Microbial profile of keratitis: A retrospective review of South Africa’s private microbiological laboratory results

Due to the COVID-19 pandemic, many children missed their routine vaccinations globally. There is insufficient evidence on the trends in vaccination coverage in the private healthcare sector in South Africa. This study explored the changes in childhood vaccination patterns (non-COVID vaccines) in the private healthcare sector in South Africa using medicine claim data. Using the information on medication claims from a South African pharmaceutical benefit management (PBM) company, we performed a quantitative cross-sectional analysis comparing the period before (2018–2019) and during the COVID-19 pandemic (2020–2021). All patients who made claims within the study period were included. This study included 67,830 children aged two years and younger. In particular, from 2018 to 2021, boys (52%) outnumbered girls (48%). Pharmacists consistently held the predominant prescriber role before and during the COVID-19 pandemic. The proportion of children receiving non-COVID-19 vaccines was higher before the pandemic (60%) than during the pandemic (55%). Furthermore, there was a notable decline of 5% in measles vaccination rates during the children’s first year of life, while a notable increase was observed for measles (5%), hepatitis A (7.7%), and the pentavalent vaccine (5%) during the second year of life. Governments and private healthcare providers must take action to enhance vaccination coverage rates for children in their first year of life to prevent a resurgence of vaccine-preventable diseases. The results obtained in this study underscore the significance of implementing vaccine catch-up campaigns to address missed vaccination opportunities arising from the impact of the COVID-19 pandemic. Moreover, pharmacists emerged as the predominant healthcare providers responsible for administering vaccinations within the private healthcare sector in South Africa, both prior and during the COVID-19 pandemic. Their pivotal role in the vaccination process warrants due recognition and should not be underestimated.

BackgroundAlthough the prevalence of attention deficit hyperactivity disorder (ADHD) has remained stable, the number of patients diagnosed with ADHD has increased in recent years owing to increased awareness. Despite this increase, medical schemes in South Africa have not improved their funding models for this condition.AimThe study aimed to provide an account of the funding that medical schemes provisioned for treating ADHD in South Africa during 2022.SettingAll the South African medical schemes that were registered with the Council of Medical Schemes during 2022 (n = 72) and all their listed options were evaluated (n = 279).MethodsThe study analysed secondary data published on the medical schemes’ websites in the public domain. Statistical minimum, average, maximum and correlation analyses were performed using Excel version 16.58.ResultsAttention deficit hyperactivity disorder is not regarded as a prescribed minimum benefit (PMB) condition and therefore each medical scheme used its own approach to providing its beneficiaries with some or no benefits for ADHD. It was evident that ADHD was underfunded and lacked structured or standardised funding approaches.ConclusionAttention deficit hyperactivity disorder is underfunded in the private healthcare sector in South Africa. Better funding models are needed or ADHD needs to be registered as a PMB condition.ContributionFindings from this study highlight the urgency for structured and sufficient ADHD-specific funding by medical schemes. Considerations based on these findings may be applied in the National Health Insurance and in other countries around the world.

Background Globally Attention-Deficit/Hyperactivity Disorder (ADHD) has been in the spotlight. Despite some controversies, treatment of ADHD remains the cornerstone of patient care. Objective To describe the consumption of methylphenidate and atomoxetine in the private healthcare sector in South Africa over a four-year period (2013-2016). Method Data were extracted from the Intercontinental Marketing Service (IMS) database for the drug utilisation study. Consumption patterns were expressed as number of Defined Daily Doses (DDDs)/1000 inhabitants/day and number of DDDs/1000 inhabitants/month. Results Methylphenidate (95.85%) was the medication of choice when compared to atomoxetine (4.15%) in 2013. The corresponding figures for 2016 were 96.40% and 3.60%. Consumption of ADHD medication showed slight changes over the 4-year period. If only the private healthcare sector population is considered, consumption of methylphenidate was 6.010 DDDs/1000 inhabitants/day in 2013, and 7.827 DDDs/1000 inhabitants/day in 2016. A previous study (1994-1996) reported 0.12 DDDs/1000 inhabitants/day for methylphenidate. Consumption of atomoxetine was 0.044 DDDs/1000 inhabitants/day in 2013 and 0.050 DDDs/1000 inhabitants/day in 2016. Conclusion Consumption showed an increase in use of methylphenidate in South Africa, with small changes observed over the study period. Further studies are required.

