South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde最新文献

{"title":"Trends in general and abdominal obesity in South African adults, 1998 - 2017: A joint analysis of nine population surveys.","authors":"A Cois, J H Goedecke, K Adjaye-Gbewonyo","doi":"10.7196/SAMJ.2026.v116i7.4015","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i7.4015","url":null,"abstract":"<p><strong>Background: </strong>Obesity, a health condition characterised by abnormal accumulation of body fat, is a major public health problem, with the number of affected individuals forecasted to rise sharply worldwide. Local epidemiological data are needed to understand the epidemic's specific characteristics and to implement effective evidence-based prevention strategies.</p><p><strong>Objective: </strong>To provide insight into the South African (SA) obesity epidemic by analysing trends in the prevalence of general and abdominal obesity between 1998 and 2017.</p><p><strong>Methods: </strong>Harmonised data on 134 029 adults (aged ≥18 years) from nine population surveys were analysed. For each survey dataset, the population distribution of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) was estimated, along with the prevalence of obesity and abdominal obesity according to standard epidemiological definitions. Metaregression models were fitted to estimate and compare the average rates of change of the multiple obesity indicators during the study period, for the whole population and by sex, population group, province of residence and geographical type (urban v. rural).</p><p><strong>Results: </strong>Among women, the distribution of BMI, WC and WHtR showed a significant rightward shift between 1998 and 2017, with increases in median values of 1.38 (95% confidence interval (CI) 0.91 - 1.84) kg/m2/decade for BMI, 4.04 (1.27 - 6.82) cm/decade for WC and 0.03 (0.01 - 0.04) units/decade for WHtR. The prevalence of obesity rose sharply, from 29.5% (28.1 - 30.8%) in 1998 to 42.7% (41.0 - 44.4%) in 2017. The prevalence of WC-defined and WHtR-defined abdominal obesity increased from 60.0% (58.6 - 61.3%) to 77.2% (76.0 - 78.4%), and from 62.8% (61.4 - 64.2%) to 78.7% (77.4 - 80.0%), respectively. Among men, changes in the distribution were modest and median trends not statistically significant, at 0.1 (-0.27 - 0.47) kg/m2/decade for BMI, 1.19 (-0.48 - 2.87) cm/decade for WC and 0.01 (-0.01 - 0.02) units/decade for WHtR. Obesity prevalence rose from 10.1% (8.9 - 11.3%) in 1998 to 12.1% (10.7 - 13.4%) in 2017, WC-defined abdominal obesity from 21.6% (19.8 - 23.4%) to 26.4% (24.3 - 28.4%) and WHtR-defined abdominal obesity from 39.7% (37.8 - 41.7%) to 42.8% (40.6% - 45.0%). The prevalence of both general and abdominal obesity also differed across geographical type, province and population group, with a disproportionately rapid increase among groups and areas that initially exhibited lower prevalence.</p><p><strong>Conclusion: </strong>Between 1998 and 2017, the prevalence of both general and abdominal obesity in the SA adult population rose substantially. Evidence-based prevention efforts and policy strategies are urgently needed to curb the growing burden, especially among women.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 7","pages":"e4015"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective review of the clinical, biochemical and radiological spectrum of adrenal incidentalomas at Tygerberg Academic Hospital, South Africa.","authors":"M Hussain, T Jalavu, R Davis, W Conradie, M Conradie-Smit","doi":"10.7196/SAMJ.2026.v116i7.4238","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i7.4238","url":null,"abstract":"<p><strong>Background: </strong>An adrenal incidentaloma (AI) is a clinically unapparent adrenal mass >1 cm detected during imaging performed for reasons other than adrenal disease. The approach to AI is discussed extensively in international literature, but not specifically in resource-limited settings such as South Africa (SA).</p><p><strong>Objective: </strong>To describe the clinical, biochemical and radiological spectrum of AIs at Tygerberg Hospital (TBH), Cape Town, SA.</p><p><strong>Methods: </strong>This study was a retrospective descriptive review of all patients diagnosed with AI at TBH during the study period (1 January 2009 - 31 December 2023).