South African Journal of Public Health (Southern African Journal of Public Health) aims to bridge the divides between academia, policy and implementation in health systems intervention and reform. We publish papers with recognisable policy impact that draw on robust research and operational experience from both academic and non-academic authors on Population health and Preventive Medicine.
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Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
Reviving Preventive Medicine as a clinical specialty in South Africa
Copyright (c) 2025 T Maimela, H Volmink, D Basu https://creativecommons.org/licenses/by-nc/4.0
Reflections on the SAPHPMA symposium – where public health medicine stands today
South African Public Health and Preventive Medicine Association;
Copyright (c) 2025 V Naidoo https://creativecommons.org/licenses/by-nc/4.0
Estimation of postpartum morbidities and risk factors of women presenting for their first postpartum visit at a midwife obstetric unit in eThekwini, South Africa
Background. Despite reduction of the global maternal mortality ratio by 38% between 2000 and 2017, morbidities during the postpartum period remain the leading cause of maternal death in developing countries. In Africa, most maternal deaths occur during the postpartum period, and deaths during this period are common in South Africa (SA). Objectives. To estimate the incidence of postpartum morbidities and associated risk factors among women attending a community health centre in SA. Methods. A facility-based cross-sectional study was undertaken. Both continuous and categorical variables were described using descriptive statistics. Factors associated with postpartum conditions were determined by logistic regression with adjusted odds ratios (ORs), 95% confidence intervals (CIs) and p-values. Statistical significance was set at p<0.05. Results. A total of 399 postpartum women participated, with a mean age of 26.1 years. The teenage pregnancy rate was 19.3%, the majority fell into the age group 20 - 34 years (66.5%) and were single (70.1%), and 68.4% had no income. Only 30.2% of mothers had planned the index pregnancy. All of them knew their HIV status, and 41.7% were HIV infected. The postpartum morbidity rate was 35.9%. Logistic regression analysis showed that women who had normal vaginal deliveries (NVDs) and were in full-time employment had lower ORs for any postpartum morbidity (OR 0.47; 95% CI 0.26 - 0.86; p=0.014 and OR 0.44; 95% CI 0.21 - 0.88; p=0.022, respectively). Participants with no education had an OR of 3.1 (95% CI 1.21 - 8.15; p=0.019). Conclusion. The high postpartum morbidity rate is comparable to previously reported findings at midwife obstetric units in SA. Women who had no education were at increased risk of postpartum conditions, while full-time employment and NVD had protective effects. Skilled obstetric care and maintenance of strict asepsis during delivery are necessary to prevent common postpartum morbidities. Postnatal care should be improved to address the main risks to mothers, and socioeconomic challenges need to be addressed.
Copyright (c) 2025 A M Hoque, S Buckus, M Hoque, R Hoque https://creativecommons.org/licenses/by-nc/4.0
Cost analysis of the school-based human papillomavirus vaccination programme in Tshwane Health District, South Africa
Background. Cervical cancer is a significant public health concern globally. Persistent infection with high-risk human papillomavirus (HPV) types is the necessary cause of virtually all cervical cancers, although rare HPV-negative cervical cancer cases have been reported. HPV is one of the most common sexually transmitted infections worldwide and is responsible for approximately 90% of all cervical cancer cases globally. Objectives. To estimate the financial costs and cost per fully vaccinated girl (FVG) of the school-based HPV vaccination programme in Tshwane Health District, South Africa. Methods. We conducted a cross-sectional cost analysis of the 2019 vaccination campaign using the World Health Organization Cancer Prevention and Control Costing (C4P) tool. The data for the programme were obtained from the District Health Information System and financial records. Costs were categorised by component and converted to USD. Results. The programme reached 15 734 girls with two doses (71.3% uptake). The total financial cost was ZAR21 127 298 (USD1 458 704). Service delivery (71.8%) and vaccine procurement (27.1%) were the main cost drivers. The cost per FVG was ZAR1 343 (USD92.94). Conclusion. The Tshwane school-based HPV vaccination programme had a high financial cost per FVG compared with other low- and middle-income countries, largely owing to staffing and procurement costs. Optimising delivery strategies can improve cost-efficiency and sustainability.
