Groote Schuur Hospital

Musculoskeletal (MSK) injuries pose a significant health burden across sub-Saharan Africa (SSA). Despite this, regional research output is limited, constrained by insufficient infrastructure, limited funding, and underdeveloped research capacity. This bibliometric analysis examined research outputs and collaboration patterns in MSK injury research across three SSA countries, representing a spectrum of income levels: low, lower-middle, and upper-middle income. MSK injury research articles from Malawi (MLW), South Africa (SA), and Tanzania (TZN), published between January 2014 and April 2024, were identified using Web of Science and Scopus databases, and cross-referenced with ResearchGate. Data were analyzed descriptively in Excel, and institutional coauthorship and collaboration networks were mapped using VOSviewer. A total of 329 articles were published across MLW (n = 98), SA (n = 141), and TZN (n = 90) between January 2014 and April 2024. We report a steady increase in the number of publications from 2014, with a research focus on fracture management, outcomes, and lower limb injuries. Most of the research was published in partnership with high-income countries (HICs) (SA: 51%, MLW: 98%, TZN: 87%), with high-income country (HIC) institutions dominating first and last authorship in MLW (68% and 61%) and TZN (59% and 69%) publications. Most studies were descriptive and based on secondary records. Institutional networks showed strong regional collaboration in SA, international focus in MLW, and limited connectivity in TZN. MSK injury research is increasing across MLW, SA, and TZN, but remains largely HIC-led and descriptive, particularly in lower-income countries. Strengthening local leadership, regional collaboration, and research capacity is essential for more sustainable and context-specific evidence generation.

Abstract Background Retinoblastoma (Rb) is the most common childhood intraocular cancer, with heritable forms caused by pathogenic germline variants in the RB1 (or retinoblastoma 1) gene, which necessitate intensive and costly lifelong surveillance. Genetic testing enables precise risk prediction and individualized clinical management, yet data on the RB1 variant spectrum in African populations remains scarce. This study investigated the molecular landscape of clinically presumed heritable Rb in a Southern African cohort and evaluated the potential healthcare and economic benefits of implementing genetic testing. Methods Fifty-eight patients with clinically presumed heritable Rb were recruited from two tertiary hospitals in South Africa. Comprehensive RB1 gene analysis was performed using next-generation sequencing (NGS) to detect single nucleotide variants (SNVs), small insertions and deletions (indels), and copy number variants (CNVs), and was supplemented by methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA). A cost comparison model was developed to evaluate conventional clinical screening versus a genetically guided approach. Results RB1 pathogenic and/or likely pathogenic variants were identified in 84.5% (49/58) of patients, including eleven novel variants. The variant spectrum included frameshift, nonsense, splicing, intronic, and missense changes, with a notable concentration in the pocket domain region of the Rb associated protein (pRb). CNVs were detected in 10.3% of probands. Our cost analysis demonstrated significant savings associated with genetic testing, reducing surveillance-related expenses by up to US$228,989 across extended family generations in the private sector and US$166,489 in the public sector. Implementing genetic testing would also minimize unnecessary examinations and promote more efficient allocation of healthcare resources. Conclusions Comprehensive RB1 genetic testing in this Southern African cohort revealed a diverse variant landscape, including novel pathogenic changes, and demonstrated the clinical and economic value of integrating genetic testing into Rb management. These findings contribute to the global understanding of genetic variation within the RB1 gene and support tailored care strategies that can reduce the surveillance burden, optimize healthcare resources, and improve outcomes for affected families.