</p><p><strong>Results: </strong>Two hundred and ninety-five (295) patient records were screened for inclusion using the radiology and admission records. Those excluded were duplicate entries (n=50), patients not meeting criteria for AI (n=47) and diagnosis of AI with no further investigation (n=113), leaving 85 patients included. A computed tomography scan was the most frequently utilised imaging modality (n=54; 64%). Indications were abdominal pain (n=27; 32%), other gastrointestinal complaints (n=10; 12%), abdominal mass (n=7; 8%), trauma (n=3; 4%) or other (n=38; 45%). Non-functional tumours comprised 87% (n=74). Functional tumours included pheochromocytoma (PCC) (n=5; 45%), mild autonomous cortisol secretion (MACS) (n=3; 27%), primary hypercortisolaemia (n=2; 18%) and androgen-producing tumours (n=1; 9%). Fourteen patients (16%) had surgery.</p><p><strong>Conclusion: </strong>Our study demonstrated that PCC and cortisol-producing adenomas were the most common functional tumours. This is in contrast to most international studies, which show MACS as the most common functional AI. This likely reflects regional screening bias and underutilisation of dexamethasone suppression testing, rather than the true disease prevalence of PCC in the Western Cape Province. A large proportion of patients with a diagnosis of AI did not undergo any further investigation. Awareness among clinicians and collaboration with radiologists for early identification and referral of AI cases is imperative.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 7","pages":"e4238"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual misconduct as an institutional inconvenience: Silence, invisibility and complicity in health sciences in South Africa.","authors":"K Moodley, K Louw, N S Munung, A McKay, T Burgess, Z Essack, T Rossouw","doi":"10.7196/SAMJ.2026.v116i7.5503","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i7.5503","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 7","pages":"e5503"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health and rights of very young adolescents in low- and middle-income countries: A narrative review.","authors":"T Mohamed, Z Nene","doi":"10.7196/SAMJ.2026.v116i7.4290","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i7.4290","url":null,"abstract":"<p><strong>Background: </strong>Very young adolescents (VYAs), aged 10 - 14 years, represent a critical yet frequently neglected demographic in the field of sexual and reproductive health and rights (SRHR) research and programming. This developmental stage is characterised by rapid biological, cognitive, social and emotional changes that shape future sexual and reproductive trajectories. Despite their importance, the SRHR needs of VYAs remain under-represented in policy, research and service provision, particularly in low- and middle-income countries.</p><p><strong>Objectives: </strong>To synthesise existing evidence on the SRHR needs of VYAs, examine barriers and facilitators to service access, and identify strategies to strengthen age-appropriate SRHR interventions.</p><p><strong>Methods: </strong>A narrative review of English-language peer-reviewed literature, grey literature and global policy documents published between 2000 and 2024 was conducted using PubMed, Scopus and Google Scholar. Twenty-three relevant sources were included and synthesised thematically.</p><p><strong>Results: </strong>VYAs experience intersecting vulnerabilities related to early pubertal onset, restrictive gender norms, limited access to accurate SRHR information, and health systems that are primarily oriented towards older adolescents and adults. Barriers to SRHR information and services were reported in approximately half of the reviewed sources. Evidence indicates that early, context-specific interventions - particularly comprehensive sexuality education, parental engagement and adolescent-responsive health services - can improve SRHR knowledge and protective behaviours.</p><p><strong>Conclusion: </strong>Addressing the SRHR needs of VYAs is essential for advancing public health equity and broader development goals. Integrating tailored, rights-based approaches across health, education and policy frameworks can support healthier transitions through early adolescence.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 7","pages":"e4290"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns regarding toxicity associated with caffeine-containing pre-workout supplements.","authors":"J Taylor, G Tatz, N Madikizela, M Blockman","doi":"10.7196/SAMJ.2026.v116i6.5186","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.5186","url":null,"abstract":"<p><p>-.