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

{"title":"The impact of the COVID-19 pandemic on maternal mortality in a South African metropole (2020 - 2021): A retrospective cohort study.","authors":"M Hunter, L Hannan, A Boulle, M Matjila, M Ismail, J Euvrard, M-A Davies, E Kalk","doi":"10.7196/SAMJ.2026.v116i5.3856","DOIUrl":"10.7196/SAMJ.2026.v116i5.3856","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, there was a notable increase in maternal deaths across South Africa (SA). Pre pandemic, the Western Cape Province, SA, had made significant strides towards reducing maternal mortality, including HIV-related deaths. However, this progress was reversed in the pandemic period despite a relative protection of maternity services. The direct biological impact of SARS- CoV-2 may not be the sole reason for the increase in mortality.</p><p><strong>Objective: </strong>To evaluate the relative change in the maternal death rate (MDR) for non-SARS-CoV-2-related deaths during the pandemic v. pre pandemic in 2019.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including all pregnant women with a pregnancy outcome enumerated in the Provincial Health Data Centre in the Metro West region of Cape Town from 1 January 2019 to 31 January 2022. Cause of in-facility maternal death and relationship to SARS-CoV-2 infection was determined by folder review. We used interrupted time series (ITS) analysis to assess the impact of the pandemic period on non-SARS-CoV-2 causes of maternal mortality.</p><p><strong>Results: </strong>Over 98 000 women were included, with 68 deaths reviewed. The ITS model demonstrated no statistically significant change in the MDR for non-SARS-CoV-2-related deaths during the pandemic, with confidence intervals (CIs) that crossed the null for both a step change at the start of the pandemic (3.12/10 000 pregnancy outcomes; 95% CI -1.66 - 7.90) and a subsequent attenuation in the pre-pandemic downward gradient in MDR (slope change 0.47/10 000 pregnancy outcomes per month (95% CI -0.02 - 0.96). Folder review of deaths demonstrated an increase in opportunistic infections as a cause of death relative to the pre-pandemic period, mainly in women with HIV.</p><p><strong>Conclusion: </strong>Maternal healthcare services were largely protected from service disruptions during the COVID-19 pandemic. However, the increase in HIV-related opportunistic infections suggests that optimising maternal health requires an all-encompassing, functional healthcare ecosystem that can robustly maintain services for all health conditions.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3856"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166727","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":"Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection.","authors":"M Swart","doi":"10.7196/SAMJ.2026.v116i4.4818","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i4.4818","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e4818"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166892","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":"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.","authors":"M R Tlali, M A Davies, C Lombard, C Mathews, C D Parry","doi":"10.7196/SAMJ.2026.v116i4.3164","DOIUrl":"10.7196/SAMJ.2026.v116i4.3164","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3164"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166893","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":"Strengthening system leadership for the District Health System.","authors":"L Gilson, H Schneider, B Engelbrecht, M Shung-King","doi":"10.7196/SAMJ.2026.v116i4.3562","DOIUrl":"10.7196/SAMJ.2026.v116i4.3562","url":null,"abstract":"<p><p>Those working within the South African (SA) District Health System (DHS) have various roles in addressing population health and wellbeing needs. These include motivating and co-ordinating local providers offering community, primary healthcare facility and district hospital services, including prevention and promotion services, and facilitating whole-of-government and whole-of-society collaboration with other government and social actors. These roles cannot be fulfilled by exercising traditional, command-and-control public sector managerial authority. Instead, distributed system leadership is required: a form of leadership practised by individuals and teams that enables the collective action needed to address complex health needs, and that is supported by wider organisational structures and processes. Based on a range of experience, this in-practice article presents the rationale for, and description of, system leadership within the DHS; appraises current approaches to leadership and management development in South Africa from this perspective; and outlines a system leadership development approach that offers promise for DHS and health system strengthening.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3562"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166616","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":"The 6th UCT Bongani Mayosi Memorial Lecture: Fostering evidence-based humanity in the academy and beyond: Lessons from the legacy of Prof. Bongani Mayosi.","authors":"L Thabane","doi":"10.7196/SAMJ.2026.v116i4.4844","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i4.4844","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e4844"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166718","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":"Narrowing the care and treatment gap through a human resources for mental health plan: Key considerations.","authors":"M Freeman, G Wolvaardt, G Maimela","doi":"10.7196/SAMJ.2026.v116i4.4774","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i4.4774","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e4774"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166904","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":"Opportunities for health system strengthening to reduce preventable trauma deaths in the Western Cape Province, South Africa: Findings from an expert panel review.","authors":"J Dixon, S De Vries, S Bhaumik, C Dymond, M Ross, J Finn, H Geduld, E Steyn, H Lategan, L Hodsdon, J Verster, S Mukonkole, K Doubell, N-K Mould-Millman","doi":"10.7196/SAMJ.2026.v116i4.3030","DOIUrl":"10.7196/SAMJ.2026.v116i4.3030","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To assess the preventability of trauma deaths that had contact with the health system, and the associated panellists' recommendations for improvements.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3030"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166894","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":"Evaluation of healthcare resource utilisation and costs associated with anogenital warts in South Africa.","authors":"S Mutambirwa, M H Botha, B M Mulaudzi, M S Mabenge, T Gaqana","doi":"10.7196/SAMJ.2026.v116i4.2772","DOIUrl":"10.7196/SAMJ.2026.v116i4.2772","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To assess the HCRU patterns and associated treatment costs for AGW across the public and private sectors.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e2772"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166906","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":"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.","authors":"T Machemedze, P Mutevedzi, A Izu, N Myburgh, C Verwey, S Mahtab, Z Dangor, S Madhi","doi":"10.7196/SAMJ.2026.v116i4.3643","DOIUrl":"10.7196/SAMJ.2026.v116i4.3643","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3643"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166890","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":"Routine blood monitoring in acne vulgaris patients on isotretinoin: Is reassessment warranted? A retrospective cohort study from Tygerberg Hospital.","authors":"J Du Toit, N A Gray, T M Esterhuizen, W I Visser","doi":"10.7196/SAMJ.2026.v116i4.3588","DOIUrl":"10.7196/SAMJ.2026.v116i4.3588","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3588"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166901","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}