South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde[JOURNAL]

In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this f... In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this finding has led to increasing media attention, and regulatory and legal proceedings. The South African Health Products Regulatory Authority (SAHPRA) has issued a statement acknowledging the association between dMPA exposure and the development for meningiomas. However, the paucity of local data on dMPA use and the incidence of and risk factors for meningioma in both the public and private health sector make it difficult to fully assess the implications in SA. This report discusses the relevance of the association between dMPA and meningiomas in the SA context. We provide a summary of the current data on the risk of meningioma with dMPA exposure, and suggest how this should impact on recommendations for the prescribing and use of dMPA from a public health perspective. We further identify gaps in local data, and propose where efforts should be directed to collect relevant data to inform a rational national contraceptive strategy.

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Persistent hypertension, albuminuria and low glomerular filtration rate in schoolchildren in Kano metropolis, Nigeria.

Mudi A, Abdu A

S Afr Med J · 2026 Feb · PMID 42246797 · Publisher ↗

BACKGROUND: Screening for persistent hypertension, albuminuria and low estimated glomerular filtration rate (eGFR) in children may allow for early detection of kidney disease, paving the way for early intervention to slo... BACKGROUND: Screening for persistent hypertension, albuminuria and low estimated glomerular filtration rate (eGFR) in children may allow for early detection of kidney disease, paving the way for early intervention to slow disease progression. OBJECTIVE: To determine the prevalence of persistent hypertension, albuminuria and low eGFR and their associated factors in schoolchildren. METHOD: The study screened 228 schoolchildren (aged 5 - 15 years) from February 2020 to February 2021. Information about participants' sociodemographic profile and medical history was obtained through questioning. Participants' height, weight and blood pressure (BP) were measured. Their spot urine was assessed for albumin creatinine ratio (ACR), and blood for serum creatinine and eGFR. Participants with abnormal findings had a repeat assessment after a minimum of 3 months for BP, ACR and eGFR. RESULTS: The median (range) age was 13.0 (11.1 - 14.0) years, with 117 males and 111 females. Seventy-eight of the children (34%) had at least one abnormality (hypertension 1.8%, albuminuria 28% and low eGFR 9%) at recruitment. At follow-up, 33 (42%) of the 78 children had persistent abnormal findings (hypertension 1.3%, albuminuria 10.1%, low eGFR 6%). Persistent albuminuria was seen more commonly in girls and in children with low eGFR. Older children (>10 years) were more likely to have low eGFR. CONCLUSION: A two-point, multiparameter screening of children may reveal high-risk groups for kidney disease that would require further evaluation and long-term follow-up. Such screenings can be integrated into school entry health assessment programmes to allow for early detection of kidney disease.

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E-cigarette, cannabis, hookah and tobacco use patterns in fee-paying South African high schools.

