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.
The SAJPH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
Integrated person centered care for improved coordination
Copyright (c) 2024 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
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
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
Governance of health facilities in South Africa
Copyright (c) 2024 Claudia Naidu https://creativecommons.org/licenses/by-nc/4.0
Usefulness of clinical economics in managing a complex hospital system for better patient outcomes
Clinical economics or medical economics refers specifically to the economic aspects of clinical decision-making and practices in the healthcare realm, especially at the individual patient level. It is essential for management of complex hospital systems by optimising resource allocation, driving quality improvement, promoting patient-centred care, reducing disparities, informing health policy, and managing clinical as well as financial risks. By integrating economic principles with clinical practice, hospitals can achieve better patient outcomes while ensuring the efficient use of resources. The practice of clinical economics includes cost-effectiveness analyses of different treatment options, resource utilisation in clinical settings, and other economic considerations in the context of individual patient care. It could also assist in balancing the focus from the perspectives of patients, doctors and managers by reaching a consensus among them with regard to different perceptions and values for clinical decisions. Training in clinical economics should therefore become a mandatory component of education for all healthcare professionals, and should include continuing professional education (such as conferences and journal clubs), recertification programmes and practice guideline development.
Copyright (c) 2024 M I Mogari, M N Mutshekwane, A Manning, Z Ngcwabe, L Majake, M Mathebula, E Kenoshi https://creativecommons.org/licenses/by-nc/4.0
Identification and uptake of cervical cancer screening during active surveillance in HIV-positive women attending a primary health care facility in Tshwane District, South Africa
Cervical cancer constitutes 20 - 25% of cancers in women in Sub-Saharan Africa. It is a preventable disease, subject to adequate screening, management and follow up. Nevertheless, more than half a million women worldwide develop invasive cervical cancer annually, with middle-and low-income countries achieving only 19% of successful screening coverage compared with high-income countries (63%). The age-standardised incidence rate for cervical cancer in South Africa is 24.71 per 100 000 women.
Copyright (c) 2024 A Rab, y Xu, G Tesema, J Kistan https://creativecommons.org/licenses/by-nc/4.0
Professionalising health technology assessment in South Africa
Health technology encompasses interventions developed to prevent, diagnose or treat medical conditions; promote health; provide rehabilitation or organise healthcare delivery. The intervention can be a test, device, medicine, vaccine, procedure, program or system.[1] Health technology assessment (HTA) is a multidisciplinary evaluation process that assesses the properties of health technologies and interventions. It uses specific methods to determine the value of a health technology at different points in its lifecycle. The purpose of the HTA is to inform decision-making to promote equitable, efficient and high-quality health and health care systems. [1,2] It bridges the gap between the realms of research, policy making and service delivery.
Copyright (c) 2024 D Mueller, M Poluta, M Brand, N Mutshekwane https://creativecommons.org/licenses/by-nc/4.0
Sixth Edition Galien Forum Africa, Dakar, Senegal 3 - 7 October 2023 -
Copyright (c) 2024 A Singo, K Tshabalala, M Chisale-Mabotja, I Seck https://creativecommons.org/licenses/by-nc/4.0
The prospect of social medicine in South Africa
The term “médecine sociale” (social medicine in English) was first coined in 1848 during the French Revolution by Dr. Jules Guérin. It is a branch of medicine that focuses on the impact of social and economic conditions on health, disease, and the practice of medicine, with the intention of creating a healthier society. It is an interdisciplinary program between medicine and social sciences, expected to equip medicine with the knowledge and skills needed for analyzing the social causes of health and illness, akin to how the alliance between medicine and laboratory sciences provided insights into the biological, chemical, and physical bases of diseases. Social medicine is also interconnected with social determinants of health. While social determinants of health specifically target social and environmental conditions that affect health, social medicine has a broader scope, encompassing the entire social context of health, including societal structures and cultural factors. In the post-apartheid era, social medicine could play an important role in transforming the healthcare system to ensure equity and inclusivity, leading to improved health outcomes. This would require re-engineering the education of health professionals in South Africa at both undergraduate and postgraduate levels, as practiced in many parts of the world. This will assist South Africa in joining the global movement of social medicine for the promotion of human rights and social justice in medicine, and a better understanding of the impact of social factors on the aetiology and management of medical disorders in the 21st century.
