Thembelihle Sam Ntuli

Background: Caregivers of children with hydrocephalus in low-resource settings face profound challenges, yet their experiences within the South African context are poorly documented. Aim: This study aimed to investigate the interrelated challenges encountered by caregivers of paediatric patients with hydrocephalus. Setting: This study was conducted at two academic tertiary hospitals in Limpopo and Gauteng provinces. Methods: A qualitative exploratory study using semi-structured interviews recruited 39 caregivers of paediatric patients with hydrocephalus. Data were analysed using inductive thematic analysis in NVivo 16 software, and the analysis was halted at saturation. Results: Caregivers were predominantly young and unemployed. Four overarching thematic challenges emerged: (1) health system challenges; (2) socioeconomic consequences of caring for a child with hydrocephalus; (3) psychosocial and caregiving burden; and (4) formal social protection availability. Conclusion: Caregivers endure severe, interconnected systemic, financial, and psychosocial burdens that critically compromise their well-being and care capacity. Findings underscore an urgent need for holistic, family-centred interventions, including systemic healthcare reforms, economic protection, integrated psychosocial support, and structured caregiver education programmes to mitigate this crisis and improve patient outcomes. Contribution: The study advances the understanding of how health system limitations intersect with poverty, amplifying caregiver vulnerability and inequity.

Read high quality peer-reviewed journal's articles on Science of Nursing and Health Practices / Science infirmière et pratiques en santé.

Introduction: Parental employment, school grade, and location significantly influence learners’ mental health literacy (MHL), impacting early detection and help-seeking behaviors. Aim: This study investigates the determinants of adolescent MHL in selected secondary schools in Tshwane, South Africa. Methods: A secondary data analysis was conducted using 529 secondary school learners selected through stratified random sampling from five different schools: four in townships and one in an urban area. Ordinal logistic regression was performed to identify significant predictors of MHL, with a p-value less than .05 considered statistically significant. Results: The study findings indicated that school level factors were statistically significant. Learners attending urban schools were three times more likely to demonstrate higher mental health literacy than those attending township schools (OR = 3.03, 95% CI [2.02, 4.55], p < .001). Moreover, Grade 12 learners exhibited significantly higher odds of mental health literacy compared to those in lower grades (OR = 6.24, 95% CI [2.24, 17.39], p < .001). The effect of parental employment status was evident: learners whose parents were employed showed significantly higher odds of mental health literacy compared to learners from other parental employment categories (OR = 1.65, 95% CI [1.30, 2.09], p < .001). Conclusions: School-level factors (urban location and Grade 12) and parental employment were significant predictors, emphasizing the role of contextual and socioeconomic influences on learners’ MHL.

Background: The coronavirus disease 2019 (COVID-19) pandemic placed unprecedented strain on healthcare systems worldwide, potentially exacerbating existing vulnerabilities in maternal healthcare. This study examines the pandemic’s impact on obstetric haemorrhage-related mortality in South Africa using the data from the Confidential Enquiry into Maternal Deaths (CEMD). Methods: We conducted a retrospective analysis of maternal mortality data from 2017–2023, focusing on obstetric haemorrhage mortality trends before, during and after the COVID-19 pandemic. Data were extracted from national confidential enquiries, including institutional maternal mortality ratios (iMMR) and absolute death numbers. Results: The analysis revealed a significant increase in obstetric haemorrhage mortality during the peak pandemic years (2020–2021), with deaths rising from 179 in 2019 to 237 in 2021, and iMMR increasing from 18.1 to 23.3 per 100 000 live births. This was followed by a substantial decline in subsequent years (2022–2023). The findings suggest that initial pandemic disruptions severely impacted maternity care services, while subsequent recovery reflects adaptive strategies and resource reallocation. Conclusion: The COVID-19 pandemic exposed critical vulnerabilities in South Africa’s ability to maintain essential maternity services during health system shocks. Contribution: The confidential enquiry process provides invaluable insights for strengthening health system resilience and preparing for future emergencies.

Background: Maternal mortality highlights health system effectiveness and social fairness. South Africa’s Confidential Enquiry into Maternal Deaths (CEMD) monitors and improves maternal healthcare. While initial decreases in maternal mortality were positive, the COVID-19 pandemic and ongoing provincial inequalities jeopardise reaching the Sustainable Development Goal (SDG) target. Aim: This analysis evaluated South Africa’s maternal mortality reduction path by examining CEMD data trends, the pandemic’s effect and provincial disparities to gauge progress towards its SDG commitments. Methods: A longitudinal trend analysis was conducted using secondary data from CEMD reports (2017–2022). The analysis focused on national and provincial institutional Maternal Mortality Ratio (iMMR) trends. Comparative analysis quantified changes and identified patterns of disparity. Results: Pre-pandemic improvement was abruptly reversed by a significant 42% surge in the national iMMR during the pandemic, underscoring the fragility of previous gains. Although a decrease was observed in 2022, the rate remained above the 2019 baseline, indicating an incomplete recovery. Furthermore, profound inter-provincial disparities were evident, with only two provinces sustaining a downward trend, the majority showing no clear improvement and three provinces consistently exhibiting exceptionally high and volatile iMMRs. Lessons learnt: South Africa is not yet on track to meet its SDG target for maternal mortality. The pandemic exposed and exacerbated systemic weaknesses, while deep-rooted provincial inequities persist. Achieving sustainable progress requires a dual strategy: building a more resilient health system capable of withstanding future shocks and implementing targeted, equity-focused interventions in underperforming regions to ensure that maternal healthcare is accessible and effective for all.