Filby S, Van Zyl-Smit R, Soin G … +1 more , Kurten S

S Afr Med J · 2026 Feb · PMID 42246796 · Publisher ↗

BACKGROUND: Monitoring adolescent substance use is crucial for informing public health strategies. However, in South Africa (SA), recent large-sample data on the use and co-use of tobacco, nicotine and cannabis among you... BACKGROUND: Monitoring adolescent substance use is crucial for informing public health strategies. However, in South Africa (SA), recent large-sample data on the use and co-use of tobacco, nicotine and cannabis among youth remain scarce. OBJECTIVES: To describe the use and co-use of cannabis, hookah, tobacco cigarettes and electronic cigarettes (e-cigarettes/vapes) among SA high-school learners, and to examine how these patterns vary by school-based characteristics, including grade, school fee category and school gender composition. METHODS: A cross-sectional survey was administered to 25 149 learners in grades 8 - 12 from 52 fee-paying high schools across eight provinces. Learners reported their past-30-day use of cannabis, hookah, tobacco cigarettes and e-cigarettes/vapes. Key outcomes included current use of each individual product, any one of the four products, as well as dual-usage patterns. Multilevel logistic regressions examined associations between school grade, fee category (lower-, mid-, or high-fee), gender composition (co-educational, all boys, all girls) and the odds of single, any and dual product use. RESULTS: Among sampled learners, 19.39% (95% confidence interval (CI) 18.91 - 19.88) reported current use of any product. Vape use was most prevalent (16.83%, 95% CI 16.37 - 17.30), followed by cannabis (5.13%, 95% CI 4.86 - 5.41), hookah (3.16%, 95% CI 2.95 - 3.39) and tobacco cigarettes (2.08%, 95% CI 1.91 - 2.27). Dual use was especially common among vape users, with more than one-third (34.31%, 95% CI 32.88 - 35.77) reporting concurrent use of at least one other product: 22.06% (95% CI 20.83 - 23.35) cannabis, 13.50% (95% CI 12.50 - 14.58) hookah and 10.13% (95% CI 9.25 - 11.08) tobacco cigarettes. Usage rates were highest among learners in Grade 12, in co-educational schools and in lower-fee schools. Multivariable regression analyses showed that advanced grade level was significantly associated with increased odds of current use across all product types. Compared with learners in all-boys schools, those in co-educational schools had significantly higher odds of cannabis use (odds ratio (OR) 1.53, p<0.05) and dual use (OR 1.42, p<0.1), while learners in all-girls schools had significantly lower odds of any product use (OR 0.75, p<0.05) and of vape use (OR 0.73, p<0.05). Regression results further revealed significantly elevated odds of hookah use and dual use among learners attending lower- and middle-fee schools compared with learners in high-fee schools. CONCLUSION: The widespread use of e-cigarettes, along with dual use among e-cigarette users, in fee-paying high schools signals a significant public health concern, underscoring the need for comprehensive interventions. Elevated hookah and dual use in lower-fee schools, along with increased cannabis and dual use in co-educational settings, underscore the need for targeted interventions to address context-specific vulnerabilities among SA adolescents.

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Profile of deliberate self-poisoning admissions in KwaZulu-Natal Province, South Africa (2018 - 2023) and the impact of COVID-19.

Pillay S

S Afr Med J · 2026 Feb · PMID 42246795 · Publisher ↗

BACKGROUND: Deliberate self-poisoning (DSP) is a common method of attempted suicide globally, particularly among young adults and women. In South Africa (SA), DSP is the second most frequent method of attempted suicide,... BACKGROUND: Deliberate self-poisoning (DSP) is a common method of attempted suicide globally, particularly among young adults and women. In South Africa (SA), DSP is the second most frequent method of attempted suicide, after hanging. The COVID-19 pandemic raised concerns about potential increases in suicidal behaviour, but data on its impact on DSP in resource-constrained settings are limited. OBJECTIVE: To describe the profile of DSP admissions at a large tertiary hospital in KwaZulu-Natal (KZN) Province, SA, over 2018 - 2023, and to assess whether the COVID-19 pandemic influenced the frequency or outcomes of these cases. METHODS: I conducted a retrospective review of all DSP admissions from 2018 to 2023 at a large tertiary hospital in KZN, SA. All patients aged ≥13 years who intentionally ingested a toxic substance (overdose or poison) were included. Demographic information, substances ingested and clinical outcomes (intensive care unit (ICU) admission, acute medical complications, in-hospital mortality) were recorded. Descriptive statistics were used to characterise the patient cohort, and multivariate logistic regression was used to identify independent predictors of acute medical complications, including an assessment of the COVID-19 pandemic period as a potential risk factor. RESULTS: A total of 716 DSP cases were analysed over the study period, with a median age of 26 years and a female predominance (64.7%). Medication overdose was the principal mechanism (81%), and the most frequently involved substances were paracetamol (17.6%) and antiretroviral (ARV) medications (16.8%). Acute clinical outcomes were generally favourable: 3.4% of patients required ICU admission, 1.3% developed serious medical complications and the in-hospital mortality rate was 0.7%. A history of psychiatric illness was a strong independent predictor of acute medical complications (odds ratio 9.4, p=0.007). The annual volume of DSP cases showed no significant difference across the pre-pandemic (2018 - 2019), pandemic (2020 - 2021) and post-pandemic (2022 - 2023) periods (p=0.18). CONCLUSION: DSP in this setting predominantly affects young adults, especially females, and often involves overdose of readily accessible medications (notably paracetamol and ARV drugs). While acute outcomes were largely favourable, with low rates of severe complications and death, the high involvement of common pharmaceuticals underscores the need for preventive strategies to reduce DSP incidents. Notably, no surge in DSP cases was observed during the COVID-19 pandemic, suggesting that the pandemic's impact on suicidal behaviour is context-specific.