Copyright (c) 2025 T Ledibane, N R Ledibane, M Matlala https://creativecommons.org/licenses/by-nc/4.0
Spatiotemporal analysis of visceral leishmaniasis in the state of Bahia, Brazil, 2007 - 2017: Socioeconomic and environmental aspects
Background. Visceral leishmaniasis (VL) is a neglected zoonosis caused by the parasite Leishmania infantum, present throughout the world. In Bahia, a state in the north-eastern region of Brazil, there is a high prevalence. Objectives. To evaluate the role of socioeconomic and environmental factors in the epidemiology of VL though spatiotemporal analysis. Methods. Epidemiological data for Bahia were extracted from the System for Notification of Diseases of the Ministry of Health (SINAN), data on prolonged droughts were obtained through the Civil Bureau of the Government of the State of Bahia, and socioeconomic indicators were obtained through the Socioeconomic Performance Index (IPESE) and DATASUS, the Brazilian public unified health system department responsible for providing health data. Relative risk for VL was calculated for age classes, clinical manifestations, comorbidities and deaths, while spatial analysis relied on kernel density analyses to determine spatial patterns. Correlations between socioeconomic indices and epidemiological markers were explored. Results. From 2007 to 2017, 3 847 new VL cases and 227 deaths were reported in Bahia. The mean incidence was 1.73 per 100 000 population. Cases and deaths were concentrated in the central-northern region of the state, a relatively poor area with a dry/semi-arid climate. Cases were more frequent in urban areas (54.1%), in males (60.7%) and in children aged <10 years (48.2%). Municipalities that declared a state of emergency due to prolonged drought (SECO dataset) and IPESE were positively correlated (p=0.0001 and p=0.013, respectively) with VL cases reported in all age groups. Deaths from VL were significantly correlated with the Gini index (p=0.043). Conclusion. Our results paint a picture of socioeconomic and climatic vulnerability as determinants of VL epidemiology. Addressing socioeconomic inequalities and enhancing models to predict prolonged drought are actions that should be included in the prevention and control of VL, given that vulnerable populations will be the most affected by the frequency and intensity of extreme climatic events.
Copyright (c) 2025 L B da Costa, R Lustosa, M Solcà, C G Zeppelini, E Silver Soares, E Martins Neto, C R Franke https://creativecommons.org/licenses/by-nc/4.0
Integrated person centered care for improved coordination
Determining the incidence of breast cancer in Mbekweni, Paarl, South Africa, and the lived experiences of the women involved: A mixed-methods study
Background. Breast cancer was the most common cancer diagnosed in South African (SA) females in the year 2022, accounting for 24.1% of all cancers diagnosed. There are cultural factors that are thought to affect the early diagnosis of breast cancer in black SA women. No information on the incidence of breast cancer or its determinants specific to the study setting could be found. Objectives. To determine the incidence of breast cancer in women aged 35 - 69 years living in the Mbekweni community in Paarl, SA, and to evaluate the lived experiences of the women involved. Methods. This was a prospective observational study, with a convergent parallel mixed-methods design. The quantitative data were collected by means of a self-completed questionnaire, and findings on clinical breast examination, imaging reports and referrals to higher levels of care. The qualitative data were collected through small focus group discussions which were recorded, transcribed, and analysed through inductive thematic analysis. Results. Of the sample population of 381 participants, a total of 55 (14.4%) were found to have suspicious clinical findings and required an imaging study. Upon receipt of the imaging reports, 4 (1.0%) required referral for biopsies or further management. At the time of writing, only 1 participant (0.3%) had been confirmed as having cancer, which was used to calculate an incidence of breast cancer of 6 cases per 1 000 person-years. Although only a single case was identified during the study period, there was some awareness of and insight into breast cancer in this community. There was also a perceived increase in the prevalence of breast cancer. However, it is a disease still stigmatised by a plethora of myths and cultural beliefs, which negatively influences women’s choice to seek help early. Conclusion. The incidence of breast cancer in women aged 35 - 69 years in Mbekweni was low in absolute terms, with only one confirmed case during the study period. Despite this, some insight and awareness surrounding breast cancer in the community was evident. There is a significant desire for more information in this community, which can provide healthcare workers with a valuable opportunity to educate and empower the members and positively influence the overall health of the community.
