Explore the vast range of titles available.

Background: Maternal mortality highlights health system effectiveness and social fairness. South Africa’s Confidential Enquiry into Maternal Deaths (CEMD) monitors and improves maternal healthcare. While initial decreases in maternal mortality were positive, the COVID-19 pandemic and ongoing provincial inequalities jeopardise reaching the Sustainable Development Goal (SDG) target. Aim: This analysis evaluated South Africa’s maternal mortality reduction path by examining CEMD data trends, the pandemic’s effect and provincial disparities to gauge progress towards its SDG commitments. Methods: A longitudinal trend analysis was conducted using secondary data from CEMD reports (2017–2022). The analysis focused on national and provincial institutional Maternal Mortality Ratio (iMMR) trends. Comparative analysis quantified changes and identified patterns of disparity. Results: Pre-pandemic improvement was abruptly reversed by a significant 42% surge in the national iMMR during the pandemic, underscoring the fragility of previous gains. Although a decrease was observed in 2022, the rate remained above the 2019 baseline, indicating an incomplete recovery. Furthermore, profound inter-provincial disparities were evident, with only two provinces sustaining a downward trend, the majority showing no clear improvement and three provinces consistently exhibiting exceptionally high and volatile iMMRs. Lessons learnt: South Africa is not yet on track to meet its SDG target for maternal mortality. The pandemic exposed and exacerbated systemic weaknesses, while deep-rooted provincial inequities persist. Achieving sustainable progress requires a dual strategy: building a more resilient health system capable of withstanding future shocks and implementing targeted, equity-focused interventions in underperforming regions to ensure that maternal healthcare is accessible and effective for all.

Background: The coronavirus disease 2019 (COVID-19) pandemic placed unprecedented strain on healthcare systems worldwide, potentially exacerbating existing vulnerabilities in maternal healthcare. This study examines the pandemic’s impact on obstetric haemorrhage-related mortality in South Africa using the data from the Confidential Enquiry into Maternal Deaths (CEMD).Methods: We conducted a retrospective analysis of maternal mortality data from 2017–2023, focusing on obstetric haemorrhage mortality trends before, during and after the COVID-19 pandemic. Data were extracted from national confidential enquiries, including institutional maternal mortality ratios (iMMR) and absolute death numbers.Results: The analysis revealed a significant increase in obstetric haemorrhage mortality during the peak pandemic years (2020–2021), with deaths rising from 179 in 2019 to 237 in 2021, and iMMR increasing from 18.1 to 23.3 per 100 000 live births. This was followed by a substantial decline in subsequent years (2022–2023). The findings suggest that initial pandemic disruptions severely impacted maternity care services, while subsequent recovery reflects adaptive strategies and resource reallocation.Conclusion: The COVID-19 pandemic exposed critical vulnerabilities in South Africa’s ability to maintain essential maternity services during health system shocks.Contribution: The confidential enquiry process provides invaluable insights for strengthening health system resilience and preparing for future emergencies.

Background Despite the increasing burden of non-communicable diseases in developing countries, knowledge about gestational diabetes mellitus among pregnant women receiving antenatal care is insufficient. The aim of this study was to investigate the level of awareness and knowledge of Gestational Diabetes Mellitus (GDM) among pregnant women receiving antenatal care at local healthcare facilities in the mopani district of the Limpopo Province in South Africa. Methods Simple random sampling was used to identify and select pregnant women receiving antenatal care during clinic visits. Health facilities in the district were selected using a multistage sampling technique: the facilities were initially clustered before being randomly sampled. A semi-structured questionnaire and data entry form were used to collect data. Collected data was subsequently analysed using the Statistical Package for the Social Sciences (SPSS) version 29.0.0.0. Results The findings of this study show that most pregnant women (87.4%) were uninformed regarding GDM. Healthcare workers were found to be the most common source of health-related information for patients. Most pregnant women had inadequate knowledge about the predisposing factors associated with GDM, testing methods, treatment, and future health outcomes for both the mother and child. Health education on GDM was found to be limited to pregnant women who were diagnosed with the condition. Conclusion The study revealed that awareness and knowledge about GDM among pregnant women receiving antenatal care at healthcare facilities insufficient.