Copyright (c) 2024 L F Adonis, D Basu https://creativecommons.org/licenses/by-nc/4.0
Professional education and training of public health and preventive medicine specialists in Canada
Public health and preventive medicine (PHPM) specialist physicians focus on the population rather than individuals as their patients. These specialists assess the health status of a community and subsequently develop, implement and evaluate effective interventions at the population level to improve health. This work brings together their medical expertise, population health approach and management/ leadership skills. The Royal College of Physicians and Surgeons of Canada (RCPSC) states that ‘the Public Health and Preventive Medicine or community medicine (as called previously) specialist uses population health knowledge and skills to play leading and collaborative roles in the maintenance and improvement of the health and well-being of the community’. It is a broad speciality that requires strong generalist skills including in preventive medicine, management, epidemiology, emergency response, health promotion, and health protection.
Public health and preventive medicine; Canada; training; scope of practice
Copyright (c) 2024 J Pawa, D Basu https://creativecommons.org/licenses/by-nc/4.0
Achieving the Sustainable Development Goals health targets in South Africa
Copyright (c) 2024 Deb Basu https://creativecommons.org/licenses/by-nc/4.0
7th Public Health Conference: Understanding challenges and embracing new developments in South African population health and preventative medicine
Copyright (c) 2024 L Motimele, S Nair https://creativecommons.org/licenses/by-nc/4.0
Clinical paediatric tuberculosis research: field experiences from Cape Town, South Africa
Implementing research in low‐ and middle‐income countries (LMICs) involves multiple operational and socioeconomic challenges. In order to make global health research equitable, it is essential to overcome these challenges and implement research where the burden lies. We describe cultural, socioeconomic, recruitment and retention challenges experienced in our paediatric research in South Africa. We found that additional strategies and resources were required to address the specific cultural and socioeconomic aspects in order to conduct high‐ quality research in our facility.
Tuberculosis; LMIC; Challenges research; paediatric; field experience
clinical research; field experiences; challenges in LMIC
Paediatric research; Infectious diseases
Copyright (c) 2024 M-A Van Niekerk, M G Anthony, I Dewandel, L Africa, A Pienaar, A Mfazwe, B Bavuma, J Wolmarans, L Mpengesi, R Nelani, A Mtshabe, C Mckenzie, C Bekker, G Hoddinot, M M van der Zalm https://creativecommons.org/licenses/by-nc/4.0
The effect of COVID‐19 lockdown periods and societal restrictions on blood product usage in adult trauma patients: A retrospective observational study
Background. Blood products, though potentially lifesaving, are a scarce and costly resource. Trauma injuries, which contribute to the demand for these resources, increase in proportion to alcohol consumption. South Africa’s COVID-19 lockdown measures included a ban on alcohol sales and curfews. Objective. To investigate the effect of these societal measures on blood product usage. Methods. We retrospectively compared medical patient data from the South African National Blood Service database of red cell concentrate (RCC) usage in four disciplines during the COVID-19 period with data from the 3 years preceding the pandemic. We also examined trauma case patterns using an institutional database from the Harry Gwala Regional Hospital (HGRH) Emergency Department during the same periods. Results. In total, 16 922 RCCs at HGRH and 528 734 RCCs in KwaZulu-Natal were issued across the four disciplines, from March 2017 - March 2021. RCC usage significantly decreased among trauma patients at institutional and provincial levels during the COVID-19 period (provincial pre-lockdown mean 10.99 units per day; SD 6.89, 95% CI 10.63 - 11.35 v. lockdown 7.46 units per day; SD 5.42, 95% CI 6.14 - 8.79; p<0.01). Further, RCC usage significantly increased during the weekend immediately following the lifting of the first alcohol ban, along with a significant decrease in the number of trauma patients seen during hard lockdown periods. Conclusions. Societal restrictions, including curfews and banning alcohol consumption, decreased the use of RCCs in trauma patients. Government policies aimed at reducing alcohol-related traumatic injuries would likely have a significant impact on RCC usage.
Alcohol ban, blood products, COVID-19, lockdown periods, South Africa, trauma patients
Copyright (c) 2024 A M Levey, R Wise, D G Bishop https://creativecommons.org/licenses/by-nc/4.0