South African Medical Journal - February 2024 Vol 114 No 2

Introduction

Is ableism still entrenched in the medical profession in South Africa?

A global call to strengthen efforts towards training more healthcare providers with disabilities highlights an under-representation of medical doctors with disabilities. The General Medical Council acknowledges their contributions to medicine.

The role of new hepatitis B vaccines in South Africa

Despite universal hepatitis B virus (HBV) vaccination since 1995, HBV remains endemic in South Africa (SA), with gaps in the prevention programme. In this review we will review progress and gaps towards HBV elimination, and discuss the potential role of novel vaccines in HBV prevention.

Household transmission of SARS-CoV-2 in a rural area in South Africa

The World Health Organization estimated that 14.9 million excess deaths were directly or indirectly attributable to the COVID 19 pandemic in 2020 and 2021. In settings where transmission was characterised by cases that were clustered geographically and by widespread community transmission, household cluster investigations showed household SARS-CoV-2 spread to be a major source of new COVID 19 cases. Household transmission has in fact been shown to be a greater contributor to the spread of SARS-CoV-2 than community spread in settings where movement was restricted, and social distancing imposed at community level to curb the spread of infection. Factors enabling transmission of SARS-CoV-2 in households include closed spaces, overcrowding, close contact for prolonged periods, and reduced use of protective equipment.

Mortality trends during the first three waves of the COVID 19 pandemic at an urban district hospital in South Africa: A retrospective comparative analysis

Since the start of the COVID 19 (C19) pandemic, there have been multiple studies worldwide. However, knowledge of mortality trends in developing countries – particularly at a district hospital (DH) level – is limited. Mortality remains high in multi-morbid ventilated patients with C19 in South Africa (SA) at any level of care. Globally, multiple independent risk factors have been identified as key contributors to the development of severe disease and mortality. These risk factors include male sex, obesity and comorbidities such as hypertension (HT), type 2 diabetes mellitus (T2DM), cardiovascular disorders, malignancies, chronic obstructive pulmonary disease, pulmonary tuberculosis (PTB) and HIV. Within SA, differential patterns of C19 deaths by sex, age, comorbidities and province have emerged. However, individuals with HT and T2DM are reliably shown to be at high risk of death from C19.

Postmortem minimally invasive tissue sampling to ascertain the cause of death in South African children: A case for implementing as standard of care

There has been a reduction in the global under-5 mortality rate from 93 deaths per 1 000 live births in 1990 to 38 in 2021. Nevertheless, under- 5 mortality rates remain high in low- and middle-income countries (LMICs). Ascertaining the cause of childhood death remains challenging in LMIC settings, and mainly premised on verbal autopsy and vital registration data. The verbal autopsy tool was developed to establish cause of death where other methods are unavailable, despite the low sensitivity (<33.3%). Determining the cause of death, even in health facilities in LMICs, is often hampered by the scarcity of diagnostic tools, multiple coexisting conditions, and paucity of postmortem sampling of the decedents. Furthermore, there is a lack of data on the cause of stillbirths, of which 98% of the 2.6 million annual cases occur in LMICs. More granular insight into the causes of deaths in children under 5 years of age from LMICs could inform interventions to achieve the Sustainable Development Goal 3.2 of reducing neonatal and under-5 mortality to as low as 12 and 25 per 1 000 live births, respectively, by 2030.

Community perceptions of community health worker effectiveness: Contributions to health behaviour change in an urban health district in South Africa

The role of the ‘community’ in community health worker (CHW) programmes across developing countries is often not clear. The World Health Organization states that communities should be vested in such programmes, yet community relationships, their views and perceptions of local CHW programmes are not well documented. CHW programmes can contribute to improvements in population health. Arvey et al. argue that while the potential of CHW programmes to improve health outcomes is evident, the details on how they make a difference is not well described in studies. This could be part of the ‘core elements’ determining effectiveness of CHW programmes, one of which is changing health behaviour of communities through consistent and sustained interactions at individual, household and community levels. The contextual factors in terms of community perceptions and local embeddedness may play a pivotal role in understanding some of the factors influencing CHW programme performance. Understanding these ‘softer’, more intangible issues may provide greater insights on how CHW programmes perform and are managed.

The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus

Low- and middle-income countries perform too few surgeries. Access to theatre is partly limited by human resource constraints, which include a critical shortage of specialists. Despite the limited number of surgeries in low-resource environments, not all high-risk patients are seen timeously prior to surgery to modify risk. This is partly due to the limited number of anaesthetists. Nearly 80% of patients presenting for surgery in low- and middle-income countries are of a low perioperative risk, yet not all of the remaining high-risk patients are seen by a specialist anaesthetist.

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis

Globally, 251 000 deaths, or 5.4% of all injury-related deaths, were due to firearm injuries in 2016, with 41% of deaths due to interpersonal violence as a result of a firearm, a 5.7% increase from 2006. Interpersonal violence was estimated to account for 1.5 million hospital admissions, with a further 28 million managed as outpatients in 2016. While there has been a global decrease in interpersonal violence between 1990 and 2013, the south sub- Saharan and Oceania regions have seen an estimated 50% increase in interpersonal violence disability adjusted life-years (DALY).