Kalafong Hospital

The Health Professions Council of South Africa recognises forensic radiography as an aspect of the diagnostic radiographer's scope of practice. In contrast, the International Association of Forensic Radiographers asserts that forensic imaging should be voluntary and undertaken only by radiographers who have received formal training in the field. This study aimed to explore diagnostic radiographers' understanding, experiences, and attitudes towards forensic radiography as encountered in their daily practice. A purposive sampling method was employed to recruit radiographers who were knowledgeable about forensic radiography through their daily practice. Participants were required to have performed forensic radiographic imaging on both living and deceased individuals and to have practised in either the public or private clinical sectors. Semi-structured interviews were conducted with 17 consenting diagnostic radiographers via the online platform Microsoft Teams. Thematic analysis was performed using an inductive approach. Four distinct themes emerged; Learning and understanding forensic radiography; Practicing forensic radiography; Emotional and psychological responses; Attitudes and motivation. Findings highlighted the complex and emotionally demanding nature of this domain, which intersects clinical and legal responsibilities. Variability in knowledge and preparedness was evident, influenced by limited undergraduate exposure, informal on-the-job learning, and inconsistent institutional support. While many radiographers valued contributing to justice, others reported apprehension and emotional distress, especially when imaging deceased individuals. These findings underscore the need for structured education, standardised forensic protocols, and psychological support to prepare radiographers for the complexities of forensic imaging. Formalised postgraduate training and maintaining voluntary participation are critical to building professional competence and resilience in this demanding field.

BackgroundKangaroo mother care (KMC) was introduced in the Tshwane Health District in South Africa in 1999. After more than two decades of the expansion of KMC services, we describe the KMC implementation trajectory in the district.MethodsA group of district clinical specialists, clinicians and academics involved in KMC implementation wrote a reflection on the status of KMC in Tshwane District and lessons for sustaining KMC services and practice.ResultsThe KMC implementation trajectory is described according to three phases: (1) a slow start (1999–2012); (2) consolidation (2012–2023); and (3) sustaining KMC beyond the COVID-19 pandemic. The Tshwane KMC programme activities are interpreted using a 10-component model for scaling up care for small and/or sick newborns at the district level. Major lessons for the sustainability of KMC practice and service include embedding system-wide supportive supervision in the health system’s budget, encouraging multidisciplinary teamwork, conducting regular KMC refresher activities, and working on improving data to enable meaningful action.ConclusionDespite great strides in KMC implementation and ongoing services in the Tshwane Health District, the road to continued sustainability remains challenging.

Radiographic findings are typical with bowing deformities, sclerotic, lucent or mixed lesions and bony expansion, often with endosteal scalloping. MRI is often non-contributory and may actually mimic a more aggressive process. Early detection and correct diagnosis allow for early preventative treatment and rehabilitation to prevent devastating neurological sequelae and disability.

BACKGROUND : Diabetes mellitus (DM) affects millions of people worldwide, with associated morbidity and premature mortality exacerbated by all forms of smoking. The effects of smokeless tobacco, such as snuff and chewing tobacco, have not been well researched. The use of these products is on the increase and is an important public health issue.
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\nOBJECTIVES : The objective is to assess the difference between snuff tobacco use and non-tobacco use with regard to all-cause mortality, diabetic nephropathy (DN), and diabetic retinopathy (DR) over a nine-year period.
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\nMETHODS : The records of 1 241 patients were assessed at the diabetic clinic at Kalafong Provincial Tertiary Hospital. Patient data extracted from the database included demographic information, clinical observations, and laboratory data. All data regarding changes in tobacco use were extracted. Survival analyses were done using Kaplan–Meier analysis with log-rank tests to assess the relationship between snuff use and time to the development of diabetes complications and mortality. To adjust for confounders such as diabetic control and duration, as well as systolic hypertension, Cox proportional hazards modelling was done with the same outcome measures.
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\nRESULTS : Of the 1 241, 120 patients died, representing a natural all-cause mortality of 9.7%. There was no statistically significant difference between snuff users and non-snuff users with regard to all-cause mortality after adjustment for age, smoking, and diastolic blood pressure. The HR for snuff use was 1.116 (CI = 0.603–2.064) (p = 0.726) after adjustment for age (HR 1.042, CI 1.026-1.058, p < 0.001), smoking (HR 1.66, CI = 1.126–2.447, p = 0.01), and diastolic blood pressure (HR 1.014, CI 1.004–1.025, p = 0.007).
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\nCONCLUSION : This study could not demonstrate any additional risk to all-cause mortality, diabetic nephropathy, or diabetic retinopathy due to the use of snuff in diabetic patients.