Background/Objectives: The overuse and misuse of antibiotics contribute to antimicrobial resistance (AMR) globally. The appropriateness of antibiotic prescribing at the primary healthcare (PHC) level must be urgently addressed to reduce high levels of inappropriate antibiotic prescribing and associated AMR. This study aimed to develop quality indicators, based on the World Health Organization (WHO)'s Access, Watch, Reserve (AWaRe) guidance, to assess the appropriateness and quality regarding antibiotic prescribing in public PHC settings in South Africa. Methods: Potential indicators were identified from indicators developed by City St George's, University of London (SGUL); a review of AWaRe-based indicators; and the results from point prevalence surveys at PHC clinics in South Africa. The indicators were developed using the RAND/UCLA Appropriateness Method. In Round 1, 12 experts individually rated 78 indicators for clarity and appropriateness. In Round 2, 10 experts rated 89 indicators for appropriateness and feasibility during an interactive online meeting. Results: The final set had 61/89 indicators (68.5%) that were rated both appropriate and feasible with agreement. Dental infections (9/9; 100%) alongside skin and soft tissue infections (11/13; 84.6%) had the highest percentage of indicators that were rated appropriate and feasible with agreement. Lower urinary tract infections (6/11; 54.5%) and general (4/8; 50%) categories had the lowest percentage of indicators rated appropriate and feasible with agreement. Conclusions: The process proved valuable in developing potential indicators for use in future antimicrobial stewardship programmes to improve antibiotic prescribing in public sector PHC facilities in South Africa and beyond.

There are three common and significant causes of lymphadenopathy (LAP) in tuberculosis-and-HIV-endemic settings - tuberculosis, lymphoma, and metastatic solid organ cancers. Overlapping clinical symptoms of these diseases necessitates diagnostic procedural investigation. Fine needle aspiration (FNA) with Xpert TB/RIF Ultra has good sensitivity for tuberculosis diagnosis, while FNA cytology can detect solid cancer lymph node metastasis, although with lower sensitivity. Critically, lymphoma cannot be reliably detected or classified using FNA. Lymphoma diagnosis often is made after repeat testing and eventual surgical excision biopsy (SEB), contributing to treatment delays, inappropriate empiric anti-tuberculosis therapy, and increased strain on already limited healthcare resources. This study presents a comparative provider-perspective cost analysis of three diagnostic procedures: FNA, SEB and core-needle biopsy (CNB). Costs were evaluated for individual procedures and within investigative pathways for unexplained LAP. Data were collected at Groote Schuur Hospital, a tertiary academic hospital in South Africa, during 2018 and 2025. Costing was conducted using a mixed-methods approach combining bottom-up ingredients-based costing with top-down allocation of overheads. Capital costs were annualised, and all costs were adjusted to 2025 values in United States dollars. Histological diagnosis and tuberculosis testing using CNB were less costly (US$ 145) than either SEB (US$ 244), or FNA cytology and tuberculosis testing (US$ 179). Total investigative costs increased substantially when repeat FNAs were required while awaiting access to SEB (US$ 518). CNB demonstrated high diagnostic accuracy and obviated the need for further procedures in most cases, improving diagnostic efficiency and offering significant potential for cost savings. Sensitivity analyses suggested further reductions in CNB costs are possible through task-shifting to junior clinicians and through the use of reusable biopsy equipment. The CNB-centred diagnostic approach to lymphadenopathy provides lower-cost, timeous, and accurate diagnosis of the three most significant causes of LAP in tuberculosis- and HIV-endemic settings. This approach enables early initiation of appropriate treatment, reduces unnecessary procedures, and optimises the use of limited healthcare resources. These findings support the integration of CNB into national diagnostic algorithms and highlight the value of investments in training and equipment to enable its decentralised implementation.

Chronic urticaria (CU) diagnosis includes the patient's clinical history and physical examination. However, atypical presentations or misdiagnosis can lead to diagnostic delay (DD). The impact and contributing factors of DD in CU are unknown and were assessed in the present study. We retrospectively analysed data from CU adult patients from the international, multicenter Chronic Urticaria Registry (CURE). Of 4332 CU patients, 61% had standalone chronic spontaneous urticaria (sCSU), 18% had ≥ 1 form of chronic inducible urticaria (CIndU), and 21% had a combination of both (CSU + CIndU). Diagnosis of CU was delayed in 24% of patients by at least 1 year. CIndU patients showed a longer DD compared to those with sCSU or CSU + CIndU (median, [IQR]: 4, [0-22] vs. 1, [0-6] vs. 2, [0-9] months, p < 0.001). Among CIndU patients, symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) patients had the longest DD compared to all other CIndU subgroups (median: 4 months, p = 0.005 for both). In CIndU patients, a longer DD was associated with having an additional CIndU (OR: 12.8, p = 0.03), younger age, comorbidities, lower disease control, and lack of second-generation H1-antihistamine treatment. In CSU patients, a DD of ≥ 6 months was associated with lower CSU activity (median weekly Urticaria Activity Score of 14 vs. 21, p = 0.02) compared to that of DD < 6 months. Diagnosis of CU is delayed in one out of four patients. Greater awareness of the guideline-recommended CU classification, clinical presentation, and diagnostic work-up can facilitate CU diagnosis.

