has demonstrated a 38% all-cause mortality reduction when administered to severe haemorrhagic shock patients in South Africa (SA). Yet its prehospital utilisation in SA remains limited owing to prehospital provider qualification restrictions, despite the region's high trauma burden. Among the 4% of prehospital providers licensed to administer TXA, prehospital eligibility and TXA administration is poorly reported. This utilisation gap suggests multifactorial barriers beyond the current scope of practice restrictions that impede effective implementation of this evidence-based intervention. OBJECTIVE: To assess patterns of TXA administration and omission during prehospital emergency care in the Western Cape Province, SA. METHODS: This is a secondary analysis from the EpiC prospective multicentre study. The current study examined 4 094 patients at risk of haemorrhage in the Western Cape from August 2021 to December 2024. First, we assessed patient and injury characteristics as well as prehospital and hospital treatments among three prehospital treatment groups: those who received TXA; those who received a lifesaving circulation intervention and no TXA; and those who received neither. Second, a subset of patients was selected for three clinical scenarios: patients with moderate to severe risk of shock; those with severe shock meeting TXA eligibility criteria; and those requiring hospital-based interventions for haemorrhage. Prehospital provider qualifications, clinical interventions and outcomes were assessed using descriptive statistics, and Sankey diagrams were used to visually depict the quantity and flow of prehospital trauma patients stratified by prehospital provider qualification. RESULTS: Only 2.8% (n=116) of all haemorrhage-risk patients received prehospital TXA despite 82% (n=3 325) presenting within the 3-hour window for administration. Among eligible patients with severe risk of shock who were managed by an advanced prehospital provider (n=161), only 19% (n=30) received TXA. Basic and intermediate prehospital providers, who cannot administer TXA under current regulations, managed 67% (n=326) of these patients. These providers frequently delivered other life-saving circulatory interventions (70 - 79%). CONCLUSION: This study reveals that only a small percentage of eligible trauma patients receive TXA despite its established mortality benefit. The principal barrier identified is the current scope-of-practice restriction preventing basic and intermediate prehospital providers from administering TXA, despite managing two-thirds of eligible patients and possessing the knowledge and skills to deliver TXA. We strongly recommend that the scope of TXA be extended to intermediate prehospital providers in SA.
Prevalence and socioeconomic determinants of post-acute sequelae of SARS-CoV-2 among individuals from a peri-urban township and an informal settlement in Johannesburg, South Africa.
Machemedze T, Mutevedzi P, Izu A … +5 more , Myburgh N, Verwey C, Mahtab S, Dangor Z, Madhi S
S Afr Med J · 2026 Apr · PMID 42246840 · Publisher ↗
BACKGROUND: Individuals infected with SARS-CoV-2 who develop COVID-19 are susceptible to persistent symptoms and sequelae, referred to as post-acute sequelae of SARS-CoV-2 (PASC). The prevalence of PASC is estimated to r...
