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

{"title":"Insulin pens are a necessity, not a luxury: Addressing inequitable access to diabetes treatment in South Africa's public sector.","authors":"B Jordaan, M Leuschner, V Steenkamp","doi":"10.7196/SAMJ.2025.v116i3.3606","DOIUrl":"10.7196/SAMJ.2025.v116i3.3606","url":null,"abstract":"<p><p>Diabetes is a growing public health crisis in South Africa (SA), driven by urbanisation, sedentary lifestyles, poor dietary habits and an ageing population. The country has one of the highest diabetes prevalence rates in sub-Saharan Africa, with millions affected, many of whom remain undiagnosed. The disease disproportionately impacts low-income communities, where limited healthcare access and late diagnoses lead to severe complications and economic strain. While insulin pens improve glycaemic control and patient adherence, they remain largely inaccessible in the public sector owing to high costs and restrictive procurement policies. Government reliance on vials and syringes exacerbates treatment disparities, increasing the risk of medication errors and poor health outcomes. Addressing these barriers requires policy reform, expanded subsidies and improved procurement strategies to ensure equitable access to insulin pens. By prioritising patient-centred diabetes care, SA can reduce hospitalisations, enhance treatment adherence and alleviate the broader economic and healthcare burden of diabetes.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3606"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166826","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":"Corrigendum.","authors":"Claudia Naidu","doi":"10.7196/SAMJ.2025.v116i3.5029","DOIUrl":"https://doi.org/10.7196/SAMJ.2025.v116i3.5029","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e5028"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166899","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 massive non-accreditation of medical schools in Angola by INAAREES: An urgent call for reforms in medical education in the country.","authors":"H O Chitumba, V N Nungulo, E D M Sachocal, C V M Nunes","doi":"10.7196/SAMJ.2025.v116i3.4721","DOIUrl":"https://doi.org/10.7196/SAMJ.2025.v116i3.4721","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e4721"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166882","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":"Why data is the most cost-effective investment for health technology assessment in South Africa.","authors":"E Thsehla","doi":"10.7196/SAMJ.2025.v116i3.4628","DOIUrl":"10.7196/SAMJ.2025.v116i3.4628","url":null,"abstract":"<p><p>-.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e4628"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166871","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 final referral: A 1-year retrospective review of death referrals through the lens of forensics.","authors":"S Van der Merwe, I Mentoor, N-K Mould-Millman, J Verster","doi":"10.7196/SAMJ.2025.v116i3.3644","DOIUrl":"10.7196/SAMJ.2025.v116i3.3644","url":null,"abstract":"<p><strong>Background: </strong>Under South African (SA) law, all unnatural, sudden and unexpected deaths, as well as procedure-related deaths, must be reported to the SA Police Service and referred to the Forensic Pathology Service (FPS). In the Western Cape Province, referrals to FPS require completion of the FPS100 form by a senior medical practitioner.</p><p><strong>Objective: </strong>To assess the appropriateness, completeness and legibility of FPS100 referral forms submitted to Tygerberg Forensic Pathology Services over the course of 1 year in the Western Cape Province, and to evaluate whether the suspected presumed cause of death was in line with the World Health Organization's standards.</p><p><strong>Methods: </strong>This was a cross-sectional retrospective review of all FPS100 referral forms submitted to the Tygerberg Forensic Pathology Mortuary over 1 year. An experienced forensic pathology medical practitioner reviewed the appropriateness, completeness, legibility, commissioning status and accuracy of presumed cause-of-death classifications reflected on the FPS100 referral forms received.</p><p><strong>Results: </strong>Of the 1 252 cases accompanied by a referral form, 81.6% were deemed incomplete, with 22.3% uncommissioned, rendering them inadmissible in court. Even though most of the referrals were legible, over 43% indicated misclassified formulations of the presumed causes of death.</p><p><strong>Conclusion: </strong>The study revealed significant deficiencies in FPS referrals, including incomplete or uncommissioned forms and frequent misclassification of presumed causes of death. These shortcomings undermine the legal validity of the referral forms, and may delay medicolegal processes and even result in direct subpoenas to referring medical practitioners. The findings highlight the urgent need for strengthened training for medical practitioners across all levels of experience, and for the implementation of standardised referral protocols. Equally important is enhancing awareness of the medicolegal value of FPS involvement, and the critical impact of accurate, high- quality referrals.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3644"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166859","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":"Declining adolescent pregnancies in South Africa: Insights from public sector data, 2021 - 2025.","authors":"P Barron, N Lince-Deroche, L Bamford, H Subedar, T Mbatha, Y Pillay","doi":"10.7196/SAMJ.2025.v116i3.4414","DOIUrl":"10.7196/SAMJ.2025.v116i3.4414","url":null,"abstract":"<p><strong>Background: </strong>In South Africa (SA), adolescent pregnancy, particularly in very young girls, is an issue of keen public and political concern given its social and health implications.