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Community experiences of surgery in peri-urban Cape Town.

Isiagi M, Biccard B, Kinney M … +10 more , Le Roux S, Mdayi N, Kinnes M, Mbamalu O, Gizamba J, Veitch R, Akurut E, Fadiran L, Pulani Y, Maswime S

S Afr Med J · 2026 Feb · PMID 42246794 · Publisher ↗

BACKGROUND: Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings. OBJECTIVE: To determine the surgical experie... BACKGROUND: Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings. OBJECTIVE: To determine the surgical experiences of individuals in a peri-urban community in Cape Town, South Africa. METHODS: A cross-sectional household survey of individuals in a peri-urban Cape Town community was conducted with door-to door interviews by trained community assistants, who provided multilingual translation of study materials as needed. The study (i) describes the surgical burden of disease and outcomes; (ii) assesses health-seeking behaviour and barriers to care using the Three Delays framework; and (iii) uses descriptive statistics to characterise respondent demographics and surgical experiences and χ2 tests to compare awareness, attitudes and acceptability across genders and locations. RESULTS: Data from 432 valid responses of 450 surveys conducted showed that chronic diseases were common, affecting 240/431 (56%), with a higher prevalence in females than in males (171/285 (60%) v. 63/133 (47%), p<0.05). Most participants (208/432, 44%) lived within 10 km of their nearest healthcare facility, predominantly public facilities (417/432, 97%). The Three Delays framework showed that 87/432 (20%) delayed seeking surgical care, 114/432 (26%) experienced delays reaching facilities and 95/432 (32%) faced delays in receiving appropriate care, while 95/432 (22%) reported no delays. The surgical burden was substantial, with 260/428 (60%) having undergone surgery in their lifetime and 195 surgical procedures performed in the last 5 years. Postoperative disability affected 43/432 (10%) of participants, primarily manifesting as body function impairments (22/43, 51.2%) and activity limitations (7/43, 16.3%). Only 67% understood post-surgical treatment protocols. CONCLUSION: This study reveals significant challenges in surgical care delivery in this peri-urban community. Key findings include a high chronic disease burden, substantial delays in accessing surgical care and significant postoperative disability rates. These results provide the first comprehensive assessment of surgical experiences in peri-urban Cape Town, highlighting the need for comprehensive interventions targeting chronic disease and surgical care, even in peri-urban areas close to public health facilities.

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Gender-affirming care in South Africa: A cross-sectional survey of transgender and gender-diverse people in the Eastern and Western Cape provinces, South Africa.

Bust L, Matyila SA, Welte O … +5 more , Xaba N, Zintwana Z, George A, De Jong M, Kaplan R

S Afr Med J · 2026 Feb · PMID 42246793 · Publisher ↗

BACKGROUND: Transgender and gender-diverse (TGD) people face significant discrimination in the South African (SA) health system, limiting their access to HIV services and gender-affirming care, which supports an individu... BACKGROUND: Transgender and gender-diverse (TGD) people face significant discrimination in the South African (SA) health system, limiting their access to HIV services and gender-affirming care, which supports an individual's gender identity when it does not align with their sex assigned at birth. Despite the critical role of these services for TGD people, access to care remains understudied in SA. OBJECTIVES: To describe TGD people and their access to and need for social, legal and medical transition, including psychosocial care, hormone therapy and surgery, as well as HIV services, in the Eastern Cape and Western Cape provinces, South Africa. METHODS: A cross-sectional quantitative survey design was utilised, with 150 TGD individuals recruited via convenience sampling in the Western and Eastern Cape provinces. Interviews were conducted using structured questionnaires, with data captured on REDCap. Descriptive analysis was conducted using Stata 18. RESULTS: Of the 150 respondents, 74.0% were people assigned male at birth (AMAB) and 26.0% were people assigned female at birth (AFAB). Reported gender identities showed that 68.5% of AMAB respondents identified as transgender women/female, 56.4% of AFAB respondents identified as transgender men/male and 34.0% of all respondents identified as gender diverse or non-binary. Demographics showed a vulnerable population, with 18.7% with housing insecurity and 66.0% unemployed. While social transition was common (98.7%), access to legal transition (4.0%) was very low, as was access to all forms of medical gender-affirming care, with 44.7% of TGD people accessing psychosocial care, 32.0% accessing hormone therapy and 2.7% surgery. Of the respondents who had not legally transitioned, 71.4% wanted to. Most respondents who had not accessed medical gender-affirming care services expressed a need for psychosocial care (77.1%) and hormone therapy (68.6%). Gender-affirming surgery was more variable, with 33.3% of AFAB respondents wanting bottom surgery compared with top surgery (63.9%), and 49.5% of AMAB respondents wanting bottom surgery compared with top surgery (55.9%). Almost all (99.3%) respondents had had an HIV test in their lifetime, with reported HIV prevalence differing between AMAB (34.2%) and AFAB (7.9%) respondents. PrEP uptake among HIV-negative AMAB respondents was 30.4%, and 5.7% among AFAB respondents, while 78.0% of TGD people living with HIV were on antiretroviral treatment. CONCLUSION: Findings demonstrate a critical gap between needed and actual access to legal and medical gender-affirming care services. There is an urgent need for the provision of integrated and accessible gender-affirming care and HIV services as part of comprehensive care for TGD populations within inclusive health systems nationally.