Missing or undiagnosed patients with tuberculosis (TB) or coronavirus disease 2019 (COVID-19) are of concern. Identifying both infections in patients with no diagnosis prior to death contributes to understanding the burden of disease. To confirm reports of global reduction in TB incidence, a 2012 autopsy study of adults dying at home of natural causes in a high-TB-burden setting was repeated, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assessments after the first COVID-19 surge in South Africa. Adult decedents who died at home with insufficient information to determine cause of death, no recent hospitalization, and no current antemortem TB or COVID-19 diagnosis were identified between March 2019 and October 2020 with a 4-month halt during lockdown. A standardized verbal autopsy followed by minimally invasive needle autopsy (MIA) was performed. Biopsies were taken for histopathology from liver, bilateral brain and lung; bronchoalveolar lavage fluid was collected for Xpert (MTB/RIF) and mycobacterial culture, and blood for human immunodeficiency virus (HIV) polymerase chain reaction (PCR) testing. After the start of the COVID-19 pandemic, a nasopharyngeal swab and lung tissue were subjected to SARS-CoV-2 PCR testing. Sixty-six MIAs were completed in 25 men and 41 women (median age, 60 years); 68.2% had antemortem respiratory symptoms and 30.3% were people with HIV. Overall, TB was diagnosed in 11 of 66 (16.7%) decedents, and 14 of 41 (34.1%) in the COVID-19 pandemic were SARS-CoV-2 positive. Undiagnosed TB in adults dying at home has decreased but remains unacceptably high. Forty percent of decedents had undiagnosed COVID-19, suggesting that estimates of excess deaths may underestimate the impact of SARS-CoV-2 on mortality.

BackgroundVaccines and monoclonal antibodies to protect the very young infant against the respiratory syncytial virus (RSV)-associated illness are effective for limited time periods. We aimed to estimate age-specific burden to guide implementation strategies and cost-effectiveness analyses.MethodsWe combined case-based surveillance and ecological data to generate a national estimate of the burden of RSV-associated acute respiratory illness (ARI) and severe acute respiratory illness (SARI) in South African children aged < 5 years (2011–2016), including adjustment for attributable fraction. We estimated the RSV burden by month of life in the < 1-year age group, by 3-month intervals until 2 years, and then 12 monthly intervals to < 5 years for medically and non-medically attended illness.ResultsWe estimated a mean annual total (medically and non-medically attended) of 264,112 (95% confidence interval (CI) 134,357–437,187) cases of RSV-associated ARI and 96,220 (95% CI 66,470–132,844) cases of RSV-associated SARI (4.7% and 1.7% of the population aged < 5 years, respectively). RSV-associated ARI incidence was highest in 2-month-old infants (18,361/100,000 population, 95% CI 9336–28,466). The highest incidence of RSV-associated SARI was in the < 1-month age group 14,674/100,000 (95% CI 11,175–19,645). RSV-associated deaths were highest in the first and second month of life (110.8 (95% CI 74.8–144.5) and 111.3 (86.0–135.8), respectively).ConclusionsDue to the high burden of RSV-associated illness, specifically SARI cases in young infants, maternal vaccination and monoclonal antibody products delivered at birth could prevent significant RSV-associated disease burden.

The size of adrenal incidentalomas has important implications for diagnosis and management. Recommendations from endocrine societies do not all correlate with regard to adrenal incidentaloma size. Therefore, the aim was to compare adrenal incidentaloma size recommendations between different endocrine societies and the reasoning for these recommendations.Eight different international guidelines were reviewed and compared. The smaller the size of the incidentaloma, the lower the risk for malignancy. The majority of guidelines consider 4 cm as the cut-off, but there are discrepancies. Size indications for laparoscopic adrenalectomy have a wide range from less than 4 cm up to 12 cm. The follow-up period of adrenal incidentalomas, as well as what is considered significant growth over that period, varies between the recommendations.Therefore, the clinician should be aware of the differences when managing a patient with adrenal incidentaloma. There are discrepancies in size considerations with regard to significance, treatment options, optimal follow-up period, and further management.

BackgroundType 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and public health care systems. The private system is well resourced, whereas the public sector, which treats more than 80% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector.ObjectiveThe primary objective was to quantify the cost of health care resource utilization over a 12-month period in patients with controlled and uncontrolled T1DM in the public health care sector. In addition, we will project costs for 5, 10, and 25 years and determine if there are cost differences in managing subsets of patients who achieve glycemic control (hemoglobin A1c [HbA1c] <7%) and those who do not.MethodsThe study was performed in accordance with Good Epidemiological Practice. Ethical clearance and institutional permissions were acquired. Clinical data were collected from 2 tertiary hospitals in South Africa. Patients with T1DM, who provided written informed consent, and who satisfied the inclusion criteria were enrolled in the study. Data collection included demographic and clinical characteristics, acute and chronic complications, hospital admissions, and so on. We plan to perform a cost-effectiveness analysis to quantify the costs of health care utilization in the preceding 12 months. In addition, we will estimate projected costs over the next 10 years, assuming that study participants maintain their current HbA1c level. The cost-effectiveness analysis will be modeled using the IQVIA CORE Diabetes Model. The primary outcome measures are incremental quality-adjusted life years, incremental costs, incremental cost-effectiveness ratios, and incremental life years.ResultsEthical clearance and institutional approval were obtained (reference number 200407). Enrollment began on February 9, 2021, and was completed on August 24, 2021, with 224 participants. A database lock was performed on October 29, 2021. The statistical analysis and clinical study report were completed in January 2022.ConclusionsAt present, there are no data assessing the short- and long-term costs of managing patients with T1DM in the South African public sector. It is hoped that the findings of this study will help policy makers optimally use limited resources to reduce morbidity and mortality in people living with T1DM.International Registered Report Identifier (IRRID)RR1-10.2196/44308

Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A hospital-based HAV seroprevalence study was conducted between February 2018 and December 2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents (1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11), with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most (329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74, 16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half (688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa has an intermediate HAV seroprevalence, with rates < 90% by 10 years of age (68.6%). Increased age and informal dwellings are statistically associated with HAV seropositivity, while HIV status does not significantly influence HAV seropositivity.