</p><p><strong>Objective: </strong>To provide a quantitative baseline that SA can use for targeting its efforts to address adolescent pregnancy and for measuring progress over time.</p><p><strong>Methods: </strong>Using public sector service data for deliveries and terminations of pregnancies, we estimated adolescent pregnancy rates among adolescent girls aged 10 - 14 and 15 - 19 years for the financial years 2021/22 - 2024/25.</p><p><strong>Results: </strong>In 2025, the adolescent pregnancy rate (including births and terminations) for 15 - 19-year-olds was 48.9 per 1 000. For 10 - 14-year-olds, it was 1.2 per 1 000. Both the total number of births and the adolescent pregnancy rates dropped annually over the 4-year period of review, and reversed the previous trend of increases from 2017/18 through to 2020/21. Although there were decreases in births and adolescent pregnancy rates in all provinces, there were greater decreases in the more rural provinces compared with the more urban provinces (e.g. Western Cape and Gauteng). Termination of pregnancy rates were also higher in more urban provinces.</p><p><strong>Conclusion: </strong>While SA already has a strong policy framework for addressing adolescent pregnancy, there is a need for a national strategy and improved co-ordination of efforts. Indeed, the updated 2025 World Health Organization guidelines on preventing adolescent pregnancy and mitigating its adverse impacts highlight the need for a broad, multisectoral approach.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e4414"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166849","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":"Breast cancer surgical services in South Africa: Availability and barriers to guideline-concordant care.","authors":"L Milligan, L Roodt, F Malherbe, L Cairncross","doi":"10.7196/SAMJ.2025.v116i3.3154","DOIUrl":"10.7196/SAMJ.2025.v116i3.3154","url":null,"abstract":"<p><strong>Background: </strong>Female breast cancer has become the most frequently diagnosed cancer globally. The incidence of cancer in South Africa (SA) is projected to double by 2030, and services to address the growing burden of disease are urgently needed. The distribution and capacity of existing breast cancer surgical services in SA haVE not been reported.</p><p><strong>Objective: </strong>To provide a quantitative descriptive analysis of the status of breast cancer surgical services in the public healthcare sector in SA.</p><p><strong>Methods: </strong>A descriptive cross-sectional analysis of breast cancer surgical services was performed, including the burden of disease, stage of diagnosis, available diagnostic and therapeutic modalities, waiting time to surgery and barriers to care. Clinicians at every public sector healthcare facility providing surgical care to breast cancer patients were approached to complete a quantitative survey for the year 2019.</p><p><strong>Results: </strong>Data from 43 hospitals across all nine SA provinces were included. Clinicians reported a greater proportion of late-stage breast cancer (67%) than early breast cancer (33%) at diagnosis. The less urban provinces had poorer access to diagnostic and staging modalities. Most facilities were able to provide breast-conserving surgery (79%), while fewer facilities could offer sentinel lymph node biopsy (SLNB) (53%) and still fewer could offer breast reconstruction (35%). Clinicians cited the foremost barriers to standard of care as advanced disease at diagnosis, inadequate access to surgical expertise and lack of access to essential equipment. The national average waiting time for surgery (28 days) is within the recommended timeframe from decision to treat. The representation of the multidisciplinary team across facilities does not comply with national staffing recommendations for a breast unit.</p><p><strong>Conclusion: </strong>Broad disparities exist in access to essential staging and diagnostic modalities between facilities in different provinces. In many settings, there is limited capacity to provide key surgical interventions, particularly SLNB and breast reconstruction. These findings suggest that breast cancer care in most settings within the public healthcare sector is not concordant with proposed national guidelines. There is an urgent need to address the deficits in the distribution and capacity of breast cancer surgical services in SA.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3154"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166817","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 duration of phentermine therapy in the private healthcare sector of South Africa: A retrospective analysis.","authors":"A Fourie, M Julyan, C S Mostert, J M Du Plessis","doi":"10.7196/SAMJ.2025.v116i3.3519","DOIUrl":"10.7196/SAMJ.2025.v116i3.3519","url":null,"abstract":"<p><strong>Background: </strong>Phentermine is an amphetamine derivative and is globally the most used oral appetite suppressant for obesity. Its long-term (LT) use (a period >12 consecutive weeks) may be associated with amphetamine-like adverse effects. The US Food and Drug Administration has restricted its use to short term (ST) only (not longer than 12 consecutive weeks), specifically stated in the patient information leaflet. This serves as a prescribing guideline that is provided to assist both general and specialist practitioners in drug prescribing that is rational and safe, and to maximise patient outcomes and adherence. Since, to the researchers' knowledge, there have been no studies previously undertaken in South Africa (SA) that provide data on the duration of phentermine use, this study was designed to determine whether the recommendations for the ST use of phentermine are reflected in the actual patterns of duration of this drug's use.