Immune Suppression and Antimicrobial Resistance in Hospitalised HIV Patients: Evidence from Free State and Northern Cape Hospitals.

The International Commission on Radiological Protection emphasizes dose optimization for pediatric patients due to their higher radiosensitivity. Establishing diagnostic reference levels (DRLs) supports this goal during radiological examinations. This study aimed to establish pediatric diagnostic reference levels (PiDRLs) for anteroposterior (AP) chest X-rays across four hospitals in the Northern Cape Province, South Africa. PiDRLs were calculated for 375 pediatric patients (birth to 12 years) categorized by weight bands and age groups. Image quality was assessed using an image quality assessment checklist. DRLs were determined as the 75th percentile of the dose distribution for fixed X-ray units. An image quality assessment was performed to establish if the dose levels consistently produced images of acceptable diagnostic quality. Mean PiDRLs for weight groups < 5 kg, 5- < 15 kg, 15- < 30 kg, 30- < 50 kg were 0.2 mGy, 0.2 mGy, 0.2 mGy, and 0.3 mGy, respectively. Corresponding values for age groups < 1 year, 1- < 5 years, 5- < 10 years, and 10- < 12 years were 0.2 mGy, 0.2 mGy, 0.3 mGy, and 0.3 mGy, respectively. Image quality was consistently high, with the 75th percentile slightly exceeding international benchmarks. The image quality assessment confirmed that the dose levels produced images of acceptable image quality. PiDRLs match select international benchmarks, offering a baseline for South African optimization. This study contributes valuable regional data to support radiation safety and dose optimization in pediatric medical imaging in South Africa.

Globally, concerns about increasingly sedentary lifestyles have highlighted the importance of play-based learning and physical activity. Although physical development is regarded as an essential aspect of school readiness, many factors at home and at school seem to be keeping young children from engaging in physically active play. Considering the associated educational outcomes and holistic development related to school readiness, there is a need for greater focus on movement and play at home and at school, and for partnerships to facilitate these activities. This paper emanates from a doctoral study that explored the way parents and teachers can collaborate to facilitate the development of fundamental skills through play-based movement activities. Then study was conducted in a low-socio-economic community in the Northern Cape, South Africa, with eight participants. Mezirow’s transformative learning theory served as the theoretical framework to explore more inclusive frames of reference. A participatory action learning and action research design was implemented, using arts based methods and discussions to generate data. Data analysis was conducted using Braun and Clarke’s recursive six-step reflexive thematic analysis. The findings confirmed that there are insufficient support structures, such as parental involvement, and that movement and play are often undervalued in practice, possibly owing to misperceptions about play-based learning. In addition, the pressure to achieve academically and the focus on formal tasks prevented the effective use of more active, play-based strategies in the classroom. The study contributes to the body of knowledge by considering factors to improve the collaboration between parents and teachers, thereby supporting children’s holistic development through movement play.

Access to water and sanitation remains a pressing global challenge, particularly in informal settlements where infrastructural inadequacies, insecure provision modalities, and unreliable supply networks characterise service delivery systems. This paper examines the current access to water and sanitation in the Lerato Park informal settlement located in Kimberley, Northern Cape Province, South Africa. The study employed qualitative methods, including semi-structured questionnaires with residents, key informant interviews with officials from Sol Plaatje Municipality, and direct field observations. Findings reveal that residents rely heavily on illegal water connections and temporary private contractors due to the absence of formal municipal reticulation and bulk infrastructure. Sanitation provision is primarily dependent on shared bucket toilets, which are severely overcrowded, poorly maintained, and pose significant public health, safety, and gender-based vulnerability risks, particularly for women and children. While municipal authorities acknowledge these challenges, responses remain largely reactive, constrained by limited fiscal capacity, insecure land tenure arrangements, and systemic hydrological scarcity in the Northern Cape. The paper concludes that bridging the gap between South Africa’s progressive legislative and policy frameworks and the on-the-ground realities of informal settlements requires urgent capital investment in service infrastructure, strengthened participatory planning processes, and the systematic integration of informal settlements into municipal spatial planning and service delivery instruments to ensure equitable, safe, and sustainable access to basic services.

