South African Medical Journal (SAMJ)
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More than medicine: The Department of Family Medicine’s journey to embed care and learning in the heart of the community
No full textMetabolic and bariatric surgery: Postoperative management
No full textRECOMMENDATIONS
1. HCPs can encourage PLWO who have undergone MBS to participate in and maximise their access to behavioural interventions and allied health services at an MBS centre (Level 2a, Grade B).
2. We suggest that MBS centres communicate a comprehensive care plan to primary HCPs for patients who are discharged, including MBS procedure, emergency contact numbers, annual blood tests required, long-term vitamin and mineral supplements, medications, behavioural interventions, and when to refer back (Level 4, Grade D, Consensus).
3. We suggest that after a PLWO has been discharged from the MBS centre, HCPs should annually review nutritional intake, activity, compliance with multivitamin and mineral supplements and weight, as well as assess comorbidities, order laboratory tests to assess for nutritional deficiencies, and investigate abnormal results and treat as required (Level 4, Grade D, Consensus).
4. We suggest that HCPs consider referral back to the MBS centre or to a local bariatric medicine specialist for technical or gastrointestinal symptoms, nutritional issues, pregnancy, psychological support, weight regain, or other medical issues related to MBS as described in this chapter (Level 4, Grade D, Consensus).
5. We suggest that MBS centres provide appropriate follow-up and laboratory tests at regular intervals after surgery with access to appropriate HCPs (dietitian, nurse, social worker, surgeon, bariatric physician, psychologist/psychiatrist) until discharge/referral to primary care level is deemed appropriate for the patient (Level 4, Grade D, Consensus)
An audit of extracorporeal membrane oxygenation outcomes in patients with low cardiac output syndrome at Charlotte Maxeke Johannesburg Academic Hospital, South Africa
Get PDFBackground. Extracorporeal membrane oxygenation (ECMO) is a means of supporting an inefficient cardiorespiratory system, refractory to medical treatment, with a mechanical device. Low cardiac output syndrome (LCOS) is a frequent problem after cardiopulmonary bypass. Globally, centres have investigated outcomes of ECMO and have documented associated preoperative, intraoperative and postoperative predictive factors. Our centre has used ECMO since the mid-1990s, but there has been no study investigating the outcomes.
Objectives. To evaluate 30-day survival and associated predictive factors among patients with LCOS in whom ECMO was used during or after open-heart surgery.
Methods. The study was a retrospective review of clinical records of adult patients in whom ECMO was used during or within 72 hours after open-heart surgery from November 2016 until the end of December 2022. Data were collected using the RedCap (Research Electronic Data Capture) online database manager at the University of the Witwatersrand and entered into a Microsoft Excel spreadsheet. For descriptive analysis, continuous data were analysed using a one-way analysis of variance. The association between patient factors and outcomes was analysed using Fisher’s exact test. Statistical analysis was conducted using Stata.
Results. ECMO was used in 4.6% (n=60) of 1 311 patients who underwent heart surgery during the study period, of whom 38 met the study selection criteria; of these, 6 (15.8%) survived to discharge. Of the patients who survived, 5 were black females in the working age group. All the patients who died (n=32/38; 84.2%) did so within 30 days. All the patients experienced morbidity while on ECMO. All the surviving patients survived for >30 days and were discharged from hospital.
Conclusion. Our ECMO survival rate following open heart surgery (~16%) is low compared with other better-established centres. Various factors were associated with the poor outcomes
Where is the South African prevention of fetal alcohol spectrum disorder programme? A call to action
No full textFetal alcohol spectrum disorder (FASD) prevalence is high in South Africa, and is a significant public health concern. The long-term
consequences of FASD are devastating to the individual, their family and society. Costs associated with managing these patients and the consequences of their disorder are significant. National ownership and multisectorial involvement are required to design and implement a successful FASD prevention programme
Community-based education: A strategy for training community-responsive health professionals
No full textHealth literacy on diabetes mellitus among a working population of Mthatha, Eastern Cape Province, South Africa
No full textBackground. Diabetes mellitus is one of the major killers in low- and middle-income countries. Health literacy of diabetes mellitus is crucial for effective management and prevention strategies. However, socioeconomic factors in Mthatha, South Africa, may limit adult awareness, exacerbating the prevalence of the chronic disease.