</p><p><strong>Objective: </strong>To analyse the duration of phentermine therapy in the private healthcare sector of SA.</p><p><strong>Method: </strong>A retrospective, cross-sectional drug utilisation review was conducted using longitudinal data from a SA pharmacy benefit management company's medicine claims database. Paid claims for phentermine from 1 January 2015 to 31 December 2019 were extracted for analysis. The duration of phentermine therapy, patients' age and gender and the specialty of the prescriber in patients receiving 15 mg or 30 mg of phentermine, respectively, were considered and evaluated. Statistical analyses were done with Statistical Analysis System (SAS) 9.4.</p><p><strong>Results: </strong>Records of 3 361 patients (paid claims for phentermine) were found on the claims database during the study period. The duration of therapy (DOT) with phentermine was analysed, and results indicate that 2 472 (73.55%) patients received the drug ST, with the remainder receiving the drug LT. The mean (standard deviation (SD)) DOTs with 15 mg and 30 mg phentermine were 57.26 (58.72) days and 67.10 (52.01) days, respectively.</p><p><strong>Conclusion: </strong>The study yielded highly encouraging results, affirming the ST use of phentermine. The evidence of LT use, however, opens new avenues for research. In the private healthcare sector of SA, the DOT with phentermine is not restricted to ST use, and some individuals may be exposed to the potentially harmful consequences accompanying LT therapy with phentermine.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3519"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166875","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":"Supporting doctors' mental health: Exploring the utility of a life skills programme for interns in rural Eastern Cape Province, South Africa.","authors":"Z Zingela, S Van Wyk, Y Thungana, E Abakisi","doi":"10.7196/SAMJ.2026.v116i2.3770","DOIUrl":"10.7196/SAMJ.2026.v116i2.3770","url":null,"abstract":"<p><strong>Background: </strong>Occupational stress affecting junior doctors poses a serious risk to mental health, with consequences such as anxiety, burnout, substance misuse and suicide.</p><p><strong>Objectives: </strong>To evaluate the utility of a life skills training programme (LSTP) developed and implemented at Nelson Mandela Academic Hospital in the Eastern Cape Province, South Africa, in improving stress levels and coping abilities among second-year medical interns.</p><p><strong>Methods: </strong>We used a quasi-experimental pre-post quantitative design without a control group. Identical surveys were administered before and after the intervention, including the Perceived Stress Scale (PSS-10) and items on coping behaviours. Descriptive statistics, paired t-tests and Wilcoxon signed-rank tests were used for analysis.</p><p><strong>Results: </strong>Of 56 eligible interns, 45 (80.4%) completed both pre- and post-intervention assessments. Stress scores decreased significantly (from mean 2.92 to 2.51, p<0.001), while coping scores improved (from mean 3.26 to 3.48, p=0.001). Wilcoxon tests confirmed significant gains, with enhanced confidence in ethical reasoning (Z=-5.014, p<0.001), professionalism (Z=-2.673, p=0.008) and teamwork (Z=-2.357, p=0.018). Participants who were single or lived alone showed higher stress levels. Subgroup analysis also revealed that interns who were single or lived alone had lower coping scores.</p><p><strong>Conclusion: </strong>The LSTP improved interns' mental wellbeing and coping mechanisms. Findings support integrating life skills training into internship programmes.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3770"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166821","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":"Criminalising compassion: Why Baby Saver Boxes must be protected, not punished.","authors":"S Bhamjee, S Biyela, A Marais","doi":"10.7196/SAMJ.2026.v116i2.4482","DOIUrl":"10.7196/SAMJ.2026.v116i2.4482","url":null,"abstract":"<p><p>South Africa (SA) faces a silent crisis of infant abandonment, often in unsafe environments, driven by poverty, stigma and limited access to abortion. Baby Saver Boxes - secure, monitored drop-off points - offer a humane alternative aligned with constitutional imperatives of life, dignity, healthcare and the best interests of the child. However, proposed amendments to the Children's Act risk criminalising compassion, reframing safe relinquishment as abandonment and undermining harm-reduction strategies. This punitive approach causes increased cases of neonaticide and maternal desperation, deters healthcare engagement, and places healthcare professionals in ethically fraught positions. Evidence from global best practice - including Germany's Babyklappe and US safe haven laws - demonstrates that legal recognition of safe relinquishment reduces mortality and promotes maternal health. A rights-based approach, informed by trauma-sensitive policy and intersectoral collaboration, is essential to protect vulnerable mothers and infants. SA must choose compassion over control, integrating Baby Saver Boxes into public health systems to uphold human rights and prevent avoidable deaths.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4482"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166720","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}