ABSTRACTBackgroundPoint‐of‐care rapid diagnostic testing plays a critical role in HIV detection and timely linkage to care, particularly in decentralized healthcare settings. To support testing reliability, the National Health Laboratory Service in South Africa conducts a national proficiency testing (PT) program as part of its broader quality assurance framework. This study assessed national PT performance and explored interprovincial differences.MethodsA retrospective analysis was conducted using data from three PT survey rounds (0121, 0221, and 0122) carried out between January 2021 and October 2022. Each participating facility tested six blinded serum samples per round using routinely available HIV rapid diagnostic tests. Performance was categorized as acceptable ( ≥ 80%) or unacceptable ( < 80%) in accordance with ISO 17043 standards. Descriptive statistics were used to summarize participation and performance. Chi‐square tests assessed differences by province, and binary logistic regression was used to explore factors associated with unacceptable performance.ResultsOf the 12,636 PT panels distributed across three survey rounds to approximately 4200 facilities per round, 12,447 (98.50%) were returned with valid results. Acceptable results ( ≥ 80%) were consistently high, with 97.89% in Survey 0121, 98.37% in Survey 0221, and 98.31% in Survey 0122, yielding an overall average of 98.19% (12,222/12,447) of facility–panel submissions achieving acceptable performance scores, with a mean score of 98% across rounds. A total of 793 errors (1.05%) were identified, including 351 false‐negative results (0.46%) and 442 false‐positive results (0.58%). In addition, 46 discordant results ( < 0.10%) were recorded. Significant interprovincial variation in PT performance was observed (p < 0.001), with the Northern Cape consistently reporting the highest proportion of unacceptable scores. In contrast, Limpopo and Mpumalanga achieved 100% acceptable performance across all three rounds. Logistic regression did not identify any statistically significant predictors of underperformance, although facilities in the Northern Cape showed increased odds of unacceptable scores.ConclusionThe HIV PT program demonstrated high national uptake and strong overall performance in decentralized settings. However, persistent regional disparities underscore the need for targeted quality assurance interventions and strengthened oversight in underperforming provinces to ensure comparable diagnostic quality across the national HIV testing program.

Sorghum-based porridges are a key component of breakfast meals in South African school feeding programmes. While these meals support learner nutrition and educational outcomes, their effectiveness depends on learner acceptance and the extent of plate waste. This study assessed acceptance and plate waste of two sorghum-based porridges-Mabele (100% sorghum) and Morvite (pre-cooked sorghum, 75-100% depending on flavour, with possible inclusion of soya, cow's milk, and wheat/gluten)-compared with instant maize meal, Jungle Oats (100% wholegrain oats), within the Tiger Brands Foundation breakfast programme. Patterns of waste and underlying reasons were examined across five provinces. A mixed-methods approach was used in 25 primary schools across Gauteng, KwaZulu-Natal, Limpopo, North West, and Northern Cape. Quantitative data were collected through 10-day food waste diaries completed by Volunteer Food Handlers and analysed using descriptive statistics, ANOVA, and regression models. Qualitative data were obtained from 75 semi-structured staff interviews and 25 learner focus groups, analysed thematically using ATLAS.ti version 22. Overall, food waste was low, with "no food waste" reported in over half of the observations. Acceptance of sorghum-based products varied. Morvite was generally well accepted, whereas Mabele was frequently disliked in some provinces. Key drivers of waste included food dislike, poor preparation, bland flavour, and learner absenteeism, with serving conditions and a lack of utensils as secondary factors. Although waste was modest, variability in acceptance of sorghum-based porridges suggests the need to improve preparation quality, flavour, and serving conditions to enhance programme effectiveness.

This study investigates the spatiotemporal trends of drought and its impact on child health in South Africa, focusing on low birth weight (LBW) and severe acute malnutrition in children under five. We collected data on child health indicators (LBW and malnutrition) and social determinants, including orphan status, child food poverty, proximity to clinics, water access, and sanitation access, from the Children's Institute at the University of Cape Town. Environmental data, comprising the Normalised Difference Vegetation Index (NDVI), Standardised Precipitation Evapotranspiration Index (SPEI), and maximum temperatures, were retrieved from MODIS, Global SPEI, and TerraClimate datasets, covering 2002 to 2022. We then fitted a series of linear regressions and combined them into a structural equation model to explore relationships between socio-environmental factors and child health outcomes. Results indicate that the Northern Cape, Western Cape, and Free State are highly vulnerable to agricultural drought, with NDVI showing a strong negative association with LBW and malnutrition. Orphan status emerged as a stronger predictor of malnutrition than drought. The impact of orphan status on malnutrition level is mediated by limited access to basic services such as water and sanitation. Proximity to clinics significantly influenced access to basic services, highlighting a double burden of healthcare and environmental deprivations. These findings expose the need for targeted interventions to enhance food security, water, and sanitation access, particularly for orphaned children, and to integrate drought mitigation into child health policies in South Africa.

