South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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To the Editor: In low- to middle-income countries, the majority of patients with breast cancer are diagnosed with locally advanced disease. This remains a problem at the Tygerberg Hospital breast clinic in Cape Town, South Africa, with ~60% of all patients presenting with stage 3 or 4 disease at the time of diagnosis. The reasons cited are multiple and include fear, unawareness of disease severity, concerns surrounding losing a breast, unreliable transportation, referral difficulties and financial constraints.[1].
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To the Editor: The article by Bhorat et al. [1] in the SAMJ, entitled 'Cerebral palsy and criteria implicating intrapartum hypoxia in neonatal encephalopathy - an obstetric perspective for the South African setting', starts off by raising concerns about 'steep rises in insurance premiums, placing service delivery under serious threat'. It does not acknowledge any service delivery issues that already exist in the public sector obstetric services in South Africa (SA). ⋯ That a large number of the children with cerebral palsy (CP) were delivered in the public sector service was not noted by Bhorat et al.,[1] nor was the fact that the overwhelming majority of court cases are against the state (not against individual doctors) in provinces and hospitals with significant medical staffing and resource issues. For example, the liabilities for Eastern Cape Province in the 2019/20 period were ZAR36 751 207 v. only ZAR33 155 in Western Cape Province for the same period.[2].
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In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries. ⋯ The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.
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Human papillomavirus (HPV)-based primary screening guidelines are based on screening test performance and prevalence data generated in high-resource areas with low HIV infection rates. There is an urgent need for local data on infection and disease prevalence, as well as screening test performance, among both HIV-positive and HIV-negative South African (SA) women, in order to inform updated screening guidelines. Objectives. This study describes the baseline characteristics of participants in the cross-sectional phase of the multicentric DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) screening trial. The objective was to determine the prevalence of positive screening and pre-invasive disease using different tests and strategies in the SA HIV-positive and HIV-negative population. ⋯ The baseline findings from the DiaVACCS trial confirm a high prevalence of HPV-related cervical pathology in the SA HIV-negative screening population, showing a clear need to reach these women with a screening programme. Among HIV-positive women, prevalence values were almost doubled. The prevalence of existing invasive cervical cancer was 1 - 2% of all women. Further analysis of the performance of single and multiple screening tests between the two subgroups will contribute to the choice of the most effective strategies to identify women at risk of developing invasive cancer.