South African Medical Journal - March 2024 Vol 114 No 3

Introduction

Lower respiratory tract infection admissions and deaths among children under 5 years in public sector facilities in the Western Cape Province, South Africa, before and during the COVID 19 pandemic (2019 - 2021)

The COVID 19 pandemic and subsequent responses by both the South African (SA) government and the population resulted in many changes impacting disease transmission, access to healthcare services, and population mobility. Changes were driven by a combination of public fear of COVID 19 infection, restricted provision of non-essential health services and the introduction of strict public health and social measures (PHSMs), aimed at curbing the spread of SARS-CoV-2 and ensuring sufficient hospital capacity for COVID 19 admissions.

Contribution of a bonded scholarship scheme to staffing rural health facilities

As in other parts of the world, a large proportion of the South African (SA) population live in rural areas, but are served by only 12% of the country’s doctors and 19% of nurses. There is an urgent need to find ways to staff rural healthcare facilities to ensure equitable access and provide quality services, as without staffing there can be no service. The Human Resources for Health 2030 strategy has identified a need to ‘revolutionise the selection and recruitment of health professional students’ to overcome health workforce inequities between urban and rural areas, as only ~35/1 200 SA medical graduates per annum remained in rural areas in the longer term, defined as 10 - 20 years in the Human Resources for Health Strategy 2012/13 - 2016/17.

Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans

The burden of type 2 diabetes mellitus (hereafter referred to as diabetes), at 15% among ≥25-year-old South Africans, is high and rising. This is of concern because of the heavy health burden associated with diabetes, i.e. the macro- and microvascular complications that are frequently debilitating and contribute to high levels of morbidity and mortality in the country. Moreover, in South Africa (SA), diabetes-related morbidity and mortality occur most often in working-age individuals who are also family breadwinners. This poses a serious threat, not only to health but also to economic development, and further exacerbates social inequities. Notably, diabetes is the second leading cause of mortality in the country after tuberculosis, accounting for almost 6% of deaths in 2017. Therefore, optimal diabetes management with effective intervention strategies is crucial to prevent adverse outcomes.

Determination of anti-COVID 19 IgG and IgM seroprevalence among pregnant women at Pietersburg Hospital, Limpopo Province, South Africa

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, has ravaged the world within a short period, leaving an unprecedented crisis the world has never seen before. Globally, >468 million cases of COVID 19 were confirmed, and >6 million fatalities were reported by 20 March 2022. The African continent accounted for 8 170 474 of the total cases, with 170 822 fatalities, with 3 704 784 of the confirmed cases and 99 890 fatalities being from South Africa (SA).

Cryoballoon ablation for atrial fibrillation in South Africa: One-year outcome from the Cryo Global Registry

Atrial fibrillation (AF) is imposing a rapidly increasing burden on healthcare systems worldwide. The reported prevalence of AF in South Africa (SA) is 3% in general practice, and the rate of newly diagnosed AF was 4.6 - 5.9% in patients within specialised cardiac care. Globally, catheter ablation (CA) is the recommended therapy for patients with symptomatic AF. However, a national survey from 2014 (Jardine et al.) showed that only 4.2% of AF patients in SA underwent CA for the treatment of AF. In fact, the number of CA procedures overall has steadily increased in the past decade. SA is the only country in the sub- Saharan African region to perform complex cardiac ablations requiring three-dimensional (3D) mapping and trans-septal puncture. Mkoko et al. reported that AF ablation accounted for most of the CA cases, and radiofrequency ablation (RFA) was more commonly used than cryoballoon ablation (CBA; 94.7% v. 5.3%), respectively. CBA is a ‘single-shot’ anatomical ablation approach to pulmonary vein isolation (PVI), not requiring 3D mapping. Compared with RFA, CBA is associated with an increased long-term cost-effectiveness. However, outcome data of CBA in the SA population are limited. This sub-analysis of the Cryo Global Registry assessed the procedural characteristics, safety and efficacy of CBA in patients with AF according to real-world practice in SA.