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Case fatality in severe acute malnutrition: Determinants and modifiable factors in hospitalised children in Vhembe district, South Africa.

Fakudze D, Saloojee H

S Afr Med J · 2026 Feb · PMID 42246792 · Publisher ↗

BACKGROUND: In 2019, one-quarter of child deaths in South African (SA) hospitals were attributed to severe acute malnutrition (SAM). OBJECTIVES: To identify demographic, clinical, case management and health system factor... BACKGROUND: In 2019, one-quarter of child deaths in South African (SA) hospitals were attributed to severe acute malnutrition (SAM). OBJECTIVES: To identify demographic, clinical, case management and health system factors contributing to mortality in children aged <5 years with SAM admitted to three hospitals in Vhembe district, Limpopo, SA. METHODS: A retrospective record review was conducted for children aged 6 - 59 months admitted with SAM over a 30-month period. Bivariable and multivariable regression analyses were used to determine mortality factors. RESULTS: A total of 245 children with SAM were identified, with a median (interquartile range) age of 14 (10 - 18) months. The overall SAM case-fatality rate was 26.9% (66/245), significantly higher than routine data estimates. Key clinical factors associated with mortality included diarrhoea at presentation (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.38 - 8.10), anaemia (OR 3.30, 95% CI 1.28 - 8.50), raised C-reactive protein (OR 9.29, 95% CI 2.81 - 30.76) and hyponatraemia (OR 6.64, 95% CI 2.70 - 16.31). Additional contributors included late presentation, self-referral, limited triage, poor recognition and management of comorbidities and inadequate compliance with SAM guidelines. HIV status and shock were not significant determinants of mortality. CONCLUSION: SAM mortality was alarmingly high, particularly in the context of a high middle-income country setting with established treatment protocols. The striking discrepancy between the observed case fatality rate and routine district health information system data highlights the need for review of data quality and reporting systems. Targeted interventions addressing both clinical risk factors and systemic gaps are essential to reduce mortality and improve outcomes for children with SAM.

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Costing the national clinical guidelines for prostate cancer control and management in South Africa: Public sector perspective.

Thsehla E, Khoza M, Boachie MK … +4 more , Mdewa W, Goldstein S, Somaroo H, Hofman KJ

S Afr Med J · 2026 Feb · PMID 42246791 · Publisher ↗

BACKGROUND: Prostate cancer (PCa) is the second most common cancer worldwide and the sixth leading cause of cancer deaths in men. In South Africa (SA), PCa accounts for ~13% of male deaths. The direct medical costs assoc... BACKGROUND: Prostate cancer (PCa) is the second most common cancer worldwide and the sixth leading cause of cancer deaths in men. In South Africa (SA), PCa accounts for ~13% of male deaths. The direct medical costs associated with PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management are not documented. OBJECTIVES: To estimate the direct medical costs for localised PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management in SA. METHODS: The direct medical costs for diagnosis and treatment of prostate cancer were estimated from the payer's perspective using a micro- costing approach, with a time horizon of 12 months. Cost items were identified from the national PCa clinical guidelines and quantified according to the treatment options for low- (LRPCa), intermediate- (IRPCa) and high-risk (HRPCa) categories. Cost data were obtained from different government databases. The unit costs and PCa incidence data from 2022 were then used to estimate total costs for treating all new PCa cases. Total costs were calculated for each treatment method listed in the clinical guidelines according to PCa risk categories. RESULTS: The total cost for treating 10 944 new PCa cases in 2022 was estimated at ZAR2.1 billion. Per patient costs ranged from ZAR7 265 to ZAR143 156 for LRPCa, ZAR8 926 to ZAR144 817 for IRPCa and ZAR14 874 to ZAR151 872 for HRPCa. The total cost for managing all patients with LRPCa, IRPCa and HRPCa were estimated at ZAR401.3 million, ZAR371.1 million and ZAR1.4 billion, respectively. CONCLUSION: This study estimated the cost for diagnosis and treatment of localised PCa according to national clinical guidelines for PCa control and management. The costs increased with each risk category of the cancer. The study highlights the need for policy-makers to increase early detection and management, to reduce the need for high-cost interventions.