BACKGROUND: Individuals infected with SARS-CoV-2 who develop COVID-19 are susceptible to persistent symptoms and sequelae, referred to as post-acute sequelae of SARS-CoV-2 (PASC). The prevalence of PASC is estimated to range between 10% and 30%. However, there is a paucity of data from African countries. OBJECTIVES: To investigate the prevalence and sociodemographic determinants of PASC in a peri-urban township and an informal settlement in South Africa (SA) during the COVID-19 pandemic. METHODS: A prospective cohort study was conducted among individuals residing in sampled households within the Soweto and Thembelihle Health and Demographic Surveillance System in Gauteng Province, SA. Between August 2021 and January 2022, all individuals from 214 sampled households were tested for SARS-CoV-2 and followed up for 6 months for symptoms. The prevalence of PASC, defined as persistence of symptoms through to at least 30 (PASC-30) and 90 (PASC-90) days, was evaluated, and determinants of PASC were identified using logistic regression models. RESULTS: There were 268 individuals with documented COVID-19 illness identified, of whom 65.3% (n=175) were female. The median age was 24 years. The overall prevalence of PASC-30 was 23.9% (95% confidence interval (CI) 19.2 - 29.3), including 24.6% (95% CI 19.7 - 30.3) and 12.5% (95% CI 3.5 - 36.0) in individuals who were unvaccinated or had received a COVID-19 vaccine, respectively (p=0.283). The overall prevalence of PASC-90 was 2.2% (95% CI 1.0 - 4.8). Factors associated with PASC-30 included living in an informal (39.2%, 105/268) v. formal settlement (60.6%, 163/268) (adjusted odds ratio (aOR) 4.1, 95% CI 2.1 - 8.3), although participants living in larger households (aOR 0.8, 95% CI 0.7 - 0.9, p=0.011) were less likely to report PASC-30 than those from smaller households. Age, gender, marital status, level of education, employment status, vaccination status and the presence of comorbidities were not significantly associated with PASC. CONCLUSION: PASC-30 (23.9%) was prevalent at the population level in individuals with documented COVID-19, particularly among residents of informal settlements, while PASC-90 (2.2%) was low. Further exploration into PASC within informal settlements is imperative to comprehensively understand these findings.
Routine blood monitoring in acne vulgaris patients on isotretinoin: Is reassessment warranted? A retrospective cohort study from Tygerberg Hospital.
Du Toit J, Gray NA, Esterhuizen TM … +1 more , Visser WI
S Afr Med J · 2026 Apr · PMID 42246839 · Publisher ↗
BACKGROUND: Oral isotretinoin is an indispensable treatment for patients with resistant and severe acne vulgaris, both in South Africa (SA) and globally. While routine laboratory monitoring is often deemed unnecessary fo...
BACKGROUND: Oral isotretinoin is an indispensable treatment for patients with resistant and severe acne vulgaris, both in South Africa (SA) and globally. While routine laboratory monitoring is often deemed unnecessary for young, healthy patients, it remains unclear whether this applies in the SA context. OBJECTIVES: To assess the need for routine blood monitoring for acne vulgaris patients on isotretinoin treatment at Tygerberg Hospital, SA. Specifically, we wanted primarily to determine the prevalence of patients with acne vulgaris whose oral isotretinoin treatment was altered owing to blood result abnormalities, and secondarily, to determine the prevalence of adverse events and liver function and lipid profile abnormalities associated with isotretinoin. METHODS: This was a retrospective cohort study of hospital records from patients with acne vulgaris treated with oral isotretinoin at the dermatology clinic at Tygerberg Hospital between 1 January 2020 and 31 December 2023. There were 89 eligible records extracted from the Tygerberg Hospital Enterprise Content Management system. Baseline and 6-week follow-up laboratory data, including liver function tests and lipid profile, were extracted retrospectively from the National Health Laboratory Service. RESULTS: The sample comprised 89 patient hospital records, 62% male and 38% female. Of the total, 53% were aged between 12 and 20 years. Blood result abnormalities led to alterations in treatment regimens for 2/89 (2.2%) patients: one patient required treatment termination, while another continued on low-dose isotretinoin instead of the planned dose increase. Two patients (2.2%) developed increased aspartate aminotransferase levels and five (5.6%) developed new alanine aminotransferase increases above the upper limit of the normal range. Elevated triglyceride levels occurred in two patients (2.2%), and elevated cholesterol levels in nine (10.1%). Adverse events resulting in the premature termination of treatment with isotretinoin included one case of severe chest pain, one patient with pseudotumour cerebri and one patient who developed exuberant granulation tissue. CONCLUSION: This single-centre retrospective review highlights the scarcity of blood result abnormalities due to isotretinoin in patients with acne vulgaris. There were only two patients (2.2%) who had their management altered owing to blood result abnormalities, and both had chronic conditions. This may suggest that routine monitoring is indicated in patients with comorbidities, but not in otherwise healthy young patients with acne. However, larger prospective studies are needed in SA before such conclusions can be drawn.