Objectives. To assess the level of knowledge of diabetes mellitus among adults in work settings in Mthatha.
Methods. This quantitative cross-sectional study used validated questionnaires to collect data among randomly selected adult workers in Mthatha. The study participants were aged 18 - 60 years, residing and working in Mthatha in the King Sabata Dalindyebo (KSD) subdistrict. Sample size calculations targeted recruiting a minimum of 118 participants. Knowledge adequacy was set at 70%. Helsinki declarations on ethical principles were adhered to throughout the study.
Results. A total of 118 adults, predominantly female (60.2%), with a median age of 34 years and 64.8% with post-matriculation education, participated in the study. The study revealed that only 7.6% of the participants had an adequate knowledge of diabetes mellitus, while 64.4% had a poor knowledge. Only 69.5% of the participants associated excessive sugar consumption with the development of diabetes mellitus, while 44.1% believed that medication was a better option for the control of diabetes than a diet, 34.7% understood that poor blood circulation as a complication was associated with the condition, and only 16.1% identified excessive sweating and shaking as signs of increased blood sugar levels.
Conclusion. Health literacy regarding diabetes mellitus among adult workers in Mthatha is notably low. Improving health literacy knowledge of public health and behaviour modification is crucial to successfully decrease the incidence and number of deaths associated with diabetes mellitus. Innovative approaches tailored for the control of diabetes mellitus in the workplace are needed to balance behaviour and clinical interventions on the management of the condition
A vision for South Africa’s only rural academic health complex: The case of Walter Sisulu University and the Nelson Mandela Academic Hospital Complex
No full textReducing weight bias in obesity management, practice and policy
No full textRECOMMENDATIONS
1. HCPs should assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery (Level 1a, Grade A).
2. HCPs should recognise that internalised weight bias (bias towards oneself) in PLWO can affect behavioural and health outcomes (Level 2a, Grade B).
3. HCPs should avoid using judgemental words (Level 1a, Grade A), images (Level 2b, Grade B)[2] and practices (Level 2a, Grade B)[13] when working with PLWO.
4. We recommend that HCPs avoid making assumptions that an ailment or complaint a patient presents is related to their body weight (Level 3, Grade C)
Editorial Study: Contrasting epidemiological perspectives on environmental risk factors for breast cancer in Africa and Western regions
No full textBackground. Endocrine-disrupting chemicals (EDCs) such as pesticides, plasticisers and food-related compounds are ubiquitous environmental pollutants linked to increased breast cancer risk. While substantial evidence exists from Western settings, limited data address these associations in African populations, where exposure patterns and regulatory frameworks differ markedly.
Objectives. To synthesise global epidemiological evidence on EDC exposure and breast cancer, with a focus on identifying disparities between African and Western regions.
Methods. A systematic review of PubMed (MEDLINE) was conducted by Mahasa et al. from 30 November 2024 to 14 July 2025, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search used keywords including ‘endocrine disruptors’, ‘breast cancer’, ‘climate change’, ‘air pollution’, ‘water pollution’, ‘global warming’ and ‘greenhouse effect’, and included both case-control and cohort studies.
Results. The search identified 172 eligible studies. Most were from Western countries and used biomarker-based exposure assessments. Most studies were conducted in Western countries, mainly the USA, Canada and parts of Europe, by authors such as Wolff, Brody, Stellman, Eskenazi and Rusiecki, who used biomarker-based methods to assess exposure to key endocrine-disrupting chemicals (EDCs) including dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), bisphenol A (BPA), phthalates and polychlorinated biphenyls (PCBs). These Western studies consistently linked higher levels of DDT/DDE, PCBs and certain phthalates to increased breast cancer risk. In contrast, there were only a few studies from African countries such as South Africa, Nigeria and Egypt, despite higher potential exposure through agriculture and food systems, and these were limited in scale and methodological depth, providing less conclusive evidence.
Conclusion. Regional gaps in data limit our understanding of EDC-related breast cancer risk in Africa. Targeted research and region- specific policies are urgently needed