South African Medical Journal - August 2024 Vol 114 No 8

Introduction

Primary ciliary dyskinesia: Meeting the challenges of diagnosis in South Africa

Ciliary dyskinesias are abnormalities in cilial function, and when present in the respiratory system can result in impaired mucous clearance from the respiratory tract, initiating a vicious cycle of bronchial inflammation, bacterial colonisation and bronchial wall damage that may result in bronchiectasis. Causes of ciliary dyskinesia can be primary or secondary, and result in transient or persistent ciliary impairment. The focus of this article will be primary ciliary dyskinesia (PCD), which is an inherited ciliopathy.

Saying sorry – should a ‘safe space’ be created to allow effective communication between healthcare practitioners and aggrieved parties after an iatrogenic event in South Africa?

South Africa (SA) has a significant incidence of medical negligence claims. Litigation is normally conducted in the civil courts, and in some instances, negligence can be tried in a criminal court. Matters involving medical negligence can also be reported to the Health Professions Council of SA (HPCSA). The other option available to an aggrieved party is to make use of the various alternative dispute resolution (ADR) processes, including mediation and arbitration. While these options offer various types of compensation or redress, they might not fully alleviate the aggrieved party of their pain or enable them to move on. It is often said that the patient or their family wishes to receive a sincere apology in the event that an iatrogenic event occurs. Healthcare practitioners are reluctant to issue such apologies for various reasons, including the fear of litigation against them. A situation thus occurs that gives rise to two competing interests, namely the patient or their family members wishing to receive an honest apology, and the healthcare practitioners needing to safeguard themselves against litigation. There is a lack of academic literature that addresses this clash of interests in the SA context. This article sets out what the default legal position is, and then turns to foreign law for further guidance. Section 39(1) of the Constitution of the Republic of SA states: ‘when interpreting the Bill of Rights, a court, tribunal or forum … (c) may consider foreign law.’ While not necessarily binding as such, it provides us with the opportunity to consult foreign jurisdictions that have a much more developed jurisprudence relating to disclosure of information relating to iatrogenic events. The article will conclude with providing recommendations as to how this issue can be dealt with.

The Ministerial Advisory Committees and 3 years of COVID-19 expertise – is the Department of Health’s model for information-sharing pandemic-ready?

The COVID-19 pandemic had a devastating impact on South Africa (SA). It resulted in at least 102 595 COVID-19 deaths from January 2020 to January 2024, with some authors estimating that the number of ‘excess deaths’ is likely to be several times higher. It caused immense economic disruptions, with an estimated 3 million jobs lost in the first few months of lockdown alone. More than half a million children dropped out of school, and ~2,8 million households with 10.6 million residents were affected by hunger in the last 7 days in April/May 2021. There has been both praise and criticism of the SA government’s response during this period.

The prevalence and distribution of malaria in Mpumalanga Province before and during COVID-19 (2017 - 2022)

Malaria is a preventable and treatable disease that continues to contribute to high levels of morbidity and mortality, predominantly in sub-Saharan Africa (SSA). Following years of significant advances in the effective control of malaria in Africa, progress has plateaued and, in some cases, reversed since 2015. In 2021 there were an estimated 247 million cases of malaria and 619 000 malaria-related deaths, compared with the 214 million cases and 438 000 reported in 2015, with >90% of cases and deaths occurring in Africa. Inconsistent funding with reallocation of resources towards COVID- 19, and the emergence of drug and insecticide resistance, have been identified as key factors that contribute to this progress reversal. With the ongoing COVID-19 pandemic caused by the new coronavirus, SARS-COV-2, placing an increased burden on already severely stretched health systems, there were fears that the delivery of essential malaria services would be adversely affected, reversing the progress made against malaria even further. Mathematical models predicted a sharp increase in malaria cases, with at least a doubling of malaria-related deaths in 2020 compared with 2018. Although COVID-19-linked disruptions in malaria services did not lead to a doubling of malaria-related deaths, they resulted in significant increases in cases and deaths in 2020. The Essential Health Services (EHS) pulse survey (round 3) completed in the World Health Organization (WHO) Africa Region reported that disruptions in diagnoses and treatment failures decreased markedly at the end of 2021 v. the first half of the year, with only 7 countries reporting failures, v. 16 in 2020 and 9 in early 2021.

Sexual and reproductive health and rights, HIV and migration in southern Africa: A rapid review

People move from one place to another through migration within and across national borders. Migration can be categorised as economic, sociopolitical, or voluntary. In 2020, there were 281 million migrants globally, 3.6% of the world’s population. Compared with the previous year’s total of 272 million, this represented an increase of 3.5%. About 48% of the migrants were women. A total of 21 million Africans were migrants to other African countries in 2020. Approximately 2.9 million international migrants were living in South Africa (SA) in 2020. SA continues to be the continent’s most popular destination country. The effects of migration on health are becoming more scrutinised as international migration rises in low- to middle-income countries. The study of the dynamics of migration and health ought to be a top priority for public health. Additionally, as sub-Saharan African countries work to achieve universal health coverage, migratory populations need to be considered in health policy and planning.

From economics to health outcomes: Delving into the significance of reduced insulin prices

The recent announcement of significant price reduction of insulin therapy, specifically the newer long-lasting basal insulins, by three major insulin producing manufacturers raises the question of its impact on the South African (SA) healthcare community.

The prevalence of hand pathology in regional orthopaedic hospitals in KwaZulu-Natal: A cross-sectional study

Hand pathology (HP) has the propensity to cause functional impairment and loss of income, and present significant costs in the form of expenditure on management, and loss of economic contribution from the affected patients. In the South African (SA) context, investigation has been performed to establish the aetiology of occupational hand trauma in the healthcare system of Gauteng Province. Studies emanating from occupational therapy journals document a high caseload of hand trauma in SA and the province of KwaZulu-Natal, respectively. Hand infections have also been investigated in SA, and specifically, the most common causative organisms and aetiologies have been explored. Internationally, there is an increased trend in the prevalence of hand pathology, particularly occupational injuries, and overuse syndromes. At present, there remains limited quantitative data encompassing all pathological conditions of the hand within the SA context.