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e5186"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of a prognostic score for oesophageal cancer (PSOC) for patients treated with palliative intent in a resource-limited setting.","authors":"L Ferndale, S Bhadree, W C Chen","doi":"10.7196/SAMJ.2026.v116i6.4209","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.4209","url":null,"abstract":"<p><strong>Background: </strong>Oesophageal cancer (OC) is common in South Africa (SA), where late presentation limits curative treatment. In resource- constrained settings, staging may not benefit patients with a poor prognosis. The prognostic score for oesophageal cancer (PSOC), based on Eastern Cooperative Oncology Group performance status scale, body mass index and serum albumin, was previously developed to predict short-term survival.</p><p><strong>Objective: </strong>To externally validate PSOC in an independent cohort.</p><p><strong>Methods: </strong>We performed a retrospective validation study using prospectively collected data from two public sector hospitals in KwaZulu- Natal Province, SA. Eligible patients had histologically confirmed OC and complete PSOC data, and were treated with palliative intent. The primary endpoint was survival ≥3 months. Logistic regression assessed associations between PSOC and survival. Discrimination was quantified using the area under the receiver operating characteristic curve (AUROC), calibration with the Hosmer-Lemeshow test and accuracy with the Brier score. Secondary analyses evaluated overall survival (OS) with Kaplan-Meier and Cox models.</p><p><strong>Results: </strong>We included 465 patients (mean age 61 years; male:female ratio 1:1), 97% with squamous cell carcinoma. Higher PSOC scores predicted improved survival (score 4 v. 0: odds ratio 11.87, 95% confidence interval (CI) 4.87 - 28.91; p<0.001). AUROC was 0.681 (95% CI 0.630 - 0.732) with good calibration (Hosmer-Lemeshow p=0.920). Median OS was 4.8 months, with significant survival differences across score groups (log-rank p<0.001). The Brier score was 0.190, indicating good predictive accuracy.</p><p><strong>Conclusion: </strong>PSOC is a simple, validated tool for predicting short-term survival in OC, and may guide decisions on staging v. palliation in high-incidence, resource-limited settings.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e5118"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin scar characteristics in prediction of severe intraperitoneal adhesions in women undergoing repeat caesarean section.","authors":"M Mayibenye, G A B Buga, M Mdaka, N Nanjoh","doi":"10.7196/SAMJ.2026.v116i6.3175","DOIUrl":"10.7196/SAMJ.2026.v116i6.3175","url":null,"abstract":"<p><strong>Background: </strong>Caesarean section (CS) is the most performed abdominal procedure and is known to be associated with the development of intraperitoneal adhesions. These adhesions may lead to difficult repeat surgery and complications such as haemorrhage, and bladder and bowel injury. Determining which women are at risk for adhesions could help with triaging those who may be at risk for a complicated repeat surgery. Scar characteristics have been proposed as preoperative prediction tools for adhesions.</p><p><strong>Objectives: </strong>To assess whether abdominal scar characteristics correctly predict intraperitoneal adhesions in women undergoing repeat CS.</p><p><strong>Methods: </strong>In this prospective blinded observational study at Nelson Mandela Academic Hospital, in Eastern Cape Province of South Africa, 419 women were enrolled. We assessed whether we could use skin scar characteristics to predict the presence of intraperitoneal adhesions at repeat CS. Women who met the inclusion criteria were approached in the third trimester, and the previous CS scar was examined. The characteristic features of the scar were described and documented, while the findings were blinded to the surgeon who was carrying out the CS. The surgeon was instructed to describe the types of intraperitoneal adhesions and their characteristics in theatre, documenting them on the questionnaire.