Introduction

Teenage births and pregnancies in South Africa, 2017 - 2021 – a reflection of a troubled country: Analysis of public sector data

During 2021, there were a number of media reports that teenage pregnancies had dramatically increased. For example, Save the Children noted that ‘The number of children born to teen mothers in South Africa’s most populous province, Gauteng, has jumped 60% since the start of the COVID-19 pandemic.’ A Daily Maverick column had the headline ‘Schoolgirl births “unacceptably high” in South  Africa.’ This article tests the validity of these concerns. It quantifies and analyses teenage births and pregnancies in the public sector from 2017 to 2021, showing trends geographically, as well as disaggregating data into very young teenagers 10 - 14 years old and those aged 15 - 19. The media use of the word pregnancy is loosely used, as this includes miscarriages and pregnancy terminations, which are often extremely difficult to measure, and childbearing would be the more correct and appropriate term.

High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention

Globally, non-communicable diseases (NCDs) are the leading cause of disability and premature mortality, accounting for 71% of deaths worldwide and 80.6% of years lived with disability in 2016. NCDs affect low- and middle-income countries (LMICs) disproportionately, with more than three-quarters of NCD deaths occurring in LMICs. In 2017, the burden of NCDs in sub-Saharan Africa (SSA) was higher than the global average, almost equivalent to the total burden associated with communicable, maternal, neonatal and nutritional diseases. Of note, unhealthy diets and physical inactivity, which are significantly associated with cardiometabolic conditions and cancers, are rising globally, especially among the poor residing in urban LMIC settings. South Africa (SA) also has the largest HIV epidemic and the largest antiretroviral treatment (ART) programme globally, with 7.5 million people living with HIV in 2019 and 5.2 million on ART. Of note, SA also has the highest burden of adolescent HIV globally.

Percutaneous left atrial appendage occlusion: A South African experience

Atrial fibrillation (AF) is a major global health challenge, with an estimated prevalence in the general population of 1 - 2%. It becomes more common with age, and affects up to 15% of octogenarians. AF has been shown to be independently associated with all-cause mortality, heart failure and non-fatal stroke. Oral anticoagulants (OACs) have traditionally been used for the prevention of stroke, but many AF patients are intolerant to OACs, non-adherent, or at an unacceptably high bleeding risk when taking OACs. Percutaneous left atrial appendage occlusion (LAAO) with a dedicated device is an alternative approach to thromboprophylaxis in such individuals. Percutaneous LAAO has been shown to be non-inferior compared with OACs for stroke prevention in large clinical trials, e.g. the WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF). Only very limited data are available on percutaneous LAAO in South Africa (SA), and no local outcome data have been reported. We therefore compared the safety and efficacy outcomes of an SA percutaneous LAAO programme with larger international series

Patterns of disease on admission to children’s wards and changes during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa

Reducing preventable diseases, disabilities and deaths in children remains an important and challenging endeavour that requires ongoing insight into the burden of childhood disease. Major causes of under-5 deaths in South Africa (SA) include neonatal and congenital conditions, communicable diseases, nutritional deficiencies and injuries. As mortality rates fall, the focus of child health is expanding beyond survival to include morbidity and the optimal functioning of all children, including those with disability and longterm health conditions. Current data on the non-fatal burden of disease (morbidity) are sparse for SA children, as routine indicators have focused on mortality.

Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia

COVID-19 has stretched healthcare systems globally since its identification. It has resulted in increased acute hospitalisations, a high demand for intensive care and a high in-hospital mortality rate. Available data from around the globe show that SARS-CoV-2 infection is associated with increased but varied mortality rates in persons with underlying comorbidities. Some studies in developed countries have reported increased mortality rates as high as 70%. A meta-analysis that included 60 studies with 51 225 patients reported a 24% in-hospital mortality rate among COVID-19 patients, with older age, kidney disease and diabetes mellitus (DM) being listed as risk factors for increased mortality.

Profile, presentation and outcomes of prosthetic valve endocarditis in a South African tertiary hospital: Insights from the Groote Schuur Hospital Infective Endocarditis Registry

Infective endocarditis (IE) is relatively infrequent but is associated with high mortality and morbidity. The IE-related in-hospital mortality rate is reported to be as high as 22% and the 5-year mortality rate up to 45%. The mortality rate has remained stable despite advances in healthcare. For example, the IE-associated global age-standardised mortality rate in 2015 was 1.3 per 100  000 v. 1.4 per 100  000 in 2005. In low- and middle-income countries, IE tends to affect young patients with a high background prevalence of rheumatic heart disease (RHD), and the observed IE-related age-standardised mortality rate (1.7 per 100 000) is higher than the global figures.

Accreditation

Health Professions Council of South Africa

MDB015/MPDP/038/206

3 Clinical 

Certification

Attempts allowed: 2

70% Pass rate 





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South African Medical Journal - April 2022 Vol 112 No 4

3.0 CPD Points