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Engagement in antenatal and HIV care among pregnant women before and after Option B+ policy implementation in South Africa.

Hwang C, Jinga N, Dheda M … +6 more , Mhlongo O, Phungula P, Clouse K, Huffman MD, Fox MP, Maskew M

S Afr Med J · 2026 Feb · PMID 42246790 · Publisher ↗

BACKGROUND: Substantial gains have been made in South Africa (SA) in the prevention of vertical transmission of HIV over the past decade. OBJECTIVE: To determine whether engagement in antenatal and HIV care among pregnan... BACKGROUND: Substantial gains have been made in South Africa (SA) in the prevention of vertical transmission of HIV over the past decade. OBJECTIVE: To determine whether engagement in antenatal and HIV care among pregnant women living with HIV (WLWH) differed after Option B+ implementation. METHODS: We analysed cohort data from a pregnancy and birth defects surveillance system in KwaZulu-Natal (KZN). We report on two co-primary outcomes related to engagement in HIV care: (i) timing and number of antenatal care (ANC) visits during the pregnancy period; and (ii) timing of antiretroviral therapy (ART) initiation (both self-reported ART use in interviews and observed initiation of treatment in maternal records). The association of policy era on the timing of ANC presentation was assessed using log-binomial regression modelling. We also report proportions initiating ART before or during pregnancy stratified by policy era. RESULTS: Data from 40 357 women, including 16 016 (40%) WLWH were analysed. During the Option B+ era, 24% of pregnant WLWH attended their first antenatal care visit during the first trimester, compared with 16% during the Option B era (relative risk 1.52; 95% confidence interval 1.41 - 1.64). The proportion of WLWH who initiated ART prior to pregnancy was also higher during the Option B+ era than the Option B era, though this result was limited by missing data. CONCLUSION: Engagement in antenatal and HIV care improved after Option B+ implementation. In the Option B+ era, SA has made significant progress toward the goal of eliminating mother-to-child transmission of HIV.

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A critical juncture: Reimagining a unified, integrated HIV response in South Africa.

Rees K, Wolvaardt G, Chidarikire T … +10 more , Dietrich JJ, Ibisomi L, Kufa-Chakezha T, Mabuto T, Maimela G, Mudimu E, Scott L, Smith P, Sohaba N, Chetty-Makkan C

S Afr Med J · 2026 Feb · PMID 42246789 · Publisher ↗

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Outcomes of emergency resuscitative thoracotomies in a trauma unit in Johannesburg, South Africa.