Background Hyperbilirubinaemia is a contributing condition to the prevalence of neonatal hearing loss. Because of its pathophysiology, the use of Otoacoustic Emissions (OAE) and Automated Auditory Brainstem Response (AABR) testing is essential in diagnosing hearing loss. Two-tier screening models are typically used in developing world contexts; however, a combined approach to testing (using both tests) should be used for early detection. Blood serum levels should also be monitored to determine how they impact audiological test results. Objectives To determine the outcomes of using a combined testing approach of both OAE and Auditory Brainstem Response (ABR) for both screening and diagnostic testing of neonates with hyperbilirubinaemia and studying the relationship between the test results and the serum bilirubin levels. Method A cross-sectional, comparative design was utilised. Forty neonates were tested (80 ears). Neonates underwent hearing screening and diagnostic testing (ABR and/or AABR and DPOAE tests). The study was conducted at a hospital in South Africa. Results One-third (32.5%) of the neonates had comorbidities. Screening results indicated that the AABR test could identify more cases of abnormalities than DPOAEs (p = 0.001). Participants with a serum level greater than 10 mg/dL presented with abnormal diagnostic ABR test results while passing the DPOAE test (p < 0.001). Conclusion Combined use of ABR and DPOAE testing yielded a greater identification of auditory pathology than using either test alone. Serum bilirubin levels can be used as an indicator for combination testing. Contribution Combined use of ABR and DPOAE testing leads to greater identification of auditory pathology.

Background: Multiple myeloma (MM) is a plasma cell malignancy associated with morbidity and mortality worldwide, and most patients are referred for specialist care very late with complications. The low index of suspicion among medical practitioners is among the reasons for the delay in MM diagnosis and management. This study aimed to determine the level of awareness and knowledge of MM among medical practitioners working in public hospitals of Tshwane Municipality, Gauteng Province, South Africa.Methods: A cross-sectional descriptive study on 74 doctors working in three district, one regional and one central hospital using a convenience sampling.Results: Seventy-four medical practitioners participated in this study. Their median age was 37 years with an interquartile range of 43–30 years. The majority (85%) of the respondents were aware of MM, while 74% were knowledgeable regarding MM presentations and diagnostic investigations.Conclusion: The findings highlighted a high level of awareness and knowledge of MM among the study population, but almost all of the participants requested an educational information brochure on MM.Contribution: Medical practitioners have a high level of awareness of multiple myeloma; however, there is a discrepancy between this level of awareness and the delayed presentation of patients at the public hospitals. As primary healthcare in South Africa is nurse-driven, the study indicates that not all primary healthcare providers may be aware of this disease. Future awareness campaigns should target other primary healthcare providers, including nurses and private general practitioners.

BackgroundJob satisfaction has become an area of relevance and debate in public health as it is directly linked to staff absenteeism, retention and turnover of the workforce and as such, influences the organisational commitment of the workers and the quality of health services provided. It is therefore essential to discern what drives healthcare professionals to remain working in the public health sector.AimThis study aimed to determine job satisfaction and its associated factors among healthcare professionals.SettingNorth-West province South Africa.MethodsA cross-sectional study was conducted among 244 healthcare professionals of different categories in three district hospitals. A self-administered structured questionnaire with 38 questions to measure job satisfaction was used to collect data. The chi-square test was used to compare groups, and a p-value < 0.05 was considered statistically significant.ResultsOverall, 62% of the participants were not satisfied with their job. The most common factors that participants were not satisfied with include job security (52%), standard of care (57%), opportunity to develop (59%), payment or wages (76%), workload (78%) and working environment (89%). Job satisfaction was significantly influenced by age, job category and years of service.ConclusionsThe predictors of job satisfaction include age, category of employees and years of service. Interventions are required to improve the degree of job satisfaction among health care professionals.ContributionFindings of this study will assist informing plans that are geared towards enhancing healthcare worker job satisfaction, retention and consequent health systems strengthening.

