BACKGROUND:Vacuum-assisted vaginal deliveries (VADs) are recommended as safe alternatives to second-stage caesarean deliveries (SSCDs); however, little is known about their use and associated outcomes in South African rural district hospitals without obstetric specialist support. METHODS:A 5-year retrospective cohort study was conducted at a rural district hospital in South Africa. Women who underwent a VAD attempt or SSCD in the second stage of labour were compared with respect to baseline sociodemographic and clinical characteristics, and maternal and perinatal outcomes. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs). RESULTS:Of 7293 deliveries during the study period, 567 met inclusion criteria, including 417 VAD attempts and 150 SSCDs. Baseline characteristics were largely similar, with SSCDs more frequently performed in women with a previous caesarean delivery, for prolonged second stage of labour, and by community service medical officers. Vacuum-assisted delivery attempts were more commonly used for foetal distress and were associated with significantly shorter decision-to-delivery intervals ( 30 min in 79% vs 21%, p 0.01). After adjustment, VAD attempts were associated with reduced odds of postpartum haemorrhage (aOR 0.30, 95% confidence interval [CI] 0.15-0.60), with no significant difference in composite adverse maternal outcomes (aOR 0.64, 95% CI 0.39-1.05) or composite adverse perinatal outcomes (aOR 0.82, 95% CI 0.42-1.60). CONCLUSION:In this rural district hospital setting, VAD attempts performed by doctors without obstetric specialist support were associated with improved short-term maternal outcomes and equivalent perinatal outcomes compared with SSCDs.Contribution: These findings support the safe use of VAD in rural settings and highlight the potential contribution of family physicians and family medicine registrars to second-stage obstetric decision-making.
Skin pathology is among the commonest reasons for South African primary care consultations, yet the dermatology workforce is small and unevenly distributed. Only 264 dermatologists serve a population of over 60 million, at 20.1 per million in the private sector and 1.2 per million in the public sector. Most patients with skin-related concerns usually present to general practitioners or family physicians first, who largely work with naked-eye examination alone. Dermoscopy is an evidence-based tool that significantly improves the accuracy of skin lesion assessment and is becoming routinely used in primary care in countries such as the United Kingdom and Australia. Contribution: This article argues that dermoscopy should be reconsidered as a possible primary care skill in South Africa, keeping in mind that implementation is dependent on necessary equipment and training.
Background: Adolescent pregnancy remains a public health concern in South Africa, with adolescent primigravidae often facing barriers to antenatal care (ANC) access and continuation. Their first encounter with ANC services is pivotal in shaping future engagement, yet many report uncertainty, stigma and poor communication. This study explored the experiences of adolescent primigravidae during their first ANC visit in the Ekurhuleni East sub-district, Gauteng province. Methods: A qualitative, exploratory, and descriptive design was utilised. Sixteen adolescent primigravidae between the ages of 10 and 19 years were purposively chosen from designated ANC clinics and a district hospital in the Ekurhuleni East sub-district of Gauteng Province. Data were gathered through semi-structured interviews, transcribed verbatim and analysed using Creswell’s six-step content analysis framework. Results: Five themes emerged: (1) Initial ANC clinic visits and uncertainty; (2) negative and positive interactions with the midwives; (3) age-related concerns in the ANC settings; (4) long waiting times; and (5) information and education gaps. While many participants felt hopeful and intended to continue ANC visits, some expressed uncertainty, influenced by judgement and social stigma within the ANC setting. Conclusion: The first ANC is a critical window for engagement. The experiences shared emphasised the significance of respectful interactions with providers, effective communication, and an environment that is adolescent friendly and supportive in shaping their views on ANC and utilisation. Contribution: The study offers insight into adolescent-centred ANC improvements and informs recommendations for midwifery practice, health education, and policy development.
