Background: Surveillance of notifiable medical conditions (NMCs) is vital for a prompt, appropriate response. In South Africa, studies have demonstrated under-reporting of NMCs despite it being mandatory. Emergency departments (EDs) are often the first point of contact for patients with NMCs. Objectives: This study aimed to assess ED clinicians’ knowledge, attitudes, and practices regarding the reporting of conditions that are relevant to the ED, and the use of the new mobile application for reporting. Method: A cross-sectional survey was conducted between November 2024 and April 2025, including 99 doctors at three public hospital EDs in Gauteng. The study assessed knowledge, attitudes and practices regarding NMCs and the use of the recently launched National Institute for Communicable Diseases (NICD) mobile application. Results: The overall mean knowledge score was 61% (standard deviation [s.d.] 11.2). Knowledge accuracy of category 1 NMCs (mean 72%) exceeded that of category 2 NMCs (mean 56%; p 0.001). Although 95% of respondents were aware that reporting NMCs is mandatory, 49% acknowledged under-reporting. Barriers to reporting included high workload, forgetfulness, and difficulty in locating the paper notification booklet. While 81% of respondents knew about the NICD mobile application, 68% had used it, and 17% had received formal training. Preference for the application versus the paper-based system was expressed by 78% of respondents. Conclusion: Under-reporting persists primarily because of high workload. A significant knowledge gap exists, particularly concerning category 2 NMCs. While the mobile application was preferred, a lack of formal training hinders its adoption. Staff training, feedback and reminders would improve the timely notification of these conditions. Contribution: This study identifies under-reporting of NMCs and offers recommendations to strengthen the disease surveillance system and encourages the use of digital technology for reporting.
Fungal keratitis is a vision-threatening corneal infection, most commonly caused by Fusarium and Aspergillus. We report a rare case of keratitis caused by Colletotrichum coccodes in an elderly patient with a chronic corneal ulcer refractory to fluconazole. Initial corneal scrapings were negative, delaying diagnosis. Repeat deep biopsy, fungal culture and pan-fungal polymerase chain reaction confirmed C. coccodes. The patient was managed with intensive topical amphotericin B and voriconazole, alongside a glycerol-preserved corneal patch graft to provide tectonic support. Contribution: This case highlights the diagnostic and therapeutic challenges of chronic fungal keratitis and illustrates the limitations of empiric antifungal therapy in the absence of culture-based guidance.
Background: The coronavirus disease 2019 (COVID-19) pandemic created ethical and legal tension for healthcare workers (HCWs), who had to balance professional obligations with personal safety, family responsibilities and resource limitations. The concept of ‘duty to care’ re-emerged as a contested ethical construct during periods of workforce vulnerability and healthcare scarcity. Aim: This article examines the ethical and juridical dimensions of HCWs’ duty of care during the COVID-19 pandemic, focusing on the South African constitutional framework, occupational health obligations and professional regulation, and whether this duty is absolute or subject to reasonable limits. Setting: The discussion is situated within South Africa’s healthcare response to the COVID-19 pandemic and the ethical expectations placed on clinicians in high-risk and emergency settings. Method: A narrative review was conducted using PubMed, Google Scholar and grey literature. Sources included peer-reviewed ethical analyses, legal frameworks and policy documents. A thematic synthesis analysed moral theory, legal duty, reciprocity and public health ethics. Results: The duty of care is substantial but not limited. South African law supports coexistence of rights rather than hierarchical obligations. Ethical analysis shows that proportionality, reciprocity and reasonable risk mitigation conditions professional duty. Employers must ensure adequate protection, transparent triage systems and psychosocial support. Failure to ensure reciprocity risks moral coercion and workforce attrition. The pandemic highlighted the need to define the thresholds where professional obligation yields to legitimate self-protection. Conclusion: The duty of care should be reconceptualised as a conditional, relational obligation grounded in constitutional values and public health ethics, with clear risk thresholds and enforceable reciprocal protections. Contribution: This article contributes to post-COVID-19 pandemic ethics literature by clarifying between the duty to treat, care and serve, proposing a Decatrad of operational reforms, reframing the duties as conditional, reciprocal and legally bounded.
Background: Despite the introduction of hepatitis B virus (HBV) vaccination into the South African Expanded Programme on Immunization in 1995, HBV remains an important occupational risk to healthcare workers and students. Data regarding the duration and level of HBV immunity following childhood vaccination and response to booster vaccination are required to guide vaccination policies. Objectives: The study aimed to investigate pre- and post-vaccination immunity to hepatitis B in healthcare students born after implementation of infant immunisation. Method: Healthcare students were recruited from the Central University of Technology and the University of the Free State in Bloemfontein, South Africa. Hepatitis B surface antibody (HBsAb) levels were determined at baseline, month one and month seven, while booster vaccines were administered at 0 month, 1 month and 6 months. Hepatitis B total core antibody (HBcAb) was also tested at baseline. A total of 122 students were enrolled into the study from approximately 320 eligible students. Two participants did not return following the baseline visit, and one additional participant did not return for the final sampling visit. Results: At baseline, only 43% (n = 52/122) of participants had HBsAb levels which are considered to provide adequate protective immunity. Following a single booster, 92% (n = 111/120) of healthcare students had protective HBsAb levels, which increased to 100% (n = 119/119) following three vaccine doses. No significant differences were observed when HBsAb results were grouped by race or sex. Only one case of previously resolved HBV was identified. Conclusion: The study confirmed persistence of immunological memory in most healthcare students following childhood vaccination, as evidenced by anamnestic responses to a single dose of HBV vaccine. Contribution: Laboratory confirmation of adequate responses is essential to identify those requiring further vaccination and ensure protection in the event of HBV exposure.
Background: Leprosy, caused by Mycobacterium leprae, remains a condition designated by the World Health Organization (WHO) as a neglected tropical disease, despite formal eradication in South Africa. Histopathology is pivotal in the diagnosis of leprosy, particularly in resource-limited settings. Objectives: The study aimed to describe the histopathological spectrum and clinical features of leprosy diagnosed on skin biopsies over a 10-year period in central South Africa. Method: A retrospective review was performed of histologically confirmed leprosy cases diagnosed from January 2015 to December 2024. Data were extracted from laboratory records and analysed descriptively. Results: Twelve patients were included (mean age 43.9 years, range 25 years – 64 years; male-to-female ratio 1.4:1). Most resided in the Mangaung Metropolitan area, with additional cases dispersed across the Free State and Northern Cape provinces. Punch biopsies predominated, most commonly obtained from the head and/or neck and the upper limbs. World Health Organization classification identified 62% of cases as multibacillary (MB). Ridley-Jopling (RJ) subtypes were mostly lepromatous leprosy (38%), while 23% of cases were indeterminate. Repeat biopsies revealed treatment response or persistent disease. Comorbidities included HIV and tuberculosis. Conclusion: Leprosy persists as a sporadic but geographically widespread disease in central South Africa, often presenting in advanced MB forms. Histopathology remains essential for diagnosis and subtyping. Strengthening clinician awareness, biopsy protocols, and treatment continuity is critical to achieving the goal of zero leprosy of the WHO. Contribution: The findings confirm that, although rare, leprosy still prevails in central South Africa. Therefore, clinicians and anatomical pathologists should consider a diagnosis of leprosy in patients with atypical or non-resolving signs and symptoms.
