South African Family Practice (E-Journal)
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The impact of the COVID-19 pandemic on forensic pathology services in Limpopo province, South Africa
No full textBackground: To evaluate the effects of coronavirus disease 2019 (COVID-19) and the preventative measures taken, especially how they affect forensic pathology services in rural South Africa.Methods: This retrospective analysis includes referred post-mortem cases from all forensic pathology services in Limpopo province, comparing the period before the COVID-19 pandemic (01 January 2019 to 31 December 2019) with the pandemic period (01 January 2020 to 31 December 2020). Data analysis was performed using STATA 16.0 software (StataCorp; College Station, TX). Chi-square test was employed for comparison, with a p-value 0.05 deemed statistically significant.Results: Approximately 9319 cases were submitted for post-mortem examinations, with 4857 occurring before the pandemic and 4462 during it, marking an 8.1% decrease. There was a decrease in the number of unnatural death cases, while the instances of natural deaths rose. Cases under investigation saw a notable increase. There was a marked decrease in referrals for forensic examinations across all districts. In addition, except for one facility, there was a decline in the number of cases sent for autopsies at all facilities.Conclusion: In conclusion, forensic pathology services in this province had been severely disrupted by the COVID-19 outbreak and the lockdown that followed, especially in the tertiary hospital. It has led to new challenges for case management and necessitated changes to operating procedures.Contribution: It has required modifications to operational procedures and has introduced various challenges in case management
Healthcare professionals’ knowledge and attitudes on termination of pregnancy in eThekwini
No full textBackground: While the Choice on Termination of Pregnancy (CTOP) Act No. 92 was legalised in 1996 permitting termination of pregnancy (TOP) to be accessed at various public health facilities in South Africa, unsafe abortions continue to take place outside of legally designated facilities. The aim of this study was to explore the knowledge, attitudes and practices of healthcare professionals regarding TOP services at public primary healthcare (PHC) centres in the central business district (CBD) of the eThekwini Municipality in KwaZulu-Natal Province, South Africa.Methods: This quantitative, descriptive analysis used a questionnaire to obtain data from the healthcare professionals on four areas: demographic details, knowledge of (8 questions), attitudes to (10 questions) and practices (10 questions) regarding TOP services.Results: Among the 91 participants (whose ages ranged from 32 to 48 years), 91.2% were female, 93.4% belonged to the Christian faith, 42.9% were professional nurses and 74.8% had more than 5 years’ work experience. The mean of the overall knowledge, attitude and practice score was 51.7%, 67.4% and 62.8%, respectively, which indicated poor knowledge, moderate attitude and unacceptable practice.Conclusion: While some healthcare professionals’ knowledge regarding TOP services was poor, their personal beliefs may have contributed to their attitudes and practices regarding whether to assist their patients to access such services, despite it being legal.Contribution: This study provides insight into the health worker barriers that impede TOP service provision and access in the CBD of eThekwini
Primary care clinicians’ role in advocating for equitable healthcare access
No full textNo abstract available
Primary health care strengthening through the lens of healthcare system thinking
No full textDespite the strides made in healthcare, many countries still struggle to meet citizen healthcare needs, leading to global and regional health inequalities. The complex interactions between healthcare systems and disciplines present challenges for primary care providers and family physicians. Primary care providers must be equipped with tools and resources to effectively fulfil their duties, such as clinical governance, leadership and capacity building. This article focusses on various thinking approaches that primary care providers can employ, namely systems thinking, complexity science thinking and learning health systems thinking. We appreciate that individual styles and preferences, organisational culture and systemic realities influence multiple modes of thinking and decision-making. A range of modes of thinking and mental models will assist with tackling challenges and opportunities in the primary healthcare system. We hope this brief overview encourages readers to experiment with different ways of thinking to help facilitate innovative solutions
The association between serum magnesium levels and hypertensive disorders of pregnancy
No full textBackground: Evidence on circulating magnesium and hypertensive disorders of pregnancy in African populations is limited. We assessed between-group differences in serum magnesium and examined associations with early-onset pre-eclampsia and late-onset pre-eclampsia.Methods: We conducted an analytic cross-sectional study of 252 pregnant women sampled as four clinical groups: normotensive at a first antenatal visit, normotensive at term, early-onset pre-eclampsia, and late-onset pre-eclampsia. Serum magnesium was measured. Between-group differences were tested using one-way analysis of variance with contrasts. Associations with early-onset or late-onset pre-eclampsia versus normotensive groups were estimated using logistic regression adjusted for gestational age, body mass index, and human immunodeficiency virus status. We report effect sizes and 95 percent confidence intervals.Results: Serum magnesium was lower in normotensive women at term compared with those sampled at the first antenatal visit, consistent with physiological change across gestation. No comparable decrease was observed in early-onset or late-onset pre-eclampsia. The prevalence of hypomagnesaemia differed by group and was lowest at the first antenatal visit among normotensive women, while pre-eclampsia groups showed a divergent pattern. In adjusted models, obesity was positively associated with early-onset and late-onset pre-eclampsia, whereas human immunodeficiency virus status showed no significant association.Conclusions: In this South African cohort, cross-sectional comparisons demonstrate lower serum magnesium at term in normotensive pregnancies and a divergent profile in pre-eclampsia, supporting the hypothesis of altered magnesium regulation in hypertensive disorders of pregnancy. Results represent associations rather than causal effects and motivate future longitudinal research with repeated and intracellular magnesium measurements to clarify temporality and clinical relevance.Contribution: This article adds to the limited literature on Mg dynamics in pregnancy and highlights the need for population-specific strategies to reduce maternal mortality
