BACKGROUND. Neonatal cholestatic jaundice is a common paediatric condition with a paucity of recent local data and a notable absence of locally influenced diagnostic algorithms. OBJECTIVES. To describe the causes of cholestatic jaundice, investigations conducted and patient outcomes. METHODS. This was a retrospective file review of 96 patients presenting to the Specialist Clinic at Rahima Moosa Mother and Child Hospital in Johannesburg between 1 January 2014 and 31 December 2020. Clinical features, serum biochemistry at presentation, diagnostic investigations (haematological, radiological and histological), diagnosis and outcome were analysed during data collection. RESULTS. Ninety-six patients were included in the study. The median age of jaundice onset was at 2 months, while the median age of presentation was 3.3 months. Causes of jaundice fell into three main categories: 38 had biliary atresia (BA); 24 had another specific diagnosis; and 34 remained without an underlying diagnosis (idiopathic neonatal hepatitis). An overall mortality rate of 26% was noted at a median (interquartile range) age of 13 (5 - 24) months and it was highest in the BA group (n= 14; 56%). CONCLUSION. The evaluation of neonatal jaundice requires a wide differential and expeditious referral to optimise outcomes and avoid complications. Many patients remained undiagnosed, and the overall prognosis was poor. The authors recommend the development of a locally relevant diagnostic protocol to minimise delays in the identification, diagnosis and treatment of neonatal jaundice.

BACKGROUND: Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable. OBJECTIVES: this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths. METHODS: File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths. RESULTS: A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour (< 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing. CONCLUSION: Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy. CONTRIBUTION: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths.

BACKGROUND: Neonatal deaths (NNDs) are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most NNDs are preventable. Therefore, this study reviewed perinatal clinical audit data at Kgapane Hospital over a 4-year period with a special focus on the factors associated with NNDs METHODS: File audits were performed for all NNDs occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with NNDs RESULTS: The NND rate for the study period was 12.6/1000 live births. In this study (n = 236), 90% of the deaths could be associated with four factors, namely prematurity (44%); intrapartum complications (19%) including asphyxia, meconium aspiration and breech deliveries; neonatal infections (16%) of which human immunodeficiency virus (HIV) positivity was the most prevalent; and foetal congenital abnormalities (11%). The modifiable factors included inadequate intrapartum foetal monitoring; delays in management interventions; instances where no attempts were made to refer patients for specialised care, or where no beds were available at the next level of care; patient-related factors; and inadequate adherence to management protocols, such as for the management of prematurity and HIV CONCLUSION: Understanding factors associated with NNDs can guide health worker training and improvement strategies to reduce this heart-breaking complication of pregnancy CONTRIBUTION: Family physicians working in rural hospitals are also responsible for newborn care. Understanding the factors associated with NNDs will guide them to focus training and develop improvement strategies to reduce these preventable deaths

BACKGROUND: To improve maternal health, studies of maternal morbidity are increasingly being used to evaluate the quality of maternity care, in addition to studies of mortality. While South Africa (SA) has a well-established confidential enquiry into maternal deaths, there is currently no structure in place to systematically collect and analyse maternal near-misses (MNMs) at national level OBJECTIVES: To synthesise MNM indicators and causes in SA by performing a systematic literature search, and to investigate perceived needs for data collection related to MNMs and determine whether the MNM tool from the World Health Organization (WHO-MNM) would require adaptations in order to be implemented METHODS: The study used a mixed-methods approach. A systematic literature search was conducted to find all published data on MNM audits in SA. Semi-structured interviews were conducted virtually with maternal health experts throughout the country who had been involved in studies of MNMs, and main themes arising in the interviews were synthesised. A method for MNM data collection for SA use was discussed with these experts RESULTS: The literature search yielded 797 articles, 15 of which met the WHO-MNM or Mantel et al. severe acute maternal morbidity criteria. The median (interquartile range) MNM incidence ratio in SA was 8.4/1 000 (5.6 - 8.7) live births, the median maternal mortality ratio was 130/100 000 (71.4 - 226) live births, and the median mortality index was 16.6% (11.7 - 18.8). The main causes of MNMs were hypertensive disorders of pregnancy and obstetric haemorrhage. Eight maternal health experts were interviewed from May 2020 to February 2021. All participants focused on the challenges of implementing a national MNM audit, yet noted the urgent need for one. Recognition of MNMs as an indicator of quality of maternity care was considered to lead to improved management earlier in the chain of events, thereby possibly preventing mortality. Obtaining qualitative information from women with MNMs was perceived as an important opportunity to improve the maternity care system. Participants suggested that the WHO-MNM tool would have to be adapted into a simplified tool with more clearly defined criteria and a number of specific diagnoses relevant to the SA setting. This 'Maternal near-miss: Inclusion criteria and data collection form' is provided as a supplementary file CONCLUSION: Adding MNMs to the existing confidential maternal death enquiry could potentially contribute to a more robust audit with data that may inform health systems planning. This was perceived by SA experts to be valuable, but would require context-specific adaptations to the WHO-MNM tool. The available body of evidence is sufficient to justify moving to implementation