BackgroundExtracorporeal membrane oxygenation (ECMO) for infectious causes of refractory cardiopulmonary failure is established as appropriate therapy in high-income countries. Its use in low- and middle-income nations for tropical infections is not well-studied, however, perhaps because most of these countries have not been historically able to offer ECMO support. Tropical infections remain an important cause of global morbidity and mortality, but the role of ECMO is poorly described.MethodsWe identified a list of viral, bacterial, fungal, and parasitic infections that qualified as tropical infectious diseases. These included infections that were either a World Health Organization (WHO) designated Neglected Tropical Disease (NTD) or an infectious disease with a higher prevalence in the Tropics than elsewhere. We conducted a comprehensive review of existing literature regarding ECMO use to support these infections.ResultsMultiple viral, bacterial, fungal, and parasitic tropical infections have been supported by ECMO with varying success. leptospirosis, melioidosis, and tuberculosis are conditions suitable for venovenous ECMO support with frequent use in the literature and reported survival as high as 84% in Leptospirosis. Venoarterial ECMO has been successfully used in American trypanosomiasis-related cardiogenic shock as a bridge to transplant, with one center reporting a 71% survival rate. Dengue and malaria have been successfully supported with both venovenous and venoarterial ECMO. Mortality is relatively high (> 65%) in patients who receive ECMO for Middle Eastern Respiratory Syndrome. ECMO has also supported Echinococcal infections perioperatively. There are multiple tropical infections where ECMO use has not been published.ConclusionAs the use of ECMO expands globally, more patients with tropical infections may require ECMO in both endemic and non-endemic settings. We present a scoping review on the evidence base of ECMO use to support tropical infectious diseases, with data regarding feasibility in specific disease processes as well as clinical considerations for tropical diseases on the ECMO circuit.

Strengthening research capacity in Africa is vital for tackling pressing health, educational and socioeconomic challenges facing the continent. At the core of this effort is the cultivation of innovative research leaders through postgraduate training programmes that incorporate mentorship-infused supervision. Such models have demonstrated potential in improving research skills, boosting academic productivity and fostering leadership development among emerging scholars. This systematic review and meta-synthesis protocol aims to examine existing mentorship-infused supervision practices across African higher education institutions. The review seeks to identify effective models, uncover common challenges and barriers, and generate evidence-based recommendations to develop sustainable, contextually relevant strategies. Insights from this work will inform policies and practices to enhance postgraduate research training, advance research leadership and contribute to the broader goal of strengthening research ecosystems across Africa. A systematic review and thematic meta-synthesis will be undertaken, focusing on qualitative research studies as well as the qualitative components of mixed-methods studies. Relevant studies published in English will be identified through a comprehensive search strategy. The electronic databases, including Medline/PubMed, Scopus, Web of Science, African Journals Online, EMBASE and CINAHL, will be searched to capture a wide range of peer-reviewed articles and grey literature. Databases will be searched from March 2026. Two reviewers will independently perform study selection, data extraction, quality assessment and evaluation of risk of bias, using the Critical Appraisal Skills Programme checklist. This systematic review and meta-synthesis will analyse publicly available literature and does not require ethical approval, as it involves no primary data collection. It will adhere to established ethical and methodological standards, including proper citation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings will be widely disseminated through open-access journal publication, conference presentations and targeted reports for universities, research institutions and policymakers to inform and support mentorship-based postgraduate research supervision across Africa. CDR420251049878. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049878.