BACKGROUND:The global burden of uterine fibroids (UFs) has increased from 4.5% to 68.6%, but insufficient data in sub-Saharan Africa limit the development of effective prevention and treatment strategies. The study aimed to determine the prevalence and associated risk factors of symptomatic UFs in Eswatini. METHODS:An analytical cross-sectional study used purposive sampling to enrol 645 women aged 25-64 years old with UFs or symptoms. Data were collected via face-to-face interviews with a standardised questionnaire and analysed with descriptive statistics and logistic regression. RESULTS:The overall prevalence of UFs was 67.8% (437/645). A higher prevalence was evident in the age group 50 years and older (81.4%) compared to prevalence (33.3%) in the age group 25-29 years. Notably, high prevalence was among people with diabetes (88.5%), widows (80%), those with a primary level of education (79.1%), the obese (76.3%), Depo-Provera (75.6%) and Hhohho (76.3%) participants. The univariate analysis significant association show that: for (1) ages 30-34 years (OR: 2.33; 95% CI: 1.26-4.35, p 0.007), 35-39 years (OR: 5.08; 95% CI: 2.82-9.36, p 0.001), 40-44 years (OR: 7.77, 95% CI: 4.19-14.9, p 0.001), 45-49 years (OR: 5.50; 95% CI: 2.96-10.5, p 0.001) and 50+ years (OR: 8.80, 95% CI: 4.58-17.6, p 0.001); (2) primary education (OR: 2.43; 95% CI: 1.27-4.84, p = 0.009), and secondary education (OR: 1.88; 95% CI: 1.12-3.18, p = 0.017); (3) been pregnant (OR: 1.53; 95% CI: 1.04-2.23, p = 0.029); (4) obesity (OR: 3.39, 95% CI:2.02-5.70, p 0.001); and (5) overweight (OR: 1.71; 95% CI: 1.02-2.89, p = 0.044). After adjustments, age remained significantly associated. CONCLUSION:Uterine fibroids are highly prevalent and significantly associated with age, underscoring the need for targeted awareness and future research.Contribution: The study provided insights to inform policy and enhance preventive strategies within the sexual reproductive health programs.
BACKGROUND:The separation of humans and dogs in a domestic setting may be impossible due to their long history of domestication. This close interaction can lead to conflicts and dog bites, which can cause injuries, trauma or even death. Dog bites are often underestimated, posing a significant public health risk. This study examined dog bite incidents involving humans in the Khakhu Madala area of the Thulamela sub-district in Limpopo Province, conducted within primary healthcare (PHC) facilities. METHODS:A qualitative, exploratory and descriptive approach was used to investigate dog bite incidents in the Khakhu Madala local area. The study focused on registered dog-bite victims from PHC records between January 2020 and December 2021. Participants were selected through non-probability purposive sampling. Unstructured interviews conducted with 25 participants provided rich insights. Data analysis followed Tech's eight-step criterion, ensuring trustworthiness through transferability, reliability, confirmability and credibility. RESULTS:Key themes included a lack of owner responsibility in controlling dogs, increased dog aggression contributed to the consumption of indigenous plants and other variations and structural environmental factors. CONCLUSION:The study found that improving safety requires collaboration among health professionals, community engagement and evaluation of legislation. Further research on dog bite incidents is necessary.Contribution: The article highlights the prevalence of dog bites. This will assist in raising public health awareness and in informing policies and legislation to better equip them to put measures in place regarding dog bite incidents. The article also contributes to bringing education on safe dog interactions, improving treatment protocols and informing stricter enforcement of dog control laws.
Background: With the increasing burden of non-communicable chronic diseases, it is important to empower people to self-manage their conditions. This study aimed to explore the support that persons living with chronic disease require to self-manage their conditions at a Primary Health Care (PHC) facility in the Victor-Khanye subdistrict, Delmas, Mpumalanga. Methods: Individual in-depth interviews were conducted with 14 adult participants who collected their monthly medication for diabetes, human immunodeficiency virus or hypertension. Data were analysed manually using thematic analysis. Results: Three themes were identified: (1) individual self-management; (2) support enhancing for self-management; and (3) barriers to self-management. The study highlights that self-management requires a combination of individual beliefs, capabilities, education, access to healthcare resources, financial assistance, emotional support from family and friends, and community support. While knowledge is crucial for empowering individuals to manage their diseases effectively, challenges such as financial constraints and a lack of specific self-management support provided by healthcare workers hinder many from fully implementing self-management strategies. Conclusion: Persons living with chronic disease require comprehensive care that extends beyond healthcare and includes emotional, social and financial support. Effective self-management requires access to tailored education and community support networks that allow people to take an active role in their health. Contribution: Understanding the support persons living with chronic diseases require for effective self-management is critical for improving health outcomes, enhancing quality of life and promoting sustainable healthcare systems.