BACKGROUND: Preoperative anaemia has been shown to be associated with increased postoperative morbidity and mortality, prolonged hospital stay, and increased allogeneic blood transfusions. With elective surgery there is time to manage preoperative anaemia. The aim was to determine the prevalence of preoperative anaemia and evaluate how anaemia was investigated and managed in adult patients who were referred from the Orthopaedic Clinic to the Universitas Academic Hospital Anaesthesiology Clinic between January 2016 and December 2018METHODS: The retrospective file audit included patient demographics, comorbidities and chronic medication, indication for elective surgery, haemoglobin level at first clinic visit, laboratory investigations done for anaemia, dates of clinic visits and surgery, whether the anaemia was corrected before surgery, and if there were any perioperative red cell transfusionsRESULTS: A total of 178 patients were included. The cut-off value for anaemia was 13 g/dL in both sexes. Forty-four patients (25%, 95% CI 19-32%) had preoperative anaemia with a median haemoglobin of 12.25 g/dL (IQR 11.2; 12.7). Their mean age was 63.3 (SD ± 10.0) years. Fifteen patients (34%) were booked for knee arthroplasty and 24 patients (55%) for hip replacement surgery. No workup was done for the anaemia, and only 15/44 (34%) anaemic patients received any form of treatment. Eighteen anaemic patients (41%) received perioperative red cell transfusions. Eight of the transfused patients (44%) developed postoperative sepsis, while five were still anaemic postoperativelyCONCLUSION: The prevalence of preoperative anaemia before elective orthopaedic surgery (25%) was the same as that reported before patient blood management was introduced internationally. None of the anaemic patients had a diagnostic workup and therefore did not receive therapy targeted at the cause of the anaemia. Perioperative red cell transfusions could have been significantly reduced. The clinic now focuses on managing preoperative anaemiaLevel of evidence: Level 3

BACKGROUND: The ICAM splint programme was developed in the 1980s and is known to produce favourable results in the management of extensor tendon repairs from zone IV to zone VII. It has only become popular in South Africa over the past several years and to the authors' knowledge its application in South Africa has not previously been reportedAIM: The study sought to describe the use of the ICAM splint programme following an extensor tendon repair from zone IV to VII at a specialised hand unit in SAMETHODS: The study followed a concurrent mixed methods design. In phase one, a retrospective file audit was conducted with a sample of patients following the ICAM programme (n = 75). Phase two involved individual therapist interviews (n=3), surgeon interviews (n=2) and a focus group with physiotherapists and occupational therapists (n = 7) that had experience with the ICAM splint programme. Microsoft excel was used to descriptively analyse phase one data and thematic analysis was used to analyse phase two data. Data were merged and represented in a joint displayRESULTS: The majority of patients (83%) were male with 40% in the age range of 26-35 years old. The injuries were mainly violence related (69%) in comparison to accidental injuries (31%) with extensor tendon zone V (40%) and VI (47%) being the most commonly involved. Adherence was reportedly influenced by factors such as patients' financial status, education and language barriersCONCLUSIONS: The results suggest that the ICAM splint programme is beneficial in managing extensor tendon repairs from zone IV to VII. Therapists should consider factors that affect non-adherence when selecting patients for the ICAM programme to determine its suitability. Educating patients on the ICAM splint programme is essential to facilitate adherence. Novice therapists to the ICAM programme should receive formal training to improve confidence and skill

BACKGROUND. An understanding of the lived experiences of children with congenital heart disease (CHD) will aid in improving the way that both parents and medical practitioners manage them holistically. OBJECTIVE. To explore the perceptions of children living with CHD in KwaZulu-Natal (KZN) province of South Africa (SA), on their quality of life (QoL), health needs and knowledge of their medical conditions. METHODS. A sequential explanatory mixed-methods design was employed. The study population comprised children aged between 8 and 12 years with CHD who attended cardiology clinics at the study hospital. Convenience sampling was used. Forty-three children participated in Phase 1 and 7 participants were interviewed in Phase 2. The study setting was a tertiary-level public hospital in eThekwini District, KZN, SA. The research procedure comprised a file audit of confirmed CHD in prospective participants. Caregivers completed a consent form while the children assented and completed the PedsQL 4.0 questionnaire. Interviews were conducted in Phase 2. RESULTS. Phase 1: Both genders had higher psychosocial functioning (PSF), compared with physical functioning (PF). Children with mixed cardiac defects had lower health-related quality of life (HRQoL), compared with cyanotic or acyanotic individuals. The effect of the number of cardiac procedures on the PF domain showed a significant effect (p=0.042). Phase 2: This group had poor knowledge of their medical condition and had specific health needs. CONCLUSION. The findings highlight the need for improved knowledge/information on physical capabilities, medical information and support from family, caregivers and medical staff.

BACKGROUND: Birth polymerase chain reaction (PCR) testing improves early detection of HIV and allows for early treatment initiation. National guidelines exist, but it is unknown whether these are being implemented correctly. OBJECTIVES: To determine whether HIV-exposed infants at the Mangaung University Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were scheduled and the percentage of mothers or caregivers who returned to collect the results. METHODS: The study was a retrospective descriptive file audit (1304 files) of births from 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to HIV-positive mothers. The birth register was used to collect the infants' HIV PCR test barcodes. The birth and 10-week PCR results were retrieved from an electronic database at the Virology Department, University of the Free State. RESULTS: In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%) HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result, 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested positive and 151 (96.2%) negative. CONCLUSION: The majority of HIV-exposed infants received a PCR test at birth; however, the clinic is below the national target (90%) for HIV testing. A record-keeping system of infants' visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive infants were started on antiretroviral treatment.