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

{"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}

{"title":"Beyond BRCA: Genetic testing for gynaecological cancers in South Africa.","authors":"S Barnard, B Rossouw, E Gilfillan","doi":"10.7196/SAMJ.2026.v116i2.3514","DOIUrl":"10.7196/SAMJ.2026.v116i2.3514","url":null,"abstract":"<p><strong>Background: </strong>Hereditary cancer syndromes, caused by pathogenic variants in specific genes, substantially increase an individual's risk for cancer, and are estimated to cause 10% of all uterine cancers and 20% of all ovarian cancers. However, these data are primarily based on high-income countries, and to date there are no published data on the known pathogenic variants or testing of cancer predisposition genes associated with gynaecological cancers in South Africa.</p><p><strong>Objectives: </strong>To investigate the uptake and type of molecular testing performed on patients with a suspected hereditary cancer syndrome associated with gynaecological cancer, and to assess whether patient characteristics impacted the detection of pathogenic variants.</p><p><strong>Methods: </strong>A retrospective file review was performed for patients with a confirmed diagnosis or family history of gynaecological cancer, seen by a single clinical genetics centre in Johannesburg between 2003 and 2023. Demographic information, family history and medical information were recorded and analysed.</p><p><strong>Results: </strong>A total of 104 records were included in analysis. The majority (73/104, 70.2%) of patients were seen in the private healthcare system, of whom most (41%) were of European ancestry. Of the remaining 31 public healthcare patients, the majority were of indigenous African ancestry (42%). Most (78/104, 75.0%) underwent diagnostic genetic testing. Of these, 25 (32.1%) were positive for pathogenic variants, 41 (52.6%) were negative and 12 (15.4%) returned a variant of unknown significance. Test results were significantly different between patients of European and non-European ancestry (p<0.05), with those of non-European ancestry 30% less likely to have a pathogenic variant detected (odds ratio 0.7, 95% confidence interval 0.22 - 2.21).</p><p><strong>Conclusion: </strong>A disparity exists not only in genetic testing availability but also clinic attendance between the public and private healthcare systems, which likely limits the ability to diagnose hereditary cancer syndromes associated with gynaecological cancers in public healthcare hospitals.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3514"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166754","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":"Erratum.","authors":"Authors Naidu","doi":"10.7196/SAMJ.2025.v116i2.4893","DOIUrl":"https://doi.org/10.7196/SAMJ.2025.v116i2.4893","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4893"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166760","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":"National Health Insurance in South Africa: A critical perspective on policy misalignment and constitutional constraints.","authors":"N Mofolo, C Heunis","doi":"10.7196/SAMJ.2026.v116i2.4237","DOIUrl":"10.7196/SAMJ.2026.v116i2.4237","url":null,"abstract":"<p><p>South Africa (SA)'s National Health Insurance (NHI) Act, signed into law in May 2024, represents an ambitious attempt at healthcare transformation through universal health coverage (UHC). However, this perspective argues that despite laudable intentions, the NHI faces fundamental deployment obstacles rooted in systemic policy misalignment, fragmented governance structures and legal constraints. We present a critical analysis of five major constitutional violations, multi-departmental co-ordination failures and financial sustainability concerns that threaten the NHI's transformative potential. Our perspective challenges current execution strategies, and proposes that without comprehensive organisational reforms addressing constitutional alignment, inter-departmental co-ordination and fiscal realities, the NHI risks becoming an aspirational policy rather than an operational reality. This analysis aims to promote scientific discourse about the need for systemic reform as a prerequisite for successful UHC deployment in SA.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4237"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166837","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":"Enhancing cervical cancer screening coverage in selected primary healthcare sites using Lean thinking: The CerviScreen programme.","authors":"L Naidoo, S Nxele, T Yusuf-Saka","doi":"10.7196/SAMJ.2026.v116i2.3654","DOIUrl":"10.7196/SAMJ.2026.v116i2.3654","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is the most common malignancy among South African (SA) women of reproductive age, with women living with HIV (WLWH) facing a six-fold higher susceptibility. The National Department of Health recommends baseline cervical cancer screening (CCS) for WLWH upon HIV diagnosis. SA's reported CCS rate is 19.3%, despite the World Health Organization (WHO)'s recommended 2030 target of 70%. AIDS Healthcare Foundation initiated the CerviScreen programme to improve CCS rates using Lean thinking.</p><p><strong>Objectives: </strong>To evaluate the effect of the programme on CCS coverage over a 7-month period at selected sites in the Eastern Cape and KwaZulu-Natal provinces of SA.