Copyright (c) 2025 C de Kock, G N Hudson https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc/4.0
Factors influencing stroke outcomes and the experiences of healthcare workers managing stroke patients in a South African hospital: A protocol for a mixed‐methods study
Background. Stroke, also known as cerebrovascular accident, is the second leading cause of death and a significant contributor to disability on a global scale. Stroke presents an important healthcare challenge in South Africa (SA), standing as the second most common cause of death after HIV/AIDS. However, there is a lack of comprehensive epidemiological data and research on the experiences of healthcare professionals in managing stroke patients in low- and middle-income countries such as SA. Objectives. To describe the profiles of and factors affecting outcomes for stroke patients admitted to Steve Biko Academic Hospital, Pretoria, SA, and explore the experiences of healthcare professionals managing these patients. Methods. The study will employ a mixed-methods approach, combining quantitative and qualitative methods. It will describe factors influencing outcomes for stroke patients at the hospital, utilising quantitative data analysis. Additionally, it will capture healthcare workers’ experiences through qualitative insights into their challenges and successes. Data will be gathered via REDCap forms for quantitative measures and through semi-structured interviews for qualitative information. Analysis will include descriptive statistics, logistic regression for variable relationships, and thematic analysis for qualitative patterns. Conclusions. This research aims to improve understanding of stroke management and the impact of a stroke unit at a central hospital.
Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital, Clinical governance
Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital
Neurology, Internal Medicine, Public Health Medicine
Copyright (c) 2025 L Mpuku, M Kakaza, D Basu, T Phashe https://creativecommons.org/licenses/by-nc/4.0
47th World Hospital Congress, International Hospital Federation, Rio de Janeiro 09 - 12 September 2024
Copyright (c) 2025 M C Chisale-Mabotja, M J Mathabathe https://creativecommons.org/licenses/by-nc/4.0
Oxford University Government Outcomes Lab 2024 Social Outcomes Conference, 5 – 6 September 2024
Outcomes Based Finance. Government Outcomes Lab. South Africa
Oxford Government Outcomes Lab Conference
Copyright (c) 2025 L-A C Davids, P Rousseau, N Slingers https://creativecommons.org/licenses/by-nc/4.0
Determinants of TB data quality in completeness, accuracy, and timeliness for TB programme decision-making in Tshwane District : A protocol for a cross-sec tional analytical study
Background. The quality of health information is crucial for TB programme monitoring and decision -making. South Africa faces challenges in the quality of reported TB data as evidenced in discrepancies reported between different sources. This poses a need to systematically assess the quality of TB data from districts to understand factors that contribute to TB data quality for use in decision-making. Objective. To determine factors influencing TB data quality for decision-making in the TB programme at a district level in South Africa. Methods. The study will follow a cross-sectional mixed methods design using an explanatory sequential method to achieve triangulation between the two research methods. The study setting is the Tshwane Health District (THD). Data will be collected from multiple TB data sources in selected clinics and multilevel TB programme personnel. Data collection will be conducted over six months from July 2024 to December 2024. A process flow framework will be used to document the current TB data recording systems in THD. Validated data quality assessment tools (DAQs) will be used for data auditing purposes. Furthermore, a self-administered questionnaire, and one-to-one semi-structured interviews will be used for qualitative data collection. Triangulation will be achieved by integrating both research method findings. The study will be initiated after obtaining approvals from relevant authorities. Conclusion. This research aims to gain insight and understanding of behavioural, systemic, organisational and technical factors that influence health data quality using TB programme data as a lens. This will enable quantifying of data quality elements and contribute to the body of research with regards to data quality in health.
Health data , data quality , Tuberculosis , programme decision-making
Data completeness , transparency , data reporting , timeliness
District health information system, Electronic database, source documents ,Health district ,Public health facility
Health data , data quality , Tuberculosis , programme decision-making, Data completeness , transparency , data reporting , timeliness, District health information system, Electronic database, source documents ,Health district ,Public health facility
Copyright (c) 2025 L Motimele, T Maimela, D Basu https://creativecommons.org/licenses/by-nc/4.0
A complex tapestry of urban health in South Africa
Copyright (c) 2024 D Basu https://creativecommons.org/licenses/by-nc/4.0
A cross-sectional study of the factors associated with the acceptance of oral HIV self-testing among medical students at Joseph Ki-Zerbo University in Ouagadougou in 2021
Background. New screening techniques are being used to diagnose HIV infection. Objective. To identify factors associated with the acceptance of oral HIV self-testing among medical students using the socio-ecological model. Method. We conducted a descriptive, analytical cross-sectional study among medical students from October 2020 to September 2021, with data collection carried out from 10 to 25 March 2021. Results. A total of 508 students participated, of whom 15.75% (n=80) had heard of oral HIV self-testing. The acceptance rate was 92.52% (n=470). Additionally, 76.52% (n=345) were willing to buy the self-test at a preferential price of less than Franc African Financial Community (FCFA) 1 000. Logistic regression analysis revealed a statistically significant relationship between acceptance of oral HIV self-testing and the importance placed on pre-test counselling (odds ratio (OR) 6.45, 95% CI 0.93 - 40.33; p=0.049). Conclusion. Oral HIV self-testing is widely accepted among medical students. However, pre-test counselling could further increase its use and help achieve the first 95 of the United Nations’ ambitious targets.