Evaluation of healthcare resource utilisation and costs associated with anogenital warts in South Africa.
Mutambirwa S, Botha MH, Mulaudzi BM … +2 more , Mabenge MS, Gaqana T
S Afr Med J · 2026 Apr · PMID 42246838 · Publisher ↗
BACKGROUND: Human papilloma virus (HPV), the most prevalent sexually transmitted infection worldwide, and in particular HPV 6 and 11, contribute to >90% of anogenital warts (AGW) cases, and high-risk HPV serotypes cause...
BACKGROUND: Human papilloma virus (HPV), the most prevalent sexually transmitted infection worldwide, and in particular HPV 6 and 11, contribute to >90% of anogenital warts (AGW) cases, and high-risk HPV serotypes cause >95% of cervical cancers in South Africa (SA). The healthcare resource utilisation (HCRU) and costs related to AGW in SA remain poorly understood, in both the public and private sectors. OBJECTIVE: To assess the HCRU patterns and associated treatment costs for AGW across the public and private sectors. METHODS: A descriptive, questionnaire-based study was conducted, involving 50 subject matter experts (SMEs) from SA: 24 from the private sector and 26 from the public sector. The study explored resource use, treatment patterns and cost estimation based on SME responses. RESULTS: Findings revealed that public-sector SMEs treated a larger volume of AGW patients per month (1 - 300) than private-sector SMEs (0 - 20). Most AGW patients were female, comprising 78% in the public sector and 72% in the private sector. The occurrence of AGW was higher in the public sector, ranging between 21.4% and 34.4%, while in the private sector, the occurrence ranged from 13.1% to 23.2%. The weighted cost per patient per episode was higher for females than males in both sectors. In the private sector, costs were ZAR22 482 for females and ZAR17 812 for males, while in the public sector, costs were ZAR19 220 for females and ZAR14 271 for males. The higher costs for females were driven by invasive diagnostic procedures, including vulvar colposcopy and biopsy, and a higher frequency of medical visits (2.0 - 4.4 visits in the public sector). Recurrence rates of AGW were reported at 37.6% in the private sector and 43.9% in the public sector. The total estimated treatment cost of AGW was notably higher in the public sector for both males (ZAR93.6 - ZAR138.5 billion) and females (ZAR135.2 - ZAR207.7 billion), compared with the private sector (males: ZAR11.0 - ZAR19.4 billion; females: ZAR16.7 - ZAR28.3 billion). Female patients experienced a higher burden of diagnosis, recurrence and complications than males. CONCLUSION: AGW imposes a substantial burden on SA's healthcare system, particularly in the public sector, where female patients face significant costs and complications. The use of a quadrivalent or nonavalent HPV vaccine, rather than a bivalent vaccine, could reduce the impact of AGW and its associated healthcare demands.
Best interests above belief: Constitutional guidance for life-saving medical decisions involving children.
Mahomed S
S Afr Med J · 2026 Apr · PMID 42246837 · Publisher ↗
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Narrowing the care and treatment gap through a human resources for mental health plan: Key considerations.
Freeman M, Wolvaardt G, Maimela G
S Afr Med J · 2026 Apr · PMID 42246836 · Publisher ↗
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Corrigendum.
Naidu C
S Afr Med J · 2026 Mar · PMID 42246835 · Publisher ↗
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Insulin pens are a necessity, not a luxury: Addressing inequitable access to diabetes treatment in South Africa's public sector.
Jordaan B, Leuschner M, Steenkamp V
S Afr Med J · 2026 Mar · PMID 42246834 · Publisher ↗
Diabetes is a growing public health crisis in South Africa (SA), driven by urbanisation, sedentary lifestyles, poor dietary habits and an ageing population. The country has one of the highest diabetes prevalence rates in...
