University of the Witwatersrand

Worldwide, Road Traffic Accidents (RTAs) are the 8th leading cause of death, and leading killer of children and young adults. An additional 50 million people are seriously injured annually. We argue here that RTAs are also a leading - although rarely acknowledged - cause of preventable disability in low and middle-income countries. The Road Traffic Safety community pays little attention to people disabled in an RTA once they leave medical or rehabilitative care. Disability policy, advocacy and research groups rarely consider people disabled in RTAs as a discrete subgroup within the disability community. Furthermore, the costs and consequences of RTA-related disability are greatly underestimated. A scoping review and interviews with prominent road traffic safety and disability experts identified major conceptual gaps between the fields of Road Traffic Safety and Disability, including how people disabled in RTAs are identified, followed and provided with needed services and support. The current lack of 'joined up' thinking around those who survive an RTA with a disability represents a lost opportunity to more systemically address this major global health concern.

The principles underpinning Equity, Diversity and Inclusivity (EDI) are seen by many as being essential in contemporary society while others consider it disparaging and claim it can negatively affect meritocracy. In the USA, EDI is referred to as DEI (Diversity, Equity and Inclusivity) and appears to be under attack by the present governmental agencies. Indeed, multinational companies and other governments are responding in various ways, including partial compliance and outright resistance. Wherever one stands politically on the matter, the International Federation of Anatomical Associations (IFAA) has promulgated a strong statement of intent concerning the importance of EDI and the IFAA Executive, through its Federative International Committee for Equality and Diversity in Anatomy (FICEDA), has also provided guidelines for EDI based on the results of a survey of the IFAA's member associations. The findings of that survey are presented in this article and show a clear recognition by virtually all member associations of the importance of EDI, while highlighting some areas lacking diversity and inclusivity.

Flexor tendon injuries are a common result of trauma to the hand. The mechanisms of injury often result in open wounds with contamination and infection. The complications associated with infected wounds pose challenges to flexor tendon repair. Management entails adequate eradication of infection and tissue healing prior to tendon repair. Whilst guidelines exist for the management of flexor tendon injuries of the hand, the literature puts little emphasis on the management of these cases with the presence of concomitant infection. Creating clear outlines to adequately manage such cases would aid future management for optimal outcomes. A comprehensive search of literature was conducted. Articles published in English within the last 20 years were used. Wounds with macroscopic wound contamination should receive empiric antibiotics. There is little evidence supporting prophylactic antibiotics. Pyogenic flexor tenosynovitis should be immediately taken to theatre. If possible, primary tendon repair is the ideal method of repair, however this is often limited by infection. The choice of secondary reconstruction depends on timing and extent of injury. If there is loss of nerve function, a tendon transfer is required. Tendon grafts are used in cases of loss of tendon length. A damaged tendon sheath requires two-stage tendon reconstruction. Infected wounds are a common complicating presenting factor in flexor tendon injuries. Empiric antibiotics in complex and contaminated wounds is essential. Primary tendon repairs have the best outcomes, however repair should be withheld until granulation tissue develops. Secondary repair options should be looked at on a case-specific basis.

Sub-Saharan Africa (SSA) is experiencing an epidemiological transition where non-communicable diseases are becoming the leading cause of disability and mortality alongside infectious diseases such as HIV/AIDS. Multimorbidity, the coexistence of two or more long-term conditions, is increasing in SSA. However, the cost of managing multimorbidity is largely unknown. This study aimed to estimate the economic cost of public outpatient primary care for adults with multimorbidity (HIV, hypertension, and/or diabetes, and their associated conditions: cardiovascular disease, and TB) in rural South Africa. This study used a cross-sectional, retrospective cost-of-illness approach to estimate the direct and indirect costs of multimorbidity management in Bushbuckridge, Mpumalanga, in 2022. Data were synthesized from patient-level data from eight public primary healthcare facilities within the Agincourt study site-a rapidly transitioning rural South African setting. Additionally, government reports and an existing study on transport costs and productivity losses conducted within the Agincourt study site were used to estimate the costs of managing patients in the primary care facilities. Results showed that patients with multimorbidity had higher average economic costs per patient compared to those with single conditions. Overall, patients with multimorbidity increase costs above the baseline of a patient with a single condition (R4 900/annum) by between 42% and 83%. Patients with multimorbidity also incur slightly higher costs associated with accessing primary care services compared to those with a single condition. However, our model shows that the additive cost of managing multiple conditions in separate consultations is higher than managing all conditions in one visit. This shows that managing patients within an integrated care model seems to have a cost-limiting effect. However, treatment guidelines for managing multimorbidity in South Africa should be developed to ensure standardized care.