</p><p><strong>Results: </strong>Adhesions were present in 53.5% of the 419 women enrolled. Women with dense adhesions were older, and had more previous CSs, longer incision-to-delivery time and more blood loss. The type of incision did not predict adhesions. Depressed scars were more likely to be associated with dense adhesions (p<0.0001). Using a depressed scar as a predictor had a sensitivity of 21.4% (95% confidence interval (CI) 17.5 - 25.36), and a specificity of 96.4% (CI 94.63 - 98.19), meaning it missed most participants with adhesions but had an excellent ability to identify those without adhesions. It had a positive predictive value of 87.3% (CI 84.08 - 90.46) and negative predictive value of 50.2% (CI 46.68 - 58.24).</p><p><strong>Conclusion: </strong>Although abdominal scar characteristics have low sensitivity in predicting dense intraperitoneal adhesions, they have excellent specificity. The abdominal scar can therefore be used by surgeons to identify patients who are unlikely to have dense intraperitoneal adhesions. This would be particularly useful in district hospitals for triaging patients with previous CS who can be operated on safely, while referring others to level 2 or 3 hospitals.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e3175"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing tumour site and overall survival in colon v. rectal cancer in a longitudinal cohort study in Johannesburg, South Africa.","authors":"A Pincus, Y Moodley, L Campbell, D Kruger, V Soldati, J Fabian, P Gaylard, T K Marumo, L Prodehl, N Harran, B Bebington, P Ruff","doi":"10.7196/SAMJ.2026.v116i6.4087","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.4087","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) incidence is increasing globally, with disproportionately high mortality in low- and middle-income countries. Although colon and rectal cancers are often grouped together, anatomical, molecular and clinical differences suggest they may be distinct entities, warranting unique work-up, management and diagnosis. Data from sub-Saharan Africa comparing clinical presentation and mortality outcomes among those with colon and rectal cancer remain limited. This study aimed to address this knowledge gap.</p><p><strong>Objectives: </strong>To compare the clinicopathological features, associated risk factors and overall survival (OS) of patients with colon and rectal cancers in the cohort from the Colorectal Cancer in South Africa Study in Johannesburg, South Africa (SA).</p><p><strong>Methods: </strong>The cohort eligible for inclusion in this study comprised 325 patients, recruited from 2016 to 2019, with follow-up to January 2023. Sociodemographic, clinical, treatment and OS data were analysed. Comparison by tumour location was made using t-tests and ANOVA. Cox proportional hazards regression models assessed associations with OS. Kaplan-Meier analysis was used for survival estimation.</p><p><strong>Results: </strong>Rectal cancers accounted for 52.3% of cases, right-sided colon cancers 26.2% and left-sided colon cancers 21.5%. When comparing those who presented with colon v. rectal cancers, no significant differences were observed in self-reported ethnicity, socioeconomic status (SES), family history of cancer, tobacco use, body mass index, or presence of comorbidities. Alcohol use was more common among those with colon cancer (p=0.035), and treatment differed significantly by tumour site (p<0.0001). Male sex (hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.25 - 2.61, p=0.0017), low SES (HR 3.24, CI 1.86 - 5.65, p<0.0001) and distant disease at presentation (HR 3.85, CI 2.26 - 6.57, p<0.0001) were most strongly associated with poorer OS. The tumour site had no impact on OS.</p><p><strong>Conclusion: </strong>In this SA cohort of patients with CRC, tumour site did not affect overall survival. However, male sex, advanced stage at diagnosis and low socioeconomic status were associated with poorer OS.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e4087"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological features of pregnancy-associated breast cancer at Chris Hani Baragwanath Academic Hospital, South Africa.","authors":"L Levenberg, D Kruger, H Cubash, N Murugan","doi":"10.7196/SAMJ.2026.v116i6.4285","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.4285","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-associated breast cancer (PABC), defined as cancer diagnosed during pregnancy or up to 1 year postpartum, tends to present with tumours displaying more adverse prognostic pathological features compared with those diagnosed outside of pregnancy. It is unclear if this is due to the more aggressive tumour biology associated with early-onset breast cancer, or influenced by the pregnancy independently.