Pswarayi R, Burns C, Wineberg D

S Afr Med J · 2025 Dec · PMID 42246788 · Publisher ↗

BACKGROUND: Emergency resuscitative thoracotomies (ERTs) are life-saving procedures for traumatic cardiac arrest or severe haemorrhage, but their outcomes remain variable and are influenced by several factors, including... BACKGROUND: Emergency resuscitative thoracotomies (ERTs) are life-saving procedures for traumatic cardiac arrest or severe haemorrhage, but their outcomes remain variable and are influenced by several factors, including timing, mechanism of injury and the presence of initial signs of life. Studies on ERT outcomes predominantly originate from well-resourced settings, leaving a gap in understanding their effectiveness in resource-constrained environments. OBJECTIVE: To conduct a prospective audit of ERTs performed at a level 1 trauma unit over a 1-year period (1 April 2023 - 31 March 2024), assessing initial presentation characteristics, indications for ERT and subsequent outcomes in terms of survival and complications. METHODS: A prospective analysis of 19 consecutive patients who underwent ERT was performed. Data included demographics, mechanism of injury, initial physiological parameters, ERT indications, resuscitation times, blood product transfusions, complications and survival to discharge. RESULTS: The study comprised predominantly male patients (94.74%) with a wide age range (19 - 68 years). Penetrating trauma was the most common mechanism of injury (94.44%). An association was observed between shorter interval between fluid resuscitation time and commencement of ERT time and survival. Elevated lactate levels and acidosis were more frequent in non-survivors. A high mortality rate was noted (only one patient survived). CONCLUSION: This study did not find statistically significant results, but recognising the importance of prompt and ongoing resuscitation in improving survival after ERT is consistent with existing literature. However, the small sample size significantly limits the ability to apply these findings to other cases. Larger studies are necessary to definitively establish the impact of factors such as resource limitations on ERT outcomes in under-resourced settings. The high mortality rate highlights the need for focused research into improving patient selection criteria, optimising ERT techniques and addressing resource constraints in developing countries.

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Maternal and neonatal outcomes in patients with type 1 diabetes mellitus in pregnancy in a South African cohort.

Yudelowitz G, Goolam Mahyoodeen N

S Afr Med J · 2025 Dec · PMID 42246787 · Publisher ↗

BACKGROUND: Women with type 1 diabetes mellitus (T1DM) are at high risk of maternal, pregnancy and neonatal complications. Limited data on this topic are available in Africa. OBJECTIVE: To describe characteristics of pat... BACKGROUND: Women with type 1 diabetes mellitus (T1DM) are at high risk of maternal, pregnancy and neonatal complications. Limited data on this topic are available in Africa. OBJECTIVE: To describe characteristics of patients in South Africa with T1DM in pregnancy, and associated outcomes. METHODS: Clinical and biochemical data were collected on 273 women with T1DM: maternal clinical characteristics, glycated haemoglobin (HbA1c) and maternal and neonatal complications and outcomes. RESULTS: There was a statistically significant decline in HbA1c from first presentation to delivery (8.7% (standard deviation (SD) 2.2) v. 6.4% (SD 2.4)), respectively; p<0.00001). The perinatal mortality rate was 7.2%. In this cohort, 31.9% of patients experienced hypoglycaemia. Patients with hypoglycaemia had a significantly longer duration of diabetes, and higher HbA1C than those without hypoglycaemia (7.5 (SD 5.7) v. 6.1 (SD 4.5) years, p=0.002; 9.0% (SD 1.9) v. 8.5% (SD 2.3), p=0.04, respectively)). CONCLUSION: This cohort showed a high perinatal mortality rate and a high prevalence of hypoglycaemia and caesarean section. Intensification in glycaemic control is important to improve outcomes, but comes with challenges. A significant HbA1C reduction can be achieved with regular follow-up and management with a multidisciplinary team. Despite poor baseline glycaemic control, the prevalence of congenital abnormalities and macrosomia was low.

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The usability of an electronic health record in a public healthcare facility in South Africa.

De Villiers D, Martin L, Beeka VM … +8 more , Ismail M, Mdletshe S, Mongalo N, Mponda N, Conradie W, Al-Ubaydli M, Xenou M, Edge J

