BACKGROUND. Occupational stress affecting junior doctors poses a serious risk to mental health, with consequences such as anxiety, burnout, substance misuse and suicide. OBJECTIVES. To evaluate the utility of a life skills training programme (LSTP) developed and implemented at Nelson Mandela Academic Hospital in the Eastern Cape Province, South Africa, in improving stress levels...
BACKGROUND. Hereditary cancer syndromes, caused by pathogenic variants in specific genes, substantially increase an individual's risk for cancer, and are estimated to cause 10% of all uterine cancers and 20% of all ovarian cancers. However, these data are primarily based on high-income countries, and to date there are no published data on the known pathogenic variants or testing...
BACKGROUND. Acute appendicitis is one of the most common surgical emergencies in South Africa (SA), yet local histopathological data on appendectomies remain limited. OBJECTIVE. To determine the incidence and histological patterns of appendicitis at an SA regional hospital over a 2-year period. METHODS. A retrospective review was conducted on all appendectomies performed at Tambo...
BACKGROUND. Individuals with oculocutaneous albinism (OCA) face a significantly heightened risk of developing skin cancer owing to increased sensitivity to ultraviolet (UV) radiation. Data on the epidemiology and geographical distribution of cutaneous malignancies among persons with albinism (PWA) in KwaZulu-Natal Province (KZN), South Africa, remain limited. OBJECTIVE. To...
BACKGROUND. Cervical cancer is the most common malignancy among South African (SA) women of reproductive age, with women living with HIV (WLWH) facing a six-fold higher susceptibility. The National Department of Health recommends baseline cervical cancer screening (CCS) for WLWH upon HIV diagnosis. SA's reported CCS rate is 19.3%, despite the World Health Organization (WHO)'s...
BACKGROUND. Pulmonary embolism (PE) is a leading cause of death in pregnant and postpartum women. OBJECTIVE. To evaluate the clinical presentation, management and outcomes of pregnancy-related PE managed by a multidisciplinary team. METHODS. A retrospective review was conducted of pregnant and postpartum women diagnosed with PE between 2018 and 2024 at a tertiary hospital in...
PERSPECTIVESThe state of caesarean sections in South Africa: Challenges, unknowns and the way forwardM BhathenaI; S MaswimeII; S FawcusIII; M IsiagiIV; M V KinneyVIfinal-year BA (Econ); Global Health Institute, Harvard University, Cambridge, USA IIFCOG (SA), PhD; Division of Global Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa...
South Africa (SA)'s National Health Insurance (NHI) Act, signed into law in May 2024, represents an ambitious attempt at healthcare transformation through universal health coverage (UHC). However, this perspective argues that despite laudable intentions, the NHI faces fundamental deployment obstacles rooted in systemic policy misalignment, fragmented governance structures and...
South Africa (SA) bears a significant burden of hepatitis B virus (HBV) infection, with a significant prevalence of hepatitis B surface antigen (HBsAg) among pregnant women. In response, the National Department of Health has recommended targeted birth-dose vaccination for infants born to HBsAg-positive mothers. While we commend the move towards antenatal HBsAg screening to...
South Africa (SA) faces a silent crisis of infant abandonment, often in unsafe environments, driven by poverty, stigma and limited access to abortion. Baby Saver Boxes - secure, monitored drop-off points - offer a humane alternative aligned with constitutional imperatives of life, dignity, healthcare and the best interests of the child. However, proposed amendments to the...
CORRESPONDENCEResponse to correspondence: 'Beyond valve replacement: Rethinking prosthetic heart valve care'To the Editor: Thank you for the correspondence regarding this research work. We conducted this study to assess the contemporary outcomes of patients with prosthetic mitral valves at Chris Hani Baragwanath Academic Hospital (CHBAH), the third largest hospital in the world...