Diabetes is a growing public health crisis in South Africa (SA), driven by urbanisation, sedentary lifestyles, poor dietary habits and an ageing population. The country has one of the highest diabetes prevalence rates in sub-Saharan Africa, with millions affected, many of whom remain undiagnosed. The disease disproportionately impacts low-income communities, where limited healthcare access and late diagnoses lead to severe complications and economic strain. While insulin pens improve glycaemic control and patient adherence, they remain largely inaccessible in the public sector owing to high costs and restrictive procurement policies. Government reliance on vials and syringes exacerbates treatment disparities, increasing the risk of medication errors and poor health outcomes. Addressing these barriers requires policy reform, expanded subsidies and improved procurement strategies to ensure equitable access to insulin pens. By prioritising patient-centred diabetes care, SA can reduce hospitalisations, enhance treatment adherence and alleviate the broader economic and healthcare burden of diabetes.
Barriers and facilitators to mental health service accessibility among youth in Zambia.
Kwibisa N
S Afr Med J · 2026 Mar · PMID 42246833 · Publisher ↗
BACKGROUND: Mental health challenges among Zambian youths are an increasing public health concern. Recent studies estimate that ~20% of the Zambian population is affected by mental health disorders, with adolescents show...
BACKGROUND: Mental health challenges among Zambian youths are an increasing public health concern. Recent studies estimate that ~20% of the Zambian population is affected by mental health disorders, with adolescents showing a sharp rise in reported cases, from 0.7% in 2021 to 1.54% in 2023 (2 914 to 6 825 cases). Despite this growing burden, only 0.1% of government health expenditure is allocated to mental health services, and there is currently no youth-specific policy framework in place. With young people aged 15 - 35 years comprising 36.7% of Zambia's total population, the lack of investment and targeted interventions underscores the urgency of addressing barriers and strengthening facilitators to improve youth access to mental healthcare. OBJECTIVES: To explore the barriers and facilitators that influence youths' access to mental health services in Zambia, with a focus on understanding the underlying factors that impact service utilisation. METHODS: A systematic literature review was conducted, drawing on studies published between 2005 and 2025 from databases including Google Scholar, PubMed and ResearchGate. A total of 20 articles were identified and reviewed, with inclusion based on relevance to youth mental health service accessibility in Zambia. The review did not involve any primary participants; instead, the sample consisted of peer- reviewed studies, national reports and institutional documents. Data were analysed manually using a qualitative thematic approach, where key patterns, recurring themes and emerging categories of barriers and facilitators were identified and synthesised. This approach allowed for an in-depth understanding of the cultural, social and systemic factors that influence youths' access to mental health services. RESULTS: The findings highlight several barriers to accessing mental health services, including stigma, cultural beliefs, inadequate infrastructure and resources, low mental health awareness and gendered norms. The majority of the reviewed literature focused on urban and peri-urban settings, with fewer studies addressing rural contexts. In urban and peri-urban settings, common themes included stigma, limited infrastructure concentrated in tertiary hospitals and gendered expectations that discouraged male youths from seeking care. In rural contexts, the analysis revealed geographical inaccessibility, severe shortages of trained personnel and reliance on traditional or informal sources of support. Across both settings, low awareness of mental health conditions consistently emerged as a barrier. Conversely, facilitators such as school-based mental health programmes, community outreach initiatives, peer support groups and mobile-based interventions were identified as effective strategies to enhance accessibility for youths. CONCLUSION: Access to mental health services for Zambian youths is a multifaceted web of social, cultural and systemic factors. Addressing these challenges requires a comprehensive approach. The article concludes with recommendations aimed at improving youth-friendly mental health service delivery and access.
Tackling clinical trials disparities in Africa.
Kaur M
S Afr Med J · 2026 Mar · PMID 42246831 · Publisher ↗
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Declining adolescent pregnancies in South Africa: Insights from public sector data, 2021 - 2025.