S Afr Med J · 2025 Dec · PMID 42246786 · Publisher ↗

BACKGROUND: An electronic health record (EHR) is a record of patient health information generated by encounters in healthcare delivery settings, and it plays a crucial role in the digital evolution of healthcare. EHRs, s... BACKGROUND: An electronic health record (EHR) is a record of patient health information generated by encounters in healthcare delivery settings, and it plays a crucial role in the digital evolution of healthcare. EHRs, such as 'Patients Know Best' (PKB), are commonly used in health systems of developed countries, but are lacking in developing countries. Challenges and opportunities surrounding EHRs in Africa have been identified, but limited literature exists on how these factors may impact the practical use of digital health technologies within South Africa (SA). OBJECTIVES: To determine the usability of the PKB platform, as indicated by the patients and clinical staff registered on PKB at the Breast and Endocrine Surgery Clinic, Tygerberg Hospital (TBH). In addition, this study aimed to determine patients' and clinical staff's level of engagement with the PKB platform. Level of engagement was compared with a similar patient user group in the UK. METHODS: A prospective cohort study was conducted at the Breast and Endocrine Surgery Clinic, TBH. One hundred and fifty participants, including clinic patients and staff, were enrolled. Demographic information was collected at the time of recruitment, and a questionnaire measuring perceived PKB usability was administered electronically 6 weeks post enrolment. User engagement metrics were recorded during the study. Demographic and user engagement data from 49 patients using PKB in the UK were used for comparison purposes. Statistical analysis allowed for a description of the sample's demographics, a comparison of engagement levels between groups, an assessment of PKB platform usability and the identification of factors associated with completing the questionnaire. RESULTS: During the study period, 42% of SA participants registered on PKB, 26% logged in and 20% completed the usability questionnaire, for which an adequate PKB usability score was determined. The 45 - 54-year age group engaged most, with a maximum range of 11 - 20 logins recorded. The PKB feature most frequently accessed was the message/consultation feature. By comparison, almost all (96%) UK participants completed registration and logged in. The 55 - 64-year age group engaged most, with a maximum range of over 120 logins recorded. Laboratory results were the most frequently accessed feature. CONCLUSION: Implementing an EHR system such as PKB without necessary adaptations in the current SA public healthcare system environment is not feasible. Adaptations required include allowing patients access to the EHR system without an email address, integrating the EHR system with existing information technology infrastructure and streamlining hospital digital notes with EHR systems to enhance patient engagement and reduce healthcare worker burden.

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The association between reproductive hormones and asthma-related outcomes in boys in the rural Western Cape Province, South Africa.

Phuti MS, Dalvie MA, Olaniyan T … +2 more , Basera W, Jeebhay MF

S Afr Med J · 2025 Dec · PMID 42246785 · Publisher ↗

BACKGROUND: Asthma is more prevalent and severe among boys than girls, but this pattern reverses after puberty. It has been suggested that reproductive hormones may play a role in explaining these sex differences after p... BACKGROUND: Asthma is more prevalent and severe among boys than girls, but this pattern reverses after puberty. It has been suggested that reproductive hormones may play a role in explaining these sex differences after puberty. However, the evidence for this relationship remains limited, as there have been no previous studies conducted on children in low- and middle-income countries on several reproductive endocrine hormones. OBJECTIVE: To investigate the association between reproductive endocrine hormones and asthma-related outcomes among boys residing in a rural setting. METHODS: Data on asthma outcomes and hormone levels were analysed from a cross-sectional study of 314 boys (aged 6 - 18 years) in the rural Western Cape Province, South Africa (SA). These were collected using an abbreviated International Study of Asthma and Allergies in Childhood questionnaire. Testosterone (total serum testosterone (TST) and free testosterone (FT)), luteinising hormone (LH), serum follicle- stimulating hormone (FSH), oestradiol and serum hormone-binding globulin (SHBG) were assessed using electrochemiluminescence immunoassays. RESULTS: Current wheezing (CW), asthma symptom score ≥2 and parental-reported asthma (PA) prevalence were 6.1%, 6.7% and 8.0%, respectively. Multivariate analysis showed that increasing levels of detected TST were significantly negatively associated with CW (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.45 - 0.98) and asthma symptom score (OR 0.64, 95% CI 0.43 - 0.95), while no statistically significant association was observed for PA (OR 0.86, 95% CI 0.59 - 1.25). FT levels showed an inverse association with all asthma- related outcomes, with a statistically significant association with asthma symptom score. Similar associations were found for FSH, while associations with LH were less consistent across outcomes, and no association was observed for oestradiol and SHBG. CONCLUSION: Our findings suggest that increasing serum testosterone levels (including those in the normal range and those above the normal range) detected among boys from rural settings in the Western Cape Province, SA, are associated with a reduced risk of asthma after adjusting for important underlying risk factors.

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Distribution and demographics of critical care subspecialists for adult patients in South Africa.