</p><p><strong>Objectives: </strong>To compare the clinicopathological features of patients presenting with PABC with their age-matched non-PABC controls.  Methods. Records of females of reproductive age diagnosed with breast cancer from 1 October 2006 to 31 October 2020 were retrospectively reviewed using the Chris Hani Baragwanath Academic Hospital Breast Unit electronic database. Cases of PABC were identified, and non‑PABC cases were selected as age-matched controls at a 2:1 ratio to each PABC case.</p><p><strong>Results: </strong>A total of 1 056 patients were eligible for inclusion, with 63 meeting criteria for PABC. After excluding 10 cases, 53 PABC cases were age-matched to 106 controls. The incidence of PABC was 1.5%, with a median age of 36 years. Over 90% of patients presented with palpable breast masses. PABC patients presented with significantly larger tumours (5.5 cm v. 4.0 cm) and higher nuclear grades compared with age-matched controls. PABC patients also demonstrated more oestrogen (40% v. 23%) and progesterone receptor (47% v. 28%) negativity compared with controls.</p><p><strong>Conclusion: </strong>PABC patients from our population presented with more adverse clinicopathological tumour characteristics than their age-matched controls. These findings align with existing literature, and would likely contribute to a worse prognosis in this patient group.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e4285"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental pathology of neonates diagnosed with encephalopathy soon after birth: A retrospective analytical study.","authors":"K L Sebolai, O Mekgoe, C A Wright, K Thandrayen, S C Velaphi","doi":"10.7196/SAMJ.2026.v116i6.3811","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.3811","url":null,"abstract":"<p><strong>Background: </strong>Placental pathology has been linked to neonatal encephalopathy (NE). Despite the high prevalence of NE in low- and middle- income countries (LMICs), there are limited published studies exploring this association from LMICs.</p><p><strong>Objective: </strong>To describe and analyse the histopathology of placentas from neonates diagnosed with encephalopathy shortly after birth.</p><p><strong>Methods: </strong>A retrospective analytical study was conducted on neonates diagnosed with encephalopathy at Klerksdorp/Tshepong hospital complex, South Africa. Placentas from term and near-term neonates (birthweight ≥2 000 g) diagnosed with encephalopathy within the first 24 hours of life were sent for histopathological examination. Neonates were grouped into those with encephalopathy with or without intrapartum hypoxia (IH) (base deficit ≥12 mmol/L). The severity of NE was assessed as mild, moderate or severe, according to Sarnat staging. The types and extent of placental lesions were compared between those with mild and moderate-to-severe NE, and between cases with or without IH.</p><p><strong>Results: </strong>Of 16 336 live births, 271 neonates were diagnosed with NE, and of these, 193 (71.2%) had NE with IH. Placental histopathology results were available for 239 neonates (88.2%). The median placental weight was 428 g, with 46.6% of placentas weighing below the 10th percentile. Cord abnormalities were observed in 27.2% of placentas. Nearly all placentas (98.2%) exhibited at least one histopathological lesion. The most common microscopic placental lesions identified were maternal vascular malperfusion (MVM) (55.6%), fetal vascular malperfusion (55.1%), acute chorioamnionitis (41.2%) and villitis of unknown aetiology (28.9%). There was a significant association between NE with IH and the presence of MVM, with an adjusted odds ratio of 3.24 (95% confidence interval 1.19 - 8.79). No significant association was found between the presence or number of different placental lesions and the severity of NE. Factors associated with severity of any NE (with and without IH) included an Apgar score <7 at 10 minutes (p<0.001) and pH <7.00 (p<0.001).</p><p><strong>Conclusion: </strong>A high proportion of neonates with encephalopathy showed evidence of IH. Approximately half of the placentas were below the 10th percentile in weight, and about a quarter had macroscopic cord abnormalities. Almost all neonates with encephalopathy displayed ≥1 microscopic placental lesion. A strong association was found between the presence of MVM and NE with IH.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e3811"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}