Background: The study was conducted in the Dikgale Health and Demographic Surveillance System (DHDSS) site where we have observed increasing obesity levels, particularly in women, despite evidence of high physical activity (PA) and a relatively low daily energy intake. Objective: This study aimed to assess the socio-demographic, behavioural and biological determinants of body mass index (BMI) in adult residents permanently residing in the DHDSS. Methods: A cross-sectional study was conducted in which socio-demographic, behavioural and biological characteristics from 1143 participants (aged 40-60 years) were collected using a paper questionnaire and standard anthropometric measures. Human immunodeficiency virus (HIV) testing was performed on all participants except those who indicated that they had tested positive. Chi-square and Mann-Whitney tests were used to analyze categorical and continuous variables, respectively, while hierarchical multivariate regression was used to analyze predictors of BMI. Results: The median age of women and men was 51 (46-56) and 50 (45-55) years, respectively. The prevalence of overweight-obesity was 76% in women and 21% in men. A significant negative association of BMI with HIV and smoking and a significant positive association with socio-economic status (SES) was observed in both sexes. In women, BMI was negatively associated with sleep duration (p = 0.015) and age (p = 0.012), but positively associated with sugar-sweetened beverages (SSBs) (p = 0.08). In men, BMI was negatively associated with alcohol use (p = 0.016) and positively associated with being married (p < 0.001). PA was not associated with BMI in either sexes. Full models explained 9.2% and 20% of the variance in BMI in women and men, respectively. Conclusion: BMI in DHDSS adults is not associated with physical inactivity but is associated wealth, marital status, sleep, smoking, alcohol use, and HIV status. Future studies should explore the contribution of nutrition, stunting, psycho-social and genetic factors to overweight and obesity in DHDSS.

Background: Hypertension is problem already faced by urban populations of South Africa, but little is known about its prevalence and risk factors in rural areas.Aim: To assess the prevalence of and risk factors associated with hypertension amongst adults in a rural community in South Africa.Setting: Dikgale Health and Demographic Surveillance Site, Limpopo Province, South Africa.Methods: A community-based cross-sectional survey was carried out at this site where individuals aged 15 years and older were screened using a locally adapted version of the World Health Organization STEPwise questionnaire. Demographics, anthropometry and three independent blood pressure (BP) readings were taken. The average of the three BP measurements was used in analysis, and hypertension taken as systolic and diastolic BP of ≥ 140 or ≥ 90 mmHg respectively, or at least a two-week history of antihypertensive treatment. Analysis included the Chi-square test and statistical significance was set at p ≤ 0.05.Results: A total of 1407 individuals were interviewed, of whom 1281 had complete BP, weight and height measurements taken. The mean age of participants was 44.2 ± 2 0.9 years (range 15–98 years), 63% were female, 55% were single and 90% were unemployed, whilst 13% were tobacco smokers and 20% reported drinking alcohol. Overall prevalence of hypertension was 41% and this was significantly associated with age and marital status.Conclusion: The prevalence of hypertension was found to be high. Prevention strategies are urgently needed to address this life-threatening and important risk factor for cardiovascular disease in rural Limpopo Province.

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9–78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

Introduction: Parental employment, school grade, and location significantly influence learners' mental health literacy (MHL), impacting early detection and help-seeking behaviors. Aim: This study investigates the determinants of adolescent MHL in selected secondary schools in Tshwane, South Africa. Methods: A secondary data analysis was conducted using 529 secondary school learners selected through stratified random sampling from five different schools: four in townships and one in an urban area. Ordinal logistic regression was performed to identify significant predictors of MHL, with a p-value less than .05 considered statistically significant. Results: The study findings indicated that school level factors were statistically significant. Learners attending urban schools were three times more likely to demonstrate higher mental health literacy than those attending township schools (OR = 3.03, 95% CI [2.02, 4.55], p < .001). Moreover, Grade 12 learners exhibited significantly higher odds of mental health literacy compared to those in lower grades (OR = 6.24, 95% CI [2.24, 17.39], p < .001). The effect of parental employment status was evident: learners whose parents were employed showed significantly higher odds of mental health literacy compared to learners from other parental employment categories (OR = 1.65, 95% CI [1.30, 2.09],p < .001). Conclusions: School-level factors (urban location and Grade 12) and parental employment were significant predictors, emphasizing the role of contextual and socioeconomic influences on learners' MHL. Keywords: access to services, mental health literacy, ordinal logistic regression, school location, socio-economic inequalities