The aim of this study was to identify potential drug-drug interactions (DDIs) between antiretroviral drugs (ARVs) and to determine whether prescribed daily doses (PDDs) from prescriptions can be used in the evaluation of these interactions. A quantitative, retrospective drug utilization study was performed on 49,995 and 81,096 ARV prescriptions from a South African pharmacy benefit management company, which were prescribed to 7664 and 10,162 HIV patients for 2005 and 2006, respectively. Potential DDIs identified across different age groups were 778 for 2005 and 1155 for 2006; the majority occurred in patients aged 19 to ≤45 years. The potential DDIs identified between ARVs were all interacting at clinical significance level 2 according to guidelines indicated by Tatro. These results demonstrate that potential DDIs were identified between ARVs mostly in three ARV combinations: Kaletra(®) (lopinavir/ritonavir) and efavirenz, lopinavir/ritonavir and nevirapine and combinations of indinavir and ritonavir. There is a need for more education on the prescribing protocols for ARVs in the treatment of HIV-infected patients in the private health-care sector in South Africa.

Reports have emerged globally of antimicrobial resistance (AMR) in Neisseria gonorrhoeae and Mycoplasma genitalium infections. In South Africa (SA), there are substantial differences between private and public healthcare with regard to antimicrobial drug prescribing practice, which could affect AMR patterns of private and public healthcare patients. To perform a pilot study to determine the frequency of AMR of N. gonorrhoeae and M. genitalium in patients accessing SA's private healthcare sector. In this cross-sectional study, N. gonorrhoeae-positive cultures and M. genitalium DNA samples were collected from a private healthcare reference laboratory from August 2018 to August 2019. In N. gonorrhoeae-positive cultures, antimicrobial susceptibility testing was performed, followed by N. gonorrhoeae multiantigen sequence typing (NG-MAST) to determine genetic relatedness of the isolates. To determine macrolide and fluoroquinolone resistance rates, M. genitalium-positive samples were analysed by sequencing the 23S rRNA, gyrA and parC genes. Twenty-one N. gonorrhoeae- and 27 M. genitalium-positive specimens were included in this analysis. High rates of resistance were detected among gonococcal isolates, with 90% resistance to tetracycline, 86% to penicillin and 62% to ciprofloxacin, but no resistance to azithromycin, cefixime and ceftriaxone. NG-MAST revealed genetically diverse isolates with 83% novel NG-MAST sequence types. Macrolide and fluoroquinolone resistance-associated mutations were detected in 18.5% (n=5/27) and 7.4% (n=2/27) of M. genitalium strains, respectively. We observed high frequencies of ciprofloxacin, penicillin and tetracycline resistance in N. gonorrhoeae and macrolide resistance-associated mutations in M. genitalium in private healthcare sector patients in SA. This finding highlights the need to use diagnostics for sexually transmitted infections and to include the private healthcare sector in antimicrobial surveillance and stewardship programmes.

Human immunodeficiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Retrospective drug utilisation study using data from a national medicine claims database for the period 1 January to 31 December 2004. A section of the private health care sector in South Africa. All ARV prescriptions (N=43 482) claimed during 2004. The possible DDIs found were classified according to a clinical significance rating described by Tatro (2005) in his book Drug Interaction Facts. A total of 5 305 882 medicine items were prescribed; of these, 1.92% (N=101 938) were ARVs. Of the total number of 2 595 254 prescriptions, 1.68% (N=43 482) contained ARVs. A total number of 18 035 DDIs (81 different types) were identified; of these, 83.89% (N=15 130) were DDIs between ARVs and other drugs, while 16.11% (N=2 905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, N=17) and 2 (moderate, N=1 436) represented 8.06% (N=1 453) of the total number of identified interactions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a need to understand and anticipate these DDIs and to overcome them by dose adjustments and patient education, so that they are not life threatening to HIV/AIDS patients.

The coronavirus disease 2019 (COVID-19) pandemic has put a renewed focus on the value of vaccines in combatting potentially life-threatening diseases. The primary aim was to conduct a longitudinal study on the dispensing patterns of vaccines (from 2017 to 2021) in a section of the private healthcare sector in South Africa. A descriptive cross-sectional pharmacoepidemiological study on health insurance data covering 5 years was conducted. The study included all vaccines available on the South African market (childhood, adult, travel, and other vaccines). The study population consisted of 3.8 million individuals. The descriptive statistics were calculated. The vaccine-dispensing patterns were distinctly different in 2021 compared to the preceding four years. The COVID-19 vaccine was introduced in 2021 in South Africa. Although the total number of medical insurance scheme members stayed relatively constant, the number of vaccine claims increased approximately seven-fold in 2021 compared to the average for the preceding four years (2017 to 2020). The tetanus and pneumococcal vaccines were the most dispensed bacterial vaccines, whilst the influenza and COVID-19 vaccines were the most dispensed viral vaccines. COVID-19 vaccines accounted for 55.74% of all vaccines dispensed over the 5 years, and for 85.70% of the vaccines dispensed in 2021. An increase in the number of bacterial vaccines dispensed was observed towards the middle of 2020, which was attributed to the pneumococcal vaccine. Pneumococcal vaccines were administered during the COVID-19 pandemic to prevent morbidity and mortality from co-/secondary infections and superinfections. Similar ongoing studies on vaccine-dispensing patterns in the post-COVID-19 era are necessary, especially since the outbreak of various vaccine-preventable diseases has recently been observed.