Background: Mental health literacy remains low in South Africa, particularly in nonurban settings. This study aims to determine the sociodemographic and geographic influences of mental health literacy among community health clinic attendees. Methods: This study adopted a quantitative, cross-sectional study design and was conducted between November 2019 and January 2020. A total of 385 participants were recruited through convenience sampling, with approximately 77 individuals per clinic across five sites. The participants’ responses regarding disorder recognition and perceived causes were analyzed via Pearson’s chi-square tests. To identify predictors of recognition and perceived causes, hierarchical logistic regression was performed. Statistical significance was set at p < 0.05. All analyses were conducted via STATA version 18.1 (StataCorp, Texas, USA). Results: The mean age of the study participants was 37.39±11.14 years (range: 13–80). Factors such as geographic location, gender and level of education were significant predictors of recognition. Participants attending urban clinics were more likely to correctly identify correct mental disorders than those attending township clinics were [OR = 0.32; 95% CI: (0.11, 0.93); p value = 0.036]. For correct causes, significant predictors included gender, education level, and geographic location. Urban clinic attendees were significantly more accurate at identifying the correct cause of mental disorders than township attendees were [OR = 0.42; 95% CI: (0.21, 0.83; p value = 0.013]. Conclusion: Mental health literacy in Tshwane community healthcare clinics reflects deep-rooted sociodemographic and geographic inequalities. Strengthening township clinic capacity, integrating culturally relevant health education, and prioritizing gender-sensitive outreach are essential to improve the recognition and understanding of mental disorders in underserved communities.

Background: The human papillomavirus (HPV) vaccination programme is the most effective strategy to reduce the burden of cervical cancer. However, little is known about the parents’ knowledge and awareness of the programme, as they are important role players in its successful implementation. Aim: To determine the awareness, knowledge and factors associated with HPV vaccination programme acceptability among parents of Grade 5 girls attending public primary schools. Setting: The study was conducted in Sub-District 6, Tshwane Metropolitan Municipality in the Gauteng province, South Africa. Methods: A descriptive, cross-sectional survey was conducted among 421 participants from 21 schools utilising a self-administered questionnaire. Frequency distribution and logistic regression were used to analyse data. STATA 17 SE software was used. Results: About 321 questionnaires (N = 321) were returned, constituting a response rate of 76%. The levels of awareness (n = 279, 87%) and acceptability (n = 286, 89%) were high, with relatively lower, but still significant knowledge (n = 215, 67%). Black parents who were aware and knowledgeable about the programme were significantly more likely to accept the vaccination programme. Conclusion: Despite high levels of programme awareness and acceptability among parents of eligible girls, there remained crucial knowledge gaps regarding programme specifics. Inadequate knowledge may contribute to parents’ low submission of consent forms, resulting in sub-optimal vaccine uptake. Contribution: Enhanced parental education on HPV vaccination and its proven effectiveness is essential to ensure optimal vaccine uptake, prevent infection and address vaccine hesitancy.

Background: In 2024, type 2 diabetes mellitus (T2DM) – a public health challenge – affected 589 million adults worldwide. In South Africa, the prevalence is estimated at 15%, contributing to approximately 3.4 million deaths. Achieving optimal glycaemic control in patients is challenging, resulting in preventable complications and deaths. Systemic reforms and targeted interventions are urgently required. Aim: To identify barriers faced by healthcare professionals (HCPs) to effectively manage patients with T2DM. Setting: A survey was conducted in the Tshwane Metropolitan Municipality, Gauteng province, South Africa. Methods: The study involved 205 HCPs across 22 clinics and 6 community health centres from May 2022 to June 2022. Data were analysed descriptively. Categorical variables were compared using Fisher’s exact test and a p-value of < 0.05 was considered significant. Results: Most participants were nurses (84%), < 50 years (65%), female (87%), black people (64.7%), and > 10 years experience (65%) and had academic and in-house training on T2DM (38.5%). Key barriers faced by HCPs in managing patients with T2DM included workload making it difficult monitor patients (53%) and screen for complications (57%), time pressures to deliver quality care (59%) and educate patients (69%), inadequate insulin initiation knowledge (68%) and lack of continuity of care (62%). Conclusion: Excessive workloads, insufficient staffing, time pressures, insulin inertia, and knowledge gaps – impede the delivery of personalised care, patient education and monitoring. Contribution: Addressing these challenges will require collaborative care models, workforce optimisation, targeted training, better resource allocation and health technology and can significantly improve patient outcomes and alleviate burden among HCPs.

Background: To evaluate the effects of coronavirus disease 2019 (COVID-19) and the preventative measures taken, especially how they affect forensic pathology services in rural South Africa. Methods: This retrospective analysis includes referred post-mortem cases from all forensic pathology services in Limpopo province, comparing the period before the COVID-19 pandemic (01 January 2019 to 31 December 2019) with the pandemic period (01 January 2020 to 31 December 2020). Data analysis was performed using STATA 16.0 software (StataCorp; College Station, TX). Chi-square test was employed for comparison, with a p-value < 0.05 deemed statistically significant. Results: Approximately 9319 cases were submitted for post-mortem examinations, with 4857 occurring before the pandemic and 4462 during it, marking an 8.1% decrease. There was a decrease in the number of unnatural death cases, while the instances of natural deaths rose. Cases under investigation saw a notable increase. There was a marked decrease in referrals for forensic examinations across all districts. In addition, except for one facility, there was a decline in the number of cases sent for autopsies at all facilities. Conclusion: In conclusion, forensic pathology services in this province had been severely disrupted by the COVID-19 outbreak and the lockdown that followed, especially in the tertiary hospital. It has led to new challenges for case management and necessitated changes to operating procedures. Contribution: It has required modifications to operational procedures and has introduced various challenges in case management.