South African Medical Journal - July 2022 Vol 112 No 7

Introduction

Thematic analysis of the challenges and options for the Portfolio Committee on Health in reviewing the National Health Insurance Bill

The National Health Insurance Bill (the Bill) was introduced in Parliament in August 2019. Parliament’s Portfolio Committee on Health (PCH) is responsible for obtaining public input on the Bill, reviewing it based on these inputs, and preparing a final version for the Minister to present to the National Assembly. The PCH conducted public hearings across the country, received over 100 000 submissions, and heard oral presentations from 117 respondents between 18 May 2021 and 23 February 2022.

Non-fatal injuries among boys and girls presenting to Red Cross War Memorial Children’s Hospital, Cape Town

Paediatric injuries are a growing concern globally, especially in lowand middle-income countries (LMICs), where they are associated with significant morbidity and mortality. Injuries can also result in disability, with short-term or lifelong consequences. LMICs in the African region are affected by high rates of child injury mortality, particularly from road traffic crashes and violence. Data to characterise the causes associated with childhood fatal and nonfatal injuries in these countries are very scarce, however, and sex disaggregation is not routinely undertaken during analysis.

Bleeding and thrombosis outcomes in hospitalised COVID-19 patients on low-molecular-weight heparin and antiplatelet therapy

In March 2020, the World Health Organization declared COVID-19 a pandemic. After millions of cases and deaths worldwide, effective curative treatment modalities are still lacking. As of 17 March 2022, South Africa (SA) had registered 3 698 803 COVID-19 cases and 99 767 deaths. Worldwide the total number of recorded cases was 464 593 286, with 6 082 147 deaths. Autopsies and clinical studies have described a COVID-associated coagulopathy, affecting all three aspects of Virchow’s triad and leading to thrombosis. Low-molecular-weight heparin (LMWH) is an anticoagulant used in the treatment of thromboses, and acts by binding to and activating antithrombin III, thereby inhibiting factor Xa. An increase in the incidence of thromboembolic events in COVID-19 patients despite the use of LMWH has been demonstrated in numerous studies. Arterial events including stroke, myocardial infarction and limb ischaemia have also been reported. Currently, studies are evaluating the use of higher doses of LMWH in hospitalised COVID-19 patients.

Phase I of the DiaVACCS screening trial: Study design, methods, population demographics and baseline results

South Africa (SA) suffers a double epidemic of cervical cancer and HIV infection, two diseases competing for health resources and aggravating each other. Around 12 000 new cervical cancer cases are diagnosed in SA per year, with an estimated age-standardised incidence rate of 35.3 per 100 000 women. It has been estimated that 23.9% of women between the ages of 15 and 49 years were HIV positive in 2021 and that more than half of patients with cervical cancer in southern Africa are women living with HIV (WLWH).  Infection with HIV and poor immunity influence acquisition and the clinical course of human papillomavirus (HPV)-related disease. Several studies have demonstrated a significantly higher prevalence of cervical cancer, precancerous lesions and cervical HPV infection in HIV-infected women compared with HIV-uninfected women, and this effect may be increased by late initiation of antiretroviral therapy (ART).

Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective

 Antibiotic resistance is one of the greatest global healthcare threats the world is facing. Failure to respond with appropriate action may lead to a post-antibiotic era in which ordinary infections will be untreatable. Irrational prescribing is one of the factors fuelling antibiotic resistance. Approximately 80% of antibiotic prescribing occurs in the primary healthcare setting, where almost 30% of prescribed antibiotics are unnecessary.[6] Antibiotic stewardship programmes have been identified as a key strategy to optimise antibiotic use in an attempt to reduce antibiotic resistance at both hospital and community level. Low- and middle-income countries face various challenges to successfully implement antibiotic stewardship programmes.[8] Implementation of stewardship programmes in primary care in South Africa (SA) is still developing. The Antimicrobial Resistance National Strategy Framework 2014 - 2024 was developed to support antibiotic stewardship in SA.

Maternal mental health and caregiver competence  of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa

Maternal mental health has been of interest to many researchers, who have studied the prevalence of depression and anxiety in the antenatal and postnatal periods, and the accompanying short-and long-term effects on the offspring. Depression developing during pregnancy and in the first year postpartum is the second leading factor contributing to the disease burden of childbearing women globally. Prevalence studies in developed countries report postnatal depression (PND) rates of 9 - 21%, while rates in developing countries, including South Africa (SA), are between 19.8% and 38.5%. Many mothers with PND may have developed depressive symptoms during their pregnancy. Global estimates indicate that the reproductive years are a critical period for the onset of depression, with 1 in 10 women meeting the diagnostic criteria for depression during pregnancy. The ICD-10 diagnostic criteria for PND stipulate that at least two features such as a depressed mood for most of the day, loss of interest or pleasure in ordinarily pleasurable activities (such as playing with the infant), tiredness, decreased energy, and fatigue must be present for at least 2 weeks. Moreover, the presence of any four other symptoms, including loss of confidence and self-esteem, feelings of guilt and blaming oneself, recurrent thoughts of suicide or death of self or child, difficulty in concentration, agitation or lethargy, appetite disturbance or sleep disturbance, are required for diagnosis.