Copyright (c) 2025 A Kabore, O Gouwendmanégré Bérékia, J Johns, H Tognon, L Sènami Akoyi, T S Hema Tiemoko, N Meda https://creativecommons.org/licenses/by-nc/4.0
Annual district research conferences organised in the Gauteng Province
District research conference; Ekurhuleni; Gauteng; Johannesburg; Primary health care; Tshwane;
Copyright (c) 2024 L Mpuku, G Tesema https://creativecommons.org/licenses/by-nc/4.0
Effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among HIV/AIDS patients in south-western Nigeria
Background. HIV/AIDS is still a leading cause of death and a health threat to millions worldwide. Objectives. To assess the effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among patients living with HIV in south-western Nigeria. Methods. Four hundred and forty participants were recruited from six secondary health facilities offering antiretroviral therapy (ART) services in Osun State. A multistage sampling technique was used to select eligible participants. The level of significance was set at p<0.05. Results. Of the participants, less than half (42.0%) had good knowledge on HIV and ART services, while 73.0% had good treatment adherence, about one-quarter (20.7%) had been stigmatised or discriminated against, and 58.4% had disclosed their status to their sexual partner; 75.5% of the partners were supportive afterwards. Treatment outcome was favourable for 86.4% of the participants, and there was a significant relationship between marital status and viral load suppression (p=0.003) and between adherence and viral load suppression (p=0.001). Participants with good adherence were 2.6 times more likely to have a favourable treatment outcome than those with poor adherence. Conclusion. Adherence and marital status were found to be significantly associated with suppressed viral loads among people living with HIV.
Copyright (c) 2025 S O Olarewaju, C A Akinleye , S B Bola-Oyebamiji , O O Olusola, O K Israel, N E Anegbe , G M Israel, A O Fasanu, S C Adeyemo , E M Ogba, O O Kayode, T M Jacob, E O Ewenyi, N A Emeribe, E M Farinloye https://creativecommons.org/licenses/by-nc/4.0
Experiences of the use of the levonorgestrel intrauterine device for heavy menstrual bleeding: Device discontinuation rates and reasons for discontinuation among users at a regional hospital in the Western Cape - A seven-year review
Background. Medical management for heavy menstrual bleeding (HMB) in low- and middle-income countries is limited. The National Institute for Health and Care Excellence recommends the levonorgestrel intrauterine device (LNG-IUD) as first-line management for HMB. However, since 2019, South Africa’s (SA) Essential Medicines List (EML) guidelines have listed it as the last medical treatment option in the public health sector. An economic analysis conducted from a payer’s perspective found the LNG-IUD dominant at 5 years and more cost-effective at 1 year than other medical treatment options. However, it would no longer be dominant if the 5-year discontinuation rate exceeded 40%. Assumptions about continuation rates of the LNG-IUD for HMB were made, as no local SA data are available. Objectives. To assess the discontinuation rate of the LNG-IUD for HMB after 1 year and explore the reasons for discontinuation. Methods. This was a retrospective, folder-based study of patients who received the LNG-IUD for HMB at Tygerberg Hospital, Cape Town, SA between 2014 and 2020. Results. The hospital records of all women who received the LNG-IUD were reviewed. Incomplete records, duplications or prescriptions for contraception were excluded. Complete records were available for 100 patients, of whom 68 reported symptom improvement after 1 year and continued use. Thirty-two patients discontinued use, of whom eight experienced spontaneous expulsions and 24 requested removals. Reasons for discontinuation included ongoing symptoms (n=18), adverse effects (n=4) and the desire for fertility (n=2). Fourteen of the 24 patients who requested removal had a hysterectomy. The study showed a 68% continuation rate for the LNG-IUD, which is lower than in higher-income countries (82 - 88%). This rate is considered sufficient to endorse the affordability of LNG-IUD for HMB over 5 years. Conclusion. Offering LNG-IUD as the primary treatment may potentially improve the continuation rate. Further research is needed to assess the feasibility of recommending LNG-IUD as the first-line treatment in national policy, following patient discussion.