Barron P, Lince-Deroche N, Bamford L … +3 more , Subedar H, Mbatha T, Pillay Y
S Afr Med J · 2026 Mar · PMID 42246830 · Publisher ↗
BACKGROUND: In South Africa (SA), adolescent pregnancy, particularly in very young girls, is an issue of keen public and political concern given its social and health implications. OBJECTIVE: To provide a quantitative ba...
BACKGROUND: In South Africa (SA), adolescent pregnancy, particularly in very young girls, is an issue of keen public and political concern given its social and health implications. OBJECTIVE: To provide a quantitative baseline that SA can use for targeting its efforts to address adolescent pregnancy and for measuring progress over time. METHODS: Using public sector service data for deliveries and terminations of pregnancies, we estimated adolescent pregnancy rates among adolescent girls aged 10 - 14 and 15 - 19 years for the financial years 2021/22 - 2024/25. RESULTS: In 2025, the adolescent pregnancy rate (including births and terminations) for 15 - 19-year-olds was 48.9 per 1 000. For 10 - 14-year-olds, it was 1.2 per 1 000. Both the total number of births and the adolescent pregnancy rates dropped annually over the 4-year period of review, and reversed the previous trend of increases from 2017/18 through to 2020/21. Although there were decreases in births and adolescent pregnancy rates in all provinces, there were greater decreases in the more rural provinces compared with the more urban provinces (e.g. Western Cape and Gauteng). Termination of pregnancy rates were also higher in more urban provinces. CONCLUSION: While SA already has a strong policy framework for addressing adolescent pregnancy, there is a need for a national strategy and improved co-ordination of efforts. Indeed, the updated 2025 World Health Organization guidelines on preventing adolescent pregnancy and mitigating its adverse impacts highlight the need for a broad, multisectoral approach.
The final referral: A 1-year retrospective review of death referrals through the lens of forensics.
Van der Merwe S, Mentoor I, Mould-Millman NK … +1 more , Verster J
S Afr Med J · 2026 Mar · PMID 42246829 · Publisher ↗
BACKGROUND: Under South African (SA) law, all unnatural, sudden and unexpected deaths, as well as procedure-related deaths, must be reported to the SA Police Service and referred to the Forensic Pathology Service (FPS)....
BACKGROUND: Under South African (SA) law, all unnatural, sudden and unexpected deaths, as well as procedure-related deaths, must be reported to the SA Police Service and referred to the Forensic Pathology Service (FPS). In the Western Cape Province, referrals to FPS require completion of the FPS100 form by a senior medical practitioner. OBJECTIVE: To assess the appropriateness, completeness and legibility of FPS100 referral forms submitted to Tygerberg Forensic Pathology Services over the course of 1 year in the Western Cape Province, and to evaluate whether the suspected presumed cause of death was in line with the World Health Organization's standards. METHODS: This was a cross-sectional retrospective review of all FPS100 referral forms submitted to the Tygerberg Forensic Pathology Mortuary over 1 year. An experienced forensic pathology medical practitioner reviewed the appropriateness, completeness, legibility, commissioning status and accuracy of presumed cause-of-death classifications reflected on the FPS100 referral forms received. RESULTS: Of the 1 252 cases accompanied by a referral form, 81.6% were deemed incomplete, with 22.3% uncommissioned, rendering them inadmissible in court. Even though most of the referrals were legible, over 43% indicated misclassified formulations of the presumed causes of death. CONCLUSION: The study revealed significant deficiencies in FPS referrals, including incomplete or uncommissioned forms and frequent misclassification of presumed causes of death. These shortcomings undermine the legal validity of the referral forms, and may delay medicolegal processes and even result in direct subpoenas to referring medical practitioners. The findings highlight the urgent need for strengthened training for medical practitioners across all levels of experience, and for the implementation of standardised referral protocols. Equally important is enhancing awareness of the medicolegal value of FPS involvement, and the critical impact of accurate, high- quality referrals.
The duration of phentermine therapy in the private healthcare sector of South Africa: A retrospective analysis.
