Urology pathways for the primary care physician

Urology, the oldest of the surgical specialties, delivers care that has the potential to be lifesaving and has the capacity to significantly enhance quality of life. However, there is currently an unmet demand for urological services in South Africa (SA). SA currently has only 347 active urologists registered with the Health Professions Council of South Africa, a dire urologist-to-population ratio of 0.56 per 100 000. Furthermore, 52 million people who fall outside the medical aid net are dependent on just 50 full-time urologists in the public sector across the country. Waiting lists continue to grow, and the status quo is inadequate to meet the demand. However, these issues are not unique to SA. In theory, National Health Insurance aims to provide equitable access to healthcare and general practitioners and primary care physicians, often described as the jewel in the crown of the National Health Service in the UK, will have an increasing role in managing common urological conditions here. This article provides practical, cost-effective diagnostic pathways, which are in line with international guidelines to approach common urological presentations and, except for a small number of advanced imaging requirements, can be implemented at all levels of care.

Prostate cancer perspective: Africa versus the world

Prostate cancer (PCa) is one of the most commonly diagnosed cancers among men. It is frequently cited as the most common cancer diagnosed in men and is the fifth leading cause of death globally. Similarly, PCa is the most commonly diagnosed cancer among South African (SA) men across all population groups. Black African men have been found to present later with a more advanced stage and higher histological grade at presentation than their non-black counterparts. The incidence of PCa in southern Africa has increased by an estimated 60% in the past decade and a half and could lead to an increase in mortality rates in black African men if the disease is not adequately and timeously managed.

Policy brief: Optimising antimicrobial usage in paediatric inpatient hospital settings

Antimicrobial resistance (AMR) poses a global threat to health, partly fueled by antimicrobial overuse. Paediatric inpatients are particularly vulnerable to infections, leading to high antimicrobial consumption. In low- and middle-income countries (LMICs) such as South Africa (SA), research on antimicrobial usage for neonatal and paediatric healthcare-associated infections (HAI) is limited.

Towards developing new private sector obstetric care and contracting models in South Africa: Insights from public hospitals using private general practitioners to provide caesarean deliveries

While South Africa (SA)’s total health spend of 8% - 9% of gross domestic product is comparable to other upper middle-income countries, expenditure is highly inequitably spread across the public and private sectorsand heavily skewed towards the private sector. In 2017, the per capita expenditure per year was estimated to be ZAR5 500 for those dependent on the public health system and ZAR20 000 for those who were able to afford private health insurance cover or pay out of pocket for private sector care. This has resulted in huge disparities between the two sectors. The public sector is characterised by a relatively low per-capita spend, weak infrastructure and governance and an inability to deliver accessible quality care to all who depend upon it. The private sector is characterised by a high per-capita spend and has a strong infrastructure, but is inefficient, fragmented and poorly regulated. There is a highly skewed distribution of providers towards the private sector, and the models of care for the two sectors are widely divergent with the public sector relying largely on ‘team-based’ models of care while the private sector is dominated by ‘individual provider’ models of care. This is particularly evident in the area of maternal and child care and caesarean deliveries – a major public health concern in South Africa (SA). In the public sector, caesarean delivery rates (28.1%) are in line with patterns seen in other low-and-middle-income countries, but the case fatality rate (CFR) for caesarean deliveries is three times higher than for vaginal delivery, and 27% of the caesarean deliveryrelated CFR is associated with haemorrhage. A review of avoidable factors suggests that in regional hospitals this could be due to delays in performing caesarean deliveries for obstetric emergencies due to overburdened services, whereas in district hospitals it could be due to lack of appropriate skills to perform caesarean deliveries safely and deal with surgical complications.

How far? Travel burdens for children admitted to hospitals in the Western Cape Province of South Africa

Access to health services is a key determinant of health outcomes. Service providers and consumers mediate the many parts of access in discrete and interdependent ways. Providers mediate approachability and appropriateness, and consumers the ability to recognise a need and the ability to reach a service, among other issues. Reaching a service could in turn be a composite of factors such as physical distance to a health facility, real-world travel time, transport availability and the economic cost to a household of finding or owning a vehicle for a journey.  Accessible emergency care for children is of particular importance because of their susceptibility to poor outcomes if care is delayed.

Prevalence and predictors of severe Crohn’s disease at a tertiary hospital in South Africa

Crohn’s disease (CD) is a subtype of inflammatory bowel disease, involving inflammation of the gastrointestinal tract. CD results from an interaction between genetic and environmental factors. It tends to affect the distal small intestine and colon. Inflammation in CD is discontinuous along the intestine, and can involve all layers from mucosa to serosa. Clinical presentation may depend on location of disease, and outcomes are based on individualised factors.

Diagnosis and presenting features of autoimmune hepatitis at a central referral hospital in South Africa

Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver, with a reported annual incidence rate of 0.5 - 2.2 per 100 000 population. The female-to-male ratio is approximately 4:1 in type 1 AIH and 10:1 for type 2 AIH. It can affect people of any age group and of all ethnic backgrounds. Clinical presentation may range from asymptomatic to fulminant hepatic failure. Diagnosis was aided with the development of the 1999 International Autoimmune Hepatitis Group (IAIHG) scoring system, and the subsequent 2008 simplified score intended for routine clinical practice.


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South African Medical Journal - April 2024 Vol 114 No 4