</p><p><strong>Methods: </strong>This quantitative, controlled before-and-after study retrospectively evaluated changes in CCS coverage at purposively selected quality improvement programme (QIP) sites, compared with matched control sites. Key CCS indicator data from Lean A3 tools were analysed. Repeated analysis of variance measures tested changes in CCS proportions over time, at a p<0.05 significance level.</p><p><strong>Results: </strong>Nine CerviScreen and nine control sites per province were assessed. Significant increases in CCS mean proportions were observed at QIP sites in KwaZulu-Natal (5% - 62.9%; F=8.336, p<0.001) and Eastern Cape (21.2% - 82.4%; F=15.525, p<0.001) provinces. Differences in the change of mean proportions between CerviScreen and control sites were not statistically significant in KwaZulu-Natal (F=0.022, p=0.884) and Eastern Cape (F=0.882, p=0.362). Clinically significant improvements were observed, with the estimated marginal mean at KwaZulu-Natal QIP sites consistently surpassing control sites from month 3 onwards. Eastern Cape sites maintained over 80% coverage from month 4. Screening coverage trends differed significantly between provinces (F=11.12, p=0.004).</p><p><strong>Conclusion: </strong>Lean thinking, through the CerviScreen programme, has potential to enhance and accelerate CCS among SA WLWH toward attaining the WHO target. The findings underscore the importance of adopting systematic quality improvement approaches, highlighting the need for scale-up of Lean thinking in primary healthcare settings to address underperforming indicators.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3654"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166766","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 unified medical response to gender-based violence.","authors":"N Marques, N Wayne, N Govender, U Subramaney","doi":"10.7196/SAMJ.2026.v116i2.4464","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i2.4464","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4464"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166726","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":"Reminding ourselves of the ethico-regulatory framework for health research.","authors":"Ames Dhai","doi":"10.7196/","DOIUrl":"https://doi.org/10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4902"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166806","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":"Primary cutaneous malignancies in black African patients with oculocutaneous albinism in KwaZulu-Natal Province, South Africa.","authors":"P Burge, A Madaree","doi":"10.7196/SAMJ.2026.v116i2.3821","DOIUrl":"10.7196/SAMJ.2026.v116i2.3821","url":null,"abstract":"<p><strong>Background: </strong>Individuals with oculocutaneous albinism (OCA) face a significantly heightened risk of developing skin cancer owing to increased sensitivity to ultraviolet (UV) radiation. Data on the epidemiology and geographical distribution of cutaneous malignancies among persons with albinism (PWA) in KwaZulu-Natal Province (KZN), South Africa, remain limited.</p><p><strong>Objective: </strong>To investigate the demographic and regional patterns of primary cutaneous malignancies within this high-risk population.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive analysis of all PWA diagnosed with histologically confirmed primary cutaneous malignancies treated at a tertiary healthcare centre in KZN between January 2002 and June 2022. Sociodemographic, geographical and tumour characteristics were extracted from electronic medical records.</p><p><strong>Results: </strong>A total of 221 patients (56.6% female, 43.4% male) with a mean (standard deviation) age of 37.9 (12.5) years contributed 618 histologically confirmed malignant lesions. 132/221 patients (59.7%) presented before 40 years of age. Female patients presented slightly earlier (37.1 (12.9 years)) than males (39.0 (12.0 years)). Geographical clustering was observed in eThekwini (43.0%), uMkhanyakude (20.8%) and King Cetshwayo (11.8%) municipalities. Squamous cell carcinoma (SCC) (50.2%) and basal cell carcinoma (BCC) (49.7%) were nearly equally distributed across all the districts; one cutaneous melanoma was identified.</p><p><strong>Conclusions: </strong>In KZN, PWA tended to develop skin cancer at a younger age than the general population. Notably, the proportions of SCC and BCC were roughly equivalent - a finding that contrasts with historical data, which show a predominance of SCC. The high incidence of skin cancer in coastal and rural districts aligns with elevated ambient UV exposure, and highlights disparities in healthcare access within these regions. These findings highlight the urgent need for targeted screening programmes, improved photoprotection strategies and culturally sensitive education initiatives to reduce morbidity and mortality among this vulnerable population.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3821"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166800","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":"Yackoob Kassim Seedat (7 February 1934 - 2 January 2026).","authors":"S Naicker, I P Naicker, Y Veriava, M W Makgoba","doi":"10.7196/","DOIUrl":"https://doi.org/10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4739"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166834","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":"Response to correspondence: 'Beyond valve replacement: Rethinking prosthetic heart valve care'.","authors":"R Meel","doi":"10.7196/","DOIUrl":"10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4904"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166794","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}