Fourie A, Julyan M, Mostert CS … +1 more , Du Plessis JM
S Afr Med J · 2026 Mar · PMID 42246828 · Publisher ↗
BACKGROUND: Phentermine is an amphetamine derivative and is globally the most used oral appetite suppressant for obesity. Its long-term (LT) use (a period >12 consecutive weeks) may be associated with amphetamine-like ad...
BACKGROUND: Phentermine is an amphetamine derivative and is globally the most used oral appetite suppressant for obesity. Its long-term (LT) use (a period >12 consecutive weeks) may be associated with amphetamine-like adverse effects. The US Food and Drug Administration has restricted its use to short term (ST) only (not longer than 12 consecutive weeks), specifically stated in the patient information leaflet. This serves as a prescribing guideline that is provided to assist both general and specialist practitioners in drug prescribing that is rational and safe, and to maximise patient outcomes and adherence. Since, to the researchers' knowledge, there have been no studies previously undertaken in South Africa (SA) that provide data on the duration of phentermine use, this study was designed to determine whether the recommendations for the ST use of phentermine are reflected in the actual patterns of duration of this drug's use. OBJECTIVE: To analyse the duration of phentermine therapy in the private healthcare sector of SA. METHOD: A retrospective, cross-sectional drug utilisation review was conducted using longitudinal data from a SA pharmacy benefit management company's medicine claims database. Paid claims for phentermine from 1 January 2015 to 31 December 2019 were extracted for analysis. The duration of phentermine therapy, patients' age and gender and the specialty of the prescriber in patients receiving 15 mg or 30 mg of phentermine, respectively, were considered and evaluated. Statistical analyses were done with Statistical Analysis System (SAS) 9.4. RESULTS: Records of 3 361 patients (paid claims for phentermine) were found on the claims database during the study period. The duration of therapy (DOT) with phentermine was analysed, and results indicate that 2 472 (73.55%) patients received the drug ST, with the remainder receiving the drug LT. The mean (standard deviation (SD)) DOTs with 15 mg and 30 mg phentermine were 57.26 (58.72) days and 67.10 (52.01) days, respectively. CONCLUSION: The study yielded highly encouraging results, affirming the ST use of phentermine. The evidence of LT use, however, opens new avenues for research. In the private healthcare sector of SA, the DOT with phentermine is not restricted to ST use, and some individuals may be exposed to the potentially harmful consequences accompanying LT therapy with phentermine.
Prevalence and severity of anaemia in persons with haemophilia and von Willebrand disease at Charlotte Maxeke Johannesburg Academic Hospital, South Africa.
Monaheng R, Mahlangu JN
S Afr Med J · 2026 Mar · PMID 42246827 · Publisher ↗
BACKGROUND: Haemophilia and von Willebrand disease (VWD) are inherited bleeding diatheses characterised by spontaneous or traumatic bleeding resulting in varying degrees of anaemia. Early diagnosis, treatment and prevent...