BackgroundConsideration of the patient’s perspective in healthcare is important because it may inform holistic and contextually relevant management strategies.ObjectivesThe purpose of this study was to explore patients’ experiences and perspectives about their chronic musculoskeletal (CMSK) pain and its management in the private healthcare sector in South Africa. This work was done as a pilot study to test, adapt and finalize an interview schedule.MethodsA descriptive, qualitative study was conducted. The sampling was purposive. Three patients with CMSK pain were recruited to participate in in-depth individual interviews. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analyses of the transcripts were undertaken. Initial codes were assigned and a code book developed, which was applied to the transcripts to develop categories and themes.ResultsFour themes emerged from the data: (1) the participants sought understanding about the pain’s origin and the reason for pain persistence; (2) pain impacted their lives in multiple ways; (3) the participants depended on healthcare providers (HCP) for guidance and support; and (4) they had the option of acceptance of chronic pain.ConclusionThe participants’ knowledge about their health condition had important implications as it influenced their perspectives on pain and its management. The pain presented the participants with several challenges, which included developing an understanding about pain and coping with the impact of pain in their lives. HCPs were perceived to play an important role in empowering or disempowering the participants.

BackgroundA steady growth in the consumption of medicine for Attention-Deficit/Hyperactivity Disorder (ADHD) has been evident over the past two decades. The Coronavirus disease 2019 (COVID-19) pandemic is reported to have had an effect on stimulant consumption. Methylphenidate is the main active ingredient used in the treatment of ADHD, both in children and adults.ObjectiveThe primary aim was to analyze the consumption patterns of methylphenidate in the private healthcare sector in South Africa by means of a drug utilization study using the Defined Daily Dose (DDD) methodology to establish trends, detect seasonal variations and to compare the results with international studies.MethodsA retrospective descriptive drug utilization study was conducted. IQVIA sales data from the South African private healthcare sector from 2013 to 2023 were analyzed. Consumption patterns were expressed as the number of Defined Daily Doses (DDDs)/1000 inhabitants/day and DDDs/1000 inhabitants/month. Ethical approval for the study was granted.ResultsMethylphenidate consumption showed a steady increase in the years around the pandemic period, from 9.07 (in 2018) to 9.88 DDDs/1000 inhabitants/day (in 2023), with a notable lower consumption in 2020 when the COVID-19 pandemic started. Consumption in 2013 was only 6.01 DDD/1000 inhabitants/day, which indicates an increase of 64.39 % over the 11-year period. Seasonal peaks in consumption were observed in February, May, August and November, coinciding with times before assessment periods in schools and universities.ConclusionsThere was a clear visible upward trend in the consumption of methylphenidate, with a decrease during 2020, as was also observed in other countries. Similar studies are recommended for other central nervous system drug classes.

The failure to achieve sustainable development in South Africa is due to the inability to deliver quality and adequate health services that would lead to the achievement of sustainable human security. As we live in an era of digital technology, Machine Learning (ML) has not yet permeated the healthcare sector in South Africa. Its effects on promoting quality health services for sustainable human security have not attracted much academic attention in South Africa and across the African continent. Hospitals still face numerous challenges that have hindered achieving adequate health services. For this reason, the healthcare sector in South Africa continues to suffer from numerous challenges, including inadequate finances, poor governance, long waiting times, shortages of medical staff, and poor medical record keeping. These challenges have affected health services provision and thus pose threats to the achievement of sustainable security. The paper found that ML technology enables adequate health services that alleviate disease burden and thus lead to sustainable human security. It speeds up medical treatment, enabling medical workers to deliver health services accurately and reducing the financial cost of medical treatments. ML assists in the prevention of pandemic outbreaks and as well as monitoring their potential epidemic outbreaks. It protects and keeps medical records and makes them readily available when patients visit any hospital. The paper used a qualitative research design that used an exploratory approach to collect and analyse data.