Copyright (c) 2024 A Swanepoel, T D Leong, T Esterhuizen, G S Gebhardt https://creativecommons.org/licenses/by-nc/4.0
Role of the patient and citizen in health technology assessment and decision-making in South Africa
HTA, patient involvement, decision-making, South Africa
Copyright (c) 2025 D Mueller, L Pretorius https://creativecommons.org/licenses/by-nc/4.0
Factors associated with advanced HIV in the Tshwane District drainage area: A protocol for a cross-sectional analytical study
Background. HIV continues to be a global pandemic. Despite significant achievements in reaching the global 95-95-95 targets, advanced HIV disease (AHD) continues to contribute to substantial morbidity and mortality, with 600 000 deaths worldwide in 2022 including 51 000 in South Africa (SA). The patient demographic has shifted from antiretroviral therapy (ART)-naïve individuals to those facing treatment interruptions or non-adherence. Objective. To explore the factors associated with AHD in patients within the Tshwane District drainage area, SA, where high treatment coverage has not fully curbed mortality rates. Method. This cross-sectional analytical study employs both quantitative and qualitative methods, utilising structured questionnaires and blood samples to assess ART levels, specifically dolutegravir. A minimum of 10 participants will undergo semi-structured interviews to explore their treatment experiences. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be examined through thematic analysis. Conclusion. This research aims to enhance the understanding of AHD-related factors to inform effective interventions and policies for HIV care.
Copyright (c) 2024 S Nair, K M Tshabalala , F Abdullah https://creativecommons.org/licenses/by-nc/4.0
Global surgery in Africa: Access to surgery, an opportunity to adopt a participatory community-based approach
participatory community-based approaches
Copyright (c) 2025 M Isiagi, S Maswime, K J Okop https://creativecommons.org/licenses/by-nc/4.0
Characterising the autistic spectrum and the implications for public health
In this paper, we consider the statistical distribution of Autistic Spectrum Disorder (ASD) levels in the population and hypothesise that it follows an exponential distribution. We note that the diagnosis of ASD over the past decades has been made based on an ever‐ expanded view of what constitutes autism and indicate how the associated disproportionate increase in the number of individuals diagnosed with ASD is consistent with this exponential distribution characterisation. The shift in diagnostic boundaries for ASD and the characterisation of autism as a spectrum has led to a profoundly different statistical picture of the occurrence of autism in the population and has implications for public health policy. In particular, the wider recognition of ASD as a diagnosed mental health condition could lead to a concentration of limited resources for those on the milder end of the spectrum compared with those on the severe end. Certainly, the changing composition of sub‐populations diagnosed with ASD needs to be analysed and interrogated so that a fair allocation of resources is made to the various spectrum mental health conditions.
Copyright (c) 2025 G D I Barr, L Scott https://creativecommons.org/licenses/by-nc/4.0
Monkeypox outbreak in South Africa: Immunocompromised hotbed?
Copyright (c) 2025 J Robinson, A Kashyap, I Banerjee https://creativecommons.org/licenses/by-nc/4.0
Observations and recommendations for conducting research in partnership with people with lived experience of homelessness
This commentary addresses the urgent need for responsible research practices when conducting research on populations of people with lived experiences of homelessness. Recognising the marginalisation of this group by scientific investigators in both societies, this commentary seeks to address the ethical considerations, consent processes, and community engagement necessary to conduct meaningful and respectful investigative research in this population. By summarising basic approaches that prioritise data collection, participation and engagement, this piece aims to promote a deeper understanding of the unique challenges faced by people with lived experience of homelessness and the responsibilities of researchers choosing to work on this topic.
Copyright (c) 2024 S W Grande https://creativecommons.org/licenses/by-nc/4.0
The association between intimate partner violence and cervical cancer screening among women of childbearing age in South Africa
Background. Cervical cancer is a major global public health concern, particularly in South Africa (SA), where it is the second most prevalent cancer among women. This prevalence can be attributed to several factors including poor screening rates and the prevalence of HIV. Objective. To examine the association between intimate partner violence (IPV) and cervical cancer screening (CCS) in SA, while considering the influence of other sociodemographic factors. Methods. The study used cross-sectional data from the 2016 South Africa Demographic and Health Survey, focusing on women of childbearing age who underwent CCS. Bivariate analysis was conducted to investigate the relationship between CCS and each independent variable. A binary regression model was used to determine the association between intimate partner violence and CCS while controlling for other variables. Results. The study found that 32% of women aged 15 to 49 years in SA had undergone CCS at least once in their lifetime. No significant association was established between IPV and CCS uptake (unadjusted odds ratio (uOR) 1.05, 95% CI 0.84 - 1.31; p>0.05 and adjusted odds ratio (aOR) 1.16, 95% CI 0.89 - 1.51; p>0.05 ). However, sociodemographic factors, including area of residence, age, education level, wealth, race and health insurance status, were significant predictors of CCS. Older women, those with higher education, wealthier individuals and those with health insurance were more likely to undergo screening. Conclusion. In the present study, IPV was not a significant factor directly influencing CCS uptake. Instead, a complex interplay of sociodemographic factors was identified as predictors of CCS rates. These findings highlight the need for interventions that address the barriers to CCS, particularly in rural areas and among underprivileged and minority populations. Improving education, healthcare coverage and accessibility can potentially enhance screening rates and reduce the burden of cervical cancer in SA.