BACKGROUND: Haemophilia and von Willebrand disease (VWD) are inherited bleeding diatheses characterised by spontaneous or traumatic bleeding resulting in varying degrees of anaemia. Early diagnosis, treatment and prevention of anaemia are crucial to improving physical and mental health and enhancing health-related quality of life. The global prevalence of anaemia and its associated risk factors is well established; however, there is a paucity of data on those with inherited bleeding disorders (IBD). OBJECTIVES: To describe the prevalence and severity of anaemia in haemophilia and VWD in a quaternary care facility. METHODS: Adult patients with haemophilia or VWD of any subtype were identified through hospital record reviews. After excluding those without anaemia, defined as haemoglobin (HB) <13 g/dL for males and <12 g/dL for females, data from patients with anaemia were anonymised, captured, collated and analysed. Quantitative data were summarised with standard statistical tools, and qualitative data were described. The IBD cohort demographics, anaemia severity and prevalence data were compared with those of the controls, who were age- and sex-matched adult patients admitted to the haematology ward. RESULTS: Of 1 100 patients with IBD screened, 77 met the eligibility criteria. These comprised 68 (88.3%) haemophilia patients and 9 (11.7%) patients with VWD. The majority of IBD patients were males, comprising 90.9% (n=70), while females comprised 9.1% (n=7). Of the 886 screened controls, 77 age- and sex-matched patients were selected for comparison. The prevalence of anaemia in the study cohort was 38.96% (n=30). Most patients with anaemia (96.7%, n=29) were male, with only a single female, while in the control group, 85.7% (n=66) were male and 14.3% (n=11) were female. The prevalence of severe anaemia, defined as HB <8 g/dL, was 7% in the IBD group, compared with 22.8% in the control group. In the IBD group, 40% (n=12) of patients had borderline anaemia, compared with the control population with a predominance of life-threatening anaemia (31.2%, n=24). Mild anaemia (HB <11 g/dL) was noted in 37% of the IBD study cohort v. 13% in the control population. Life-threatening anaemia was seen in 13% of the IBD cohort v. 31.2% in the control population. The prevalence of moderate anaemia was 3% in the IBD cohort v. 28.6% in controls. In the IBD cohort, 43% of the anaemic patients had iron deficiency anaemia, and 6.5% of patients in the control group had iron deficiency anaemia. CONCLUSION: This study indicates the burden of anaemia in the IBD population. Health professionals must be proactive in screening and treating anaemia in these patients. Further research is required to explore additional contributing factors. Optimisation of therapeutic strategies tailored to the unique needs of these patients is vital.
Breast cancer surgical services in South Africa: Availability and barriers to guideline-concordant care.
Milligan L, Roodt L, Malherbe F … +1 more , Cairncross L
S Afr Med J · 2026 Mar · PMID 42246826 · Publisher ↗
BACKGROUND: Female breast cancer has become the most frequently diagnosed cancer globally. The incidence of cancer in South Africa (SA) is projected to double by 2030, and services to address the growing burden of diseas...
BACKGROUND: Female breast cancer has become the most frequently diagnosed cancer globally. The incidence of cancer in South Africa (SA) is projected to double by 2030, and services to address the growing burden of disease are urgently needed. The distribution and capacity of existing breast cancer surgical services in SA haVE not been reported. OBJECTIVE: To provide a quantitative descriptive analysis of the status of breast cancer surgical services in the public healthcare sector in SA. METHODS: A descriptive cross-sectional analysis of breast cancer surgical services was performed, including the burden of disease, stage of diagnosis, available diagnostic and therapeutic modalities, waiting time to surgery and barriers to care. Clinicians at every public sector healthcare facility providing surgical care to breast cancer patients were approached to complete a quantitative survey for the year 2019. RESULTS: Data from 43 hospitals across all nine SA provinces were included. Clinicians reported a greater proportion of late-stage breast cancer (67%) than early breast cancer (33%) at diagnosis. The less urban provinces had poorer access to diagnostic and staging modalities. Most facilities were able to provide breast-conserving surgery (79%), while fewer facilities could offer sentinel lymph node biopsy (SLNB) (53%) and still fewer could offer breast reconstruction (35%). Clinicians cited the foremost barriers to standard of care as advanced disease at diagnosis, inadequate access to surgical expertise and lack of access to essential equipment. The national average waiting time for surgery (28 days) is within the recommended timeframe from decision to treat. The representation of the multidisciplinary team across facilities does not comply with national staffing recommendations for a breast unit. CONCLUSION: Broad disparities exist in access to essential staging and diagnostic modalities between facilities in different provinces. In many settings, there is limited capacity to provide key surgical interventions, particularly SLNB and breast reconstruction. These findings suggest that breast cancer care in most settings within the public healthcare sector is not concordant with proposed national guidelines. There is an urgent need to address the deficits in the distribution and capacity of breast cancer surgical services in SA.
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