BackgroundPerioperative patient-reported outcomes (PROs) allow patients to share their experiences of surgical procedures with their health care teams using standardized measures. Despite increasing recognition of their value, PROs are not routinely used in clinical practice, partly due to limited evidence of their impact on traditional clinical outcomes and uncertainty among clinicians about their use. Digital health tools offer a promising way to integrate PROs into clinical workflows and enhance patient-clinician interaction, but their success depends on person-centered design to ensure usability and relevance. Safe Surgery South Africa, a nonprofit organization, developed the Perioperative Shared Health Record (PSHR), a secure web-based tool that enables patients to share personal health information and PROs with their anesthetist and surgeon before and after surgery. Initial implementation revealed significant user experience challenges, which contributed to poor uptake.ObjectiveThis study aimed to explore factors influencing the PSHR user experience in a low- and middle-income country (LMIC) using human-centered design principles.MethodsThis observational qualitative user experience study followed the 5 design thinking stages: empathize, define, ideate, prototype, and test. Semistructured interviews were conducted with postoperative patients from both the public and private health care sectors, including those with and with no prior experience using the PSHR. Thematic analysis followed the 6-phase framework described by Braun and Clarke and was structured using Karagianni’s Optimized Honeycomb user experience model. A problem statement was developed, followed by ideation to explore solutions. Paper prototypes were created, refined, and tested through observation, interviews, and validated usability questionnaires.ResultsIn the empathize stage, 22 interviews were conducted in the private and public health care sectors in South Africa; 7 participants had previous experience using the PSHR. In the define stage, participants emphasized the need for connection, feedback, information, and support through their surgical journey. Contrary to expectations, patients were not discouraged by the length of questionnaires if they perceived them as purposeful. In the ideate stage, the team considered user expectations and PSHR integration into care processes. In the prototype stage, low-fidelity mock-ups were created and refined into paper prototypes. In the test stage, testing with 5 participants highlighted the importance of trust, communication, and user-friendly interfaces. Feedback loops and clinician engagement were identified as key motivators for sustained use. The mean usability questionnaire scores indicated excellent usability and high levels of user satisfaction across most domains.ConclusionsThis study is one of the first to apply human-centered design principles to a perioperative digital health tool in an LMIC setting, addressing usability challenges and patient engagement. Key user experience factors influencing patient engagement included communication, feedback, and access to information throughout the surgical journey. Digital health tools such as the PSHR can strengthen communication and support person-centered perioperative care by integrating PROs into clinical workflows and care processes.

Background Currently, chiropractic is not incorporated into the South African public healthcare sector despite its emphasis on the values of wellness and health. This is due to a poor relationship with mainstream medical practitioners, the construct of chiropractic education and its long standing isolation within the healthcare system within South Africa. The public healthcare sector in South Africa is strained. Low back pain is one of the main reasons patients seek medical attention from primary medical doctors. A growing body of evidence is now emerging which supports the role of chiropractic in post-­surgical rehabilitation and the treatment of extraspinal non-­pathological musculoskeletal conditions. Based on the findings of these studies, an argument could be made for the transition of chiropractic from a mainly private practice base to one that would enable it to reach to the wider population in the public healthcare sector. Aim The aim of the research study was to explore and describe the perceptions that chiropractors have about the integration of the chiropractic profession into the South African public healthcare sector. Method A descriptive exploratory qualitative approach was used to guide the study. In-­ depth interviews were conducted with ten chiropractors within the eThekwini municipality. The main research question for this study was “What are the perceptions of chiropractors in the eThekwini Municipality on the integration of chiropractic into the public healthcare sector of South Africa?” The data was analysed through thematic analysis. Results The main themes that emerged were the role of chiropractic in the healthcare system, the integration of chiropractic into the healthcare sector and the challenges facing chiropractors in the healthcare system. The themes and sub-­ themes were as follows;; • Theme 1 Role of chiropractic in the healthcare system Sub-­theme 1.1 Primary contact for neuromuscular medicine. • Theme 2 Integration of chiropractors into the public healthcare sector Sub-­theme 2.1 Relief of overworked healthcare workers. Sub-­theme 2.2 Decrease costs in surgical and medication use. Sub-­theme 2.3 Increased learning opportunities. Sub-­theme 2.4 Use of chiropractic in post-­surgical care. Sub-­theme 2.5 Need for pre-­surgical assessment. Sub-­theme 2.6 Integration facilitated by the Chiropractic Association of South Africa (CASA). • Theme 3 Challenges facing chiropractors in the public healthcare sector Sub-­theme 3.1 Opposition from medical doctors. Sub-­theme 3.2 Opposition from within the chiropractic profession. Sub-­theme 3.3 Inability to function as the primary practitioners. Sub-­theme 3.4 Unfamiliar structure of the public health care sector. Conclusion A lack of clarity on the identity and role of chiropractic in the public healthcare sector emerged from the findings of this study. Individual chiropractors, the professional body (CASA) and the Allied Health Professions Council of South Africa (AHPCSA) need to engage in active roles in the integration of chiropractic into the public healthcare sector of South Africa.