CORRESPONDENCEBeyond valve replacement: Rethinking prosthetic heart valve careTo the Editor: We read with great interest the article by Sumaraj and Meel[1] describing the clinical and echocardiographic profile of patients with prosthetic mitral valves managed at a tertiary centre in Johannesburg. This important contribution provides much-needed contemporary data from a setting...
CORRESPONDENCEResponse to correspondence regarding a call to action on the prevention of fetal alcohol spectrum disorderTo the Editor: We thank Profs H Odendaal and H C Kinney for their thoughtful letter regarding our publication in the SAMJ titled 'Where is the South African prevention of fetal alcohol spectrum disorder programme? A call to action'.[1] Additionally, we...
CORRESPONDENCERegarding a call to action on the prevention of fetal alcohol spectrum disorderTo the Editor: We refer to the recent comments by Patel etal.[1] on the prevention of fetal alcohol syndrome (FAS), and the need for a guideline for the prevention and management of this major problem.[2] We appreciate their concern about FAS and their serious desire to address it...
EDITORIALA unified medical response to gender-based violenceGender-based violence (GBV) in South Africa (SA) has long been at a national crisis point, with President Cyril Ramaphosa declaring GBV and femicide a National Disaster in 2025.[1] Prof. Ames Dhai noted in the September 2025 South African Medical Journal editorial that National Women's Day, World Breastfeeding Day and...
FROM THE EDITORReminding ourselves of the ethico-regulatory framework for health researchBefore any health research activity involving humans commences, independent ethics review and approval are necessary. Articles submitted to the SAMJ must include the ethics approval number and the name of the health research ethics committee (HREC) that reviewed the protocol. From time to...
Drawing on clinical experience as a psychiatrist working with people living with complex chronic pain, this article explores the phenomenon of patient invalidation within healthcare encounters, and examines its emotional, relational and systemic consequences. Individuals with chronic pain frequently report dismissal, minimisation, or misattribution of their symptoms, experiences...
CORRESPONDENCEClinicians and artificial intelligenceTo the Editor: We are living in the age of artificial intelligence (AI), 'technology that enables computers and machines to simulate human learning, comprehension, problem solving, decision making, creativity and autonomy'[1] As noted by Junck and Adams,[2] AI increasingly plays a role in public life - often behind the scenes in...
CORRESPONDENCETaking medicolegal mediation from principle to practice: A South African ventureTo the Editor: Medical negligence litigation in South Africa (SA) is increasing at an exponential rate (Table The prevailing legal culture defaults to resolving medicolegal disputes through litigation, which is primarily adversarial, egregiously costly and time-consuming and does not...
In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this finding has led to increasing media attention, and regulatory and legal proceedings. The South African Health Products Regulatory Authority (SAHPRA) has issued a...
BACKGROUND: Screening for persistent hypertension, albuminuria and low estimated glomerular filtration rate (eGFR) in children may allow for early detection of kidney disease, paving the way for early intervention to slow disease progression OBJECTIVE: To determine the prevalence of persistent hypertension, albuminuria and low eGFR and their associated factors in schoolchildren...
BACKGROUND: Monitoring adolescent substance use is crucial for informing public health strategies. However, in South Africa (SA), recent large-sample data on the use and co-use of tobacco, nicotine and cannabis among youth remain scarce OBJECTIVES: To describe the use and co-use of cannabis, hookah, tobacco cigarettes and electronic cigarettes (e-cigarettes/vapes) among SA high...
BACKGROUND: Deliberate self-poisoning (DSP) is a common method of attempted suicide globally, particularly among young adults and women. In South Africa (SA), DSP is the second most frequent method of attempted suicide, after hanging. The COVID-19 pandemic raised concerns about potential increases in suicidal behaviour, but data on its impact on DSP in resource-constrained...
BACKGROUND: Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings OBJECTIVE: To determine the surgical experiences of individuals in a peri-urban community in Cape Town, South Africa METHODS: A cross-sectional household survey of individuals in a peri-urban Cape Town...