Gangen U, Joubert I, Wagstaff D

S Afr Med J · 2025 Dec · PMID 42246784 · Publisher ↗

BACKGROUND: Critical care has been a recognised subspecialty in the Health Professions Council of South Africa (HPCSA) since 1992, with a formal examination to obtain the Certificate of Critical Care established in 1999... BACKGROUND: Critical care has been a recognised subspecialty in the Health Professions Council of South Africa (HPCSA) since 1992, with a formal examination to obtain the Certificate of Critical Care established in 1999 with the Colleges of Medicine of SA. SA is a country fraught with inequality, which is reflected in the population's unequal access to subspecialist-driven critical care. Intensive care units (ICUs) led by critical care subspecialists deliver more efficient and higher-quality care, with improved mortality rates and reduced lengths of ICU stay. OBJECTIVE: To count registered critical care subspecialists in SA, make comparisons with similar upper-middle-income countries, describe the workforce density across the provinces and report its make-up with regard to ethnicity and gender. METHODS: We combined a retrospective record-based review and an anonymous survey. De-identified data describing the number, location, ethnicity and gender of registered critical care subspecialists in 2023 were gathered from the HPCSA. An anonymous survey was sent to members of the Critical Care Society of Southern Africa. The density of critical care subspecialists per 100 000 adult population was calculated using publicly available data from the 2022 population census. RESULTS: As of December 2023, the total number of adult critical care subspecialists registered with the HPCSA was 82. This is almost double the number present in 2010. However, the density per 100 000 population grew by only 28%, as the adult population has also increased over time. CONCLUSION: This study has contributed new findings on the subspecialist critical care workforce by doing an official count of critical care subspecialists as recognised by the HPCSA. SA has an inadequate supply of critical care subspecialists per 100 000 population compared with similar upper-middle-income countries. There is also a maldistribution of specialists between provinces, with the more urbanised and densely populated provinces having a disproportionally high number of critical care subspecialists, leading to unequal access to this field of care.

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Association of tuberculosis active case finding with knowledge, attitudes, stigma and health-seeking behaviour among patients in Eswatini.

Chomutare H, Yah CS, Musekiwa A … +1 more , Sibanda J

S Afr Med J · 2025 Dec · PMID 42246783 · Publisher ↗

BACKGROUND: Tuberculosis (TB) poses a significant global public health challenge, with >10 million new infections reported annually, making it one of the top 10 causes of death worldwide. Eswatini has one of the world's... BACKGROUND: Tuberculosis (TB) poses a significant global public health challenge, with >10 million new infections reported annually, making it one of the top 10 causes of death worldwide. Eswatini has one of the world's highest TB incidence rates, with an estimated rate of 398 cases per 100 000 population in 2019, as reported by the World Health Organization. In Eswatini, despite the implementation of TB active case finding (ACF) interventions aimed at improving TB case detection and reducing community transmission, there is limited empirical evidence on their association with improved knowledge, attitudes and health-seeking behaviour. This study seeks to address this gap to inform future advocacy, communication and social mobilisation strategies for enhanced TB control and prevention. OBJECTIVE: To assess the association of TB ACF and improved knowledge, attitudes, perceptions of stigma and discrimination and health- seeking behaviours among individuals diagnosed with TB. METHODS: The study employed a cross-sectional design from April to May 2023 to review Eswatini TB patients from treatment registers at 14 selected TB basic management units. The TB treatment register was used to determine the entry point of TB patients into care. Those exposed to the ACF programme were located by the TB champions (community volunteers engaged to conduct TB ACF) (n=208), while the unexposed were drawn from outpatients (n=204). The scores for overall knowledge, attitude and health-seeking behaviour were transformed into binary categories based on the calculated median scores. Descriptive statistics were used to summarise participant characteristics, and a multinomial logistic regression model was applied to determine significant risk factors. RESULTS: A total of 412 TB patients (mean (standard deviation) age 42.21 (4.9) years) were included in the study, and 260 (63%) displayed knowledge about TB. Among the patients, 268 (65%) reported that they had not felt stigmatised, 147 (36%) had sought care early (within 2 weeks) and 297 (72%) exhibited good health-seeking behaviour. Exposure to ACF was associated with higher odds of TB knowledge (adjusted odds ratio (aOR) 6.85; 95% confidence interval (CI) 4.21 - 11.14; p<0.001) and higher odds of seeking care within 2 weeks of symptom onset (aOR 6.84; 95% CI 4.06 - 11.52; p<0.001). CONCLUSION: Generally, patients found through ACF were associated with greater knowledge about TB and favourable health-seeking behaviour. However, there remained a notable proportion of TB patients without adequate knowledge and with suboptimal health-seeking behaviour, who may pose a considerable risk for TB transmission.

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South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde[JOURNAL]

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