This Table of Contents reflects the print compilation of peer-reviewed articles published in the journal. Each article listed was originally published online under the journal’s open access model and remains individually accessible and citable. This compilation has been created solely for print distribution, reference, and archival purposes. No new research content is introduced. The publisher affirms that all articles included in this compilation have undergone the journal’s standard editorial and peer-review processes.
Hidradenitis suppurativa (HS), also known as acne inversa, is a heterogeneous, chronic, relapsing inflammatory disease of the pilo-sebaceous unit, primarily affecting intertriginous areas such as the axillae, groin and anogenital region. Despite its relatively low global prevalence, HS remains underdiagnosed, especially in primary care settings, where it is often mistaken for recurrent boils. The pathogenesis is multifactorial, involving follicular occlusion, immune dysregulation, genetic susceptibility, microbiome imbalance, hormonal influences and lifestyle factors. Hidradenitis suppurativa typically presents after puberty with a peak incidence during the second and third decades of life. The condition is characterised by painful nodules, abscesses and in advanced stages of the disease, forms sinus tracts and scars that greatly impair quality of life. Early recognition and a multidisciplinary management approach, including lifestyle modification, long-term medical therapy and surgical intervention when indicated, are essential to prevent disease progression and complications. This article provides an evidence-based overview of HS and practical guidance for family practitioners on its recognition, classification and management within the South African context.
Social media has become a dominant mode of communication, education and advocacy in healthcare, offering healthcare professionals (HCPs) opportunities to connect with peers, patients and the public. However, its use carries significant ethical, legal and professional responsibilities. In South Africa, the Health Professions Council of South Africa (HPCSA) has responded to these challenges with updated guidance in Booklet 16: Ethical Guidelines on Social Media. This CPD article synthesises HPCSA guidance and complementary resources into a practical framework for responsible social media use by HCPs. The proposed framework: ‘Protect Patients, Protect Yourself, Protect the Profession’, offers actionable recommendations to ensure that online conduct upholds patient rights, safeguards professional integrity and maintains public trust in healthcare. By integrating HPCSA guidelines with international resources such as the World Medical Association’s statement on social media and secure communication platforms such as Celo and Hucu, this article provides HCPs with a structured approach to navigating the complexities of digital professionalism.
With the growing use of WhatsApp groups by general practitioners, there are clear pros and cons to their use. Peer support, easing referral and educational opportunities are thereby supported, but at the cost of potential privacy and data protection issues because of the medium and nature of the technology, and potential legal ramifications of the Protection of Personal Information Act 4 of 2013. Contribution: The use of such groups requires care and attention, and although especially useful, securing data and confidentiality is a potential cause of concern.
Iron is an essential element as it participates in a wide variety of metabolic processes, including oxygen transport, deoxyribonucleic acid synthesis and electron transport. However, as iron can form free radicals, its concentration in body tissues must be tightly regulated because, in excessive amounts, it can lead to tissue damage. Disorders of iron metabolism are among the most common diseases of humans with diverse clinical manifestations. Iron deficiency is the most common mineral deficiency, affecting approximately 20% of the population. Patients may present with an iron deficiency without anaemia, which is even more common. The World Health Organisation has estimated that approximately 8% of preschool children, 12% of pregnant women and 15% of non-pregnant women of reproductive age have anaemia, with iron deficiency being the major cause. Contribution: This review focuses on the effectiveness of different preparations to ensure more appropriate choices by prescribers that is patient-centred.