The objective of this study was to analyse the market share of generic vs originator selective serotonin re-uptake inhibitors (SSRIs), and also compare market share of different SSRIs in the private health care sector in South Africa, over a period of 4 years. This was a retrospective, descriptive study that measured generic market volume as a percentage of the total private SSRI market volume. Retail private sector sales data for six SSRIs available in the private sector in South Africa was evaluated. Sales data were obtained from various stages in the pharmaceutical supply chain, June 2009 - May 2013. Generics constituted 86% and originators 14% of the private sector market volume of SSRIs. The share of the market volume of generic medicines increased by 29.93% over this 4-year period, while an overall increase of 27.86% in the ratio of generics to originators was observed. In line with policies, generic SSRIs hold a larger volume of the market in the private sector in South Africa.

IntroductionThe public healthcare system in South Africa services the majority of its population, as many are unable to afford the services that exist in the private sector. The public sector has become overburdened with many issues. Some of the issues that plague this sector include a lack of resources, insufficiency of personnel and financial constraints due to over-usage. Based on this context, the introduction of complementary alternative medicine, such as homoeopathy, into the public healthcare system exists as one of the potential resolutions to this burdened healthcare sector. Therefore, the aim of the study was gather data, both descriptive and statistical, from healthcare professionals in order to develop a model for integrating homoeopathy into the public healthcare system.MethodsThe researcher conducted a mixed methods study using the explanatory sequential design. Thus, the study was conducted in two Phases. Phase 1 employed quantitative measurement tools, where data was collected from medical doctors, nurses and homoeopaths through paper-and-pen/ electronic surveys. Phase 2 incorporated qualitative measurement tools, where data was collected from Chief Operating Officers as well as nursing managers through semi-structured interviews. The data from both phases was then compared and contrasted to guide the development of a model for integration.DiscussionsBased on the current circumstances that exist in South Africa, it was established from the results of the study that the integration of homoeopathy into the public healthcare system would be complex in nature, due to the changes that would need to be made in both the public and private sector.ConclusionsThe findings of the study have revealed that integration is not an isolated event and if were to occur, would involve the participation of various stakeholders. Currently, homoeopathy only exists in the private sector, along with the other natural therapies as well as mainstream medicine. The public sector only offers mainstream medicine and this has been a reality since inception of this sector. Though there have been some talks of certain natural therapies, such as traditional medicine being integrated into the sector, no solid discussions have been concluded.Lessons learntThe public healthcare sector in South Africa is under increasing pressure. The users of this sector are not always guaranteed health benefits and are unfortunately not able to receive the same quality of care as those who can afford the services of the better resourced private healthcare sector. The integration of homoeopathy presents as a possible solution to some of the issues experienced. The government in South Africa has raised the possibilities of an integrated approach to healthcare to address these issues, albeit it has been unclear how such integration will take place.LimitationsPatients/public sector users being excluded from the study was seen as one of the biggest limitations. The researcher believed that patients’ perceptions are equally important as those of the practitioners.Suggestions for future researchThe model not being tested and implemented presented as a limitation of the study. This meant that further research ought to be considered regarding the phenomenon being investigated.

The need for rehabilitation is increasing on a global level due to a rise in non-communicable diseases, aging and medical advances, and in South Africa (SA), due to the quadruple burden of disease. More information is required regarding rehabilitation scope and practices in SA to optimize the provision of rehabilitation interventions in the context of the transforming health care sector in SA, a low-to-middle-income country (LMIC). The purpose of this study is to explore the perspectives of South African rehabilitation stakeholders on the landscape of rehabilitation in SA. A descriptive qualitative study, with an interpretive approach, was used to explore stakeholder perspectives on rehabilitation practices in the public health care sector of SA. Semi-structured interviews were conducted with 12 rehabilitation stakeholders. Data were analyzed using a combination of deductive and inductive processes to generate themes and categories. We identified 5 main themes, with subsequent categories and sub-categories. The themes include a composite definition of rehabilitation, core elements of rehabilitation provision, challenges affecting rehabilitation practices, the importance of policy implementation, and the progress of rehabilitation in SA. Despite a common understanding of rehabilitation practices in SA amongst stakeholders, many persistent challenges hamper the delivery of effective rehabilitation services. We recommend that further research explore the rehabilitation needs of end-users, together with collaborative research for priority setting on the translation of policy to practice ensuring equitable and quality rehabilitation service delivery.