Portfolio of learning in clinical training
No full textWorkplace-based assessment is increasingly crucial in the postgraduate training of specialists in South Africa, including for family physicians. A portfolio of learning allows a structured, flexible way to present evidence of learning. Portfolios are increasingly digitally based as e-portfolios. Portfolios are used for encouraging self-reflective learning, for transforming learning, and for gathering evidence of skills necessary for future employment. Portfolios support assessment for learning and assessment of learning. This necessitates registrar reflections, supervisor feedback and interaction, and linkages to entrustable professional activities (EPAs). The e-portfolio facilitates triangulation, aggregation and saturation of data points for the various EPAs to support clinical competency committees to make high-stakes evaluations of registrar portfolios. While the initial design and development costs are significant, operational costs become affordable when shared across all training programmes. The portfolio of learning has been a key priority in family medicine for almost 15 years. Initially, a paper-based portfolio was adopted to collect evidence of learning for the national exit-level outcomes. It was converted into an e-portfolio and implemented nationally through the coordination of the South African Academy of Family Physicians. In 2023, the e-portfolio was redesigned to gather evidence of learning for 22 EPAs, and a further revision took place in 2024. A portfolio of learning offers a valuable alternative to traditional assessment methods, allowing for a comprehensive understanding of registrars’ growth over time
Fall risk screening: Audiologists’ perceived knowledge, views and reported practice
No full textBackground: Falls among older adults are a major public health issue. In South Africa, where the elderly population is expected to quadruple within the next three decades, fall prevention is critical.Methods: This study evaluated South African audiologists’ perceived knowledge, views and reported practices regarding fall risk screening (FRS) in older adults. A quantitative online survey was conducted using an adapted questionnaire designed to assess various aspects of FRS practice. Data were analysed using descriptive and inferential statistics.Results: The survey received responses from 106 audiologists. Most respondents reported using familiar tools, such as case history and vestibular assessments, to conduct FRS, with fewer utilising functional balance measures. Only 11% of audiologists reported prior knowledge of FRS, while 69% – 74% perceived their knowledge as insufficient to screen or counsel older adults. While 58% recognised FRS as part of the audiologist’s scope, only 21% felt comfortable conducting it. Key barriers included insufficient training (80%) and time constraints (48%). Despite this, 98% expressed interest in learning about FRS and 90% believed FRS could enhance the profession.Conclusion: The findings underscore the need for improved clinical guidelines, educational initiatives and practice standards to better equip audiologists in fall prevention efforts and a collaborative approach to fall risk management for older adults.Contribution: This study emphasises the importance of incorporating FRS into undergraduate audiology curricula and continuous professional development programmes and encourages the use of a biopsychosocial approach and collaboration among multidisciplinary teams in fall risk management for older adults
Regional anaesthesia in the emergency centre: Knowledge, attitudes and practices of doctors in the Western Cape, South Africa
No full textBackground: Regional anaesthesia in emergency centres (ECs) offers clear benefits for patient care and system efficiency. However, its use in South African ECs remains inconsistent, and the knowledge, attitudes and practices of emergency doctors are not well understood. A notable gap exists in formal training.Methods: A cross-sectional survey was conducted among EC doctors at four district hospitals in the Metro-East health district of the Western Cape, South Africa. Data were collected via an electronic questionnaire exploring knowledge, attitudes and practices related to regional anaesthesia.Results: Eighty-five doctors participated (58% response rate). Among them, 67.1% had prior training in peripheral nerve blocks, predominantly informal and peer-based (98.2%), with only 8.8% receiving formal training. Most (96.5%) expressed interest in further training. Regional anaesthesia was underused: 36.5% used it less than monthly, 23.5% weekly and only 2.4% daily. Despite this, 77.6% rated it as important or very important, and 75.3% scored its usefulness ≥ 7/10. Barriers included limited confidence in managing local anaesthetic toxicity and inconsistent monitoring: 39.1% never monitored, while only 25% did so consistently. The most cited barrier (92.9%) was a lack of knowledge.Conclusion: Despite strong interest and favourable attitudes, regional anaesthesia remains underutilised because of limited knowledge, informal training and concerns about safety and monitoring.Contribution: This study reveals a disconnect between positive clinician attitudes and limited practical competence. It underscores the need for structured, formal educational initiatives to support safe and effective regional anaesthesia use in district ECs