Copyright (c) 2024 M Hollington https://creativecommons.org/licenses/by-nc/4.0
Challenges and opportunities for snus as a tobacco harm reduction product in Malawi
Background. Tobacco use remains a global public health challenge, including in Malawi. Evidence from many countries indicates that availability of safer nicotine products, including snus, helps drive down smoking rates. Snus is an important potential harm reduction tool in resource-poor settings where smoking cessation services are few and where other safer products, including e-cigarettes and heated tobacco products, are expensive. Malawi is a tobacco-growing country with the ability to produce snus, but the potential of snus as a harm reduction tool in Malawi remains insufficiently explored. Objective. To explore the feasibility and acceptability of snus as a harm reduction tool among smokers seeking cessation services at Daeyang Luke Mission Hospital in Lilongwe, Malawi. Methods. The 4-month study employed a prospective observational design with baseline and follow-up data. After enrolment in the study, participants were provided with snus. Data collection involved administering semi-structured questionnaires and monthly follow- ups to monitor snus usage and experience. The study faced challenges such as limited sample size and diversity needed to draw broader conclusions. Another challenge was the uniform provision of snus without assessing participants’ nicotine dependency levels or individual needs. Results. The age range of the 34 study participants was 19 - 64 ears. Only 14 participants had prior knowledge of safer nicotine products. Of the 14, only one participant knew about snus. Of the 34 participants, 28 reported a positive experience with snus, such as improved oral hygiene and absence of second-hand smoke, indicating acceptability of the product. Conclusion. The study highlights the potential of snus as a feasible harm reduction tool for smokers seeking to quit cigarette smoking, suggesting that it could be incorporated into smoking cessation interventions and tobacco control strategies.
Copyright (c) 2025 M Nyirongo, C Ngoma, M Udedi, N Kasomekera, I Mayenda https://creativecommons.org/licenses/by-nc/4.0
Nurses’ knowledge of the clinical management of hypertensive disorders of pregnancy in low- and middle-income countries: A narrative review
Background. Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia (PE) and eclampsia, are significant contributors to maternal morbidity and mortality worldwide. The exact cause of this pregnancy condition is unknown, and it has no specific treatment apart from delivery of the fetus and placenta. Nurses, especially in low- and middle-income countries (LMICs), play a critical front-line role in identifying women at risk of HDP, initiating clinical management, and ensuring timely referrals to appropriate healthcare facilities. Objectives. This narrative review aimed to assess the knowledge and practices of professional nurses, including midwives, in identifying women at risk of developing HDP during pregnancy, childbirth and the immediate postpartum period. Methods. A systematic literature search was conducted using PubMed, Google Scholar and ScienceDirect. Keywords included ‘pre- eclampsia’, ‘nurses’ knowledge’, ‘management of HDP’ and ‘training of nurses’. The search was not restricted by publication year. Results. The review revealed significant gaps in nurses’ knowledge regarding management of PE. Early identification of women with HDP risk factors during antenatal visits is of critical importance for maternal and fetal health. However, inadequate training on diagnostic criteria, blood pressure measurement techniques, and initial treatment protocols remains a challenge in LMICs. Effective communication between primary healthcare facilities and referral hospitals is essential for managing severe PE and eclampsia. Conclusion. Despite the provision of guidelines, maternal morbidity and mortality rates remain high in LMICs owing to insufficient training of nurses and resource constraints. Emphasis on mandatory training programmes for all health professionals at primary healthcare level is crucial. Strengthened referral systems are also necessary to improve outcomes for women with HDP.
Copyright (c) 2025 Z Mkhize, V Dorasmy , O P Khaliq, J Moodley https://creativecommons.org/licenses/by-nc/4.0
Governance of health facilities in South Africa