Background: Obstetric patients exhibit ‘accelerated starvation’, increasing the risk of ketoacidosis. Fasting guidelines aim to reduce pulmonary aspiration, but prolonged preoperative starvation may cause metabolic disturbances. This study aimed to assess the relationship between fasting duration and the incidence of metabolic disturbances. Methods: We conducted a prospective observational study of patients undergoing elective caesarean section at Harry Gwala Regional Hospital. Fasting duration was recorded via questionnaire. Preoperative venous bicarbonate, base excess, glucose and ketone levels were measured to determine the incidence of metabolic disturbances before anaesthesia. Results: We recruited 107 patients. Of which, 30% were acidotic (base excess less than −3). The acidotic group had a longer starvation time than the non-acidotic group (mean starvation time 14.8 h [standard deviation [s.d.] 2.68, 95% confidence interval [CI] 13.8–15.7] versus 12.75 h [s.d. 3.18, 95% CI 11.8–13.2]; p 0.01). Ketosis occurred in 32% of patients and was associated with longer starvation times (p 0.01). Conclusion: Starvation periods exceeded recommendations and were associated with metabolic disturbances, including acidosis, hypoglycaemia and elevated ketones in elective caesarean patients. Adherence to fasting guidelines should be reinforced, and patients with extended starvation require further assessment. Future research should focus on optimising fasting durations and improving compliance with established guidelines. Contribution: This study demonstrates the metabolic impact of extended preoperative fasting periods in elective caesarean sections. Findings reinforce the need for quality improvement programmes to reduce prolonged fasting periods in the perioperative period.
Background: The attitude that one holds towards healthcare services is an important factor associated with health-seeking behaviour. People with bad experiences of previously used healthcare services are less likely to engage with healthcare services; the healthcare worker-patient relationship is an important factor influencing attitudes towards healthcare services. This study aimed to determine the attitude of men towards public health services and utilisation practices. Methods: A self-administered questionnaire was administered using a quantitative cross-sectional design on 400 men conveniently selected from randomly selected communities within the selected districts. Data from 387 questionnaires successfully returned were analysed using the Statistical Package for Social Sciences version (SPSS) 29.0. for Windows. Results: Out of 387 men, 310 (81%) reported that during consultation, healthcare professionals do not respect patients, and the majority (88%; 339) reported that the waiting period in public healthcare facilities is very long. Most men (84%, 322) felt more at ease going to a private health facility than a public one. About 54% (204) of the men visited public health facilities to seek health services. There was a statistically significant relationship between men’s level of education and utilisation of healthcare services (p = 0.005). Conclusion: These men held negative attitude towards public health facilities and reported a lack of respect for patients by health workers. Revitalisation of work ethics and professional conduct among public healthcare workers is needed to remind workers about their code of conduct and improve the provision of public health services in a manner that users feel comfortable visiting health facilities to seek the services. Contribution: The study brings meaningful insights of men’s attitudes towards public health services and may help to better understand why few men engage in health services.
Background: Family physicians (FP) strengthen the quality of district health services. The South African Academy of Family Physicians (SAAFP) recommended that, by 2030, there be one FP per district hospital, community health centre or subdistrict without a community health centre. This study aimed to evaluate progress towards achieving the SAAFP’s goals. Methods: A cross-sectional, descriptive survey collected data from senior academics in family medicine at all ten universities for 2024. Data focused on the presence, number and characteristics of employment of FPs across all 52 districts, 242 subdistricts and 607 district health facilities. Descriptive and mixed-effects regression analyses were used. Results: South Africa achieved 18.9% of the SAAFP goals, with enormous variability between provinces. Gauteng achieved 55% coverage, while the Northern Cape had no coverage. The Western Cape (34.5%) and Limpopo (23.4%) exceeded that national average. Family physicians were more likely to be employed in district hospitals (odds ratio [OR] 8.5; 95% confidence interval [CI]: 4.1–17.4, p 0.001) and metropolitan districts (OR 20.9; 95% CI: 4.0–109.4, p 0.001). Approximately 1 in 10 held medical officer posts (11.7%), and almost all were employed full time (96.3%). A substantial number (40.7%) were joint staff with universities. Conclusion: The deployment of FPs within the district health system has expanded but remains limited relative to SAAFP goals, with ongoing inequities in distribution. Achieving the goals is possible with the commitment of national and provincial policymakers and of human resources for health planners. Contribution: This study provides the first national mapping of FP distribution in the district health system, offering critical insights for workforce planning and policy implementation in support of universal health coverage.