Abstract. The Kalahari Manganese Field (KMF) in the Northern Cape Province of South Africa hosts some of the world's richest manganese deposits, largely concealed beneath thick Cretaceous to Cenozoic Kalahari Group and Karoo Supergroup sediments. To improve imaging of the concealed Transvaal Supergroup strata, a high-resolution 2D reflection seismic survey was conducted in November 2023 across the Severn farm area. The survey comprised five profiles totalling 18.9 km, acquired using 5 Hz 1C geophones connected to wireless nodes, enabling effective burial beneath loose aeolian sand for improved coupling. A compact 500 kg drop hammer, mounted on a Bobcat, served as the seismic source, offering excellent manoeuvrability across challenging sandy terrain. Shot spacing was 10 m, with four vertical stacks per shot to enhance signal-to-noise ratio. Refraction tomography using first-break travel times provided near-surface P-wave velocity models, revealing variable Kalahari sediment thicknesses ranging from 20 to 70 m and bedrock velocities of ∼ 5500 m s−1 associated with Karoo Supergroup strata. Despite the challenges posed by the thick sand cover, lithified calcrete horizons within the Kalahari sediments significantly aided seismic energy propagation. The data were processed using a conventional pre-stack imaging workflow. We tested both Kirchhoff pre-stack time migration (KPreSTM) and Kirchhoff pre-stack depth migration (KPreSDM) and compared the results. Both migration approaches revealed a high degree of similarity in reflector geometries and structural patterns, suggesting minimal lateral velocity variation across the study area. KPreSTM results were then used in the final seismic interpretation. Pre-stack time migrated sections exhibit nine laterally continuous high-amplitude reflectors between 0.05 and 3.42 km depth, corresponding to major stratigraphic boundaries from the Kalahari Group down to the Ghaap Group. Of particular interest is the moderate-amplitude reflection pair at 1.05–1.35 km depth, interpreted as the Hotazel Formation, the primary host for manganese mineralization. This study demonstrates that, when appropriately designed, reflection seismic imaging can be a powerful tool for delineating deep mineralized strata beneath thick sedimentary cover in arid environments.

BackgroundFood insecurity is a persistent socio-economic challenge in South Africa that was sharply exacerbated by the COVID-19 pandemic. This study compares household hunger during the acute pandemic period and the early recovery phase and examines how socio-economic inequalities in food security evolved.MethodsWe analyzed five waves of the National Income Dynamics Study—Coronavirus Rapid Mobile Survey (NIDS-CRAM, 2020–2021) and the National Food and Nutrition Security Survey (NFNSS, 2022). A harmonized 7-day household hunger indicator was recoded as “no household hunger” and modeled using survey-weighted logistic regression. Socio-economic-related inequality in being hunger-free was assessed using the Erreygers Concentration Index and decomposition analysis, with sensitivity checks for alternative socio-economic status (SES) specifications and model diagnostics.ResultsHunger peaked at 26.47% in Wave 1 of NIDS-CRAM and declined to 16.07% by Wave 5, before falling to 8.19% in NFNSS. Improvements were uneven; several provinces, notably the Northern Cape, Free State and North West, remained comparatively food insecure. Across all waves and NFNSS, higher SES was strongly associated with a lower risk of hunger, and living in informal or traditional dwellings and larger household size were consistently associated with a higher risk of hunger. Erreygers indices were positive in all periods, indicating pro-rich inequality in food security that intensified during the pandemic and narrowed only modestly post-pandemic, with SES the dominant contributor.ConclusionAlthough household hunger declined below pandemic peaks, the recovery in food security has been unequal and remains strongly patterned by socio-economic status and place, underscoring the need for structural, equity-focused policy responses.

Learner substance abuse is a global public health concern contributing to preventable injuries, poor academic performance, and increased dropout rates. Addressing it in schools is crucial for improving both educational and health outcomes. This study explores high school educators' perceptions and experiences of learner substance abuse. The study was conducted in six high schools in Galeshewe Township, Northern Cape province. A qualitative, exploratory and descriptive approach was employed. Sixteen Life Orientation (LO) educators were purposively sampled for in-depth interviews. Data were collected using a semi-structured guide until saturation. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability. Thematic analysis followed Braun and Clarke's six-step process, with transcription via Microsoft Word and Excel. Four themes emerged: factors driving learner substance abuse, educational disruptions, educator training and support, and intervention strategies. Educators reported substance abuse as common both in school and off-premises especially among older boys. They also observed an increasing trend among younger learners and girls. It was linked to disruptive behaviour affecting teaching and learning. Educators felt unprepared to manage these issues and criticised the LO curriculum's limitations. Educators emphasised the need for specialised training programmes to equip them with skills to manage learners involved in substance abuse. They also called for greater support from leadership in the Department of Education. The study's findings highlight the challenges of learner substance abuse in the Northern Cape and provide context-specific interventions that can be used to inform policy that addresses substance abuse in schools.

Waiting times for specialist consultations influence timely diagnosis and appropriate disease management. Given the high prevalence and morbidity associated with skin diseases, prolonged waiting times to access dermatological care have important public health implications. In South Africa, data describing waiting times for dermatology services are lacking. This descriptive cross-sectional study assessed waiting times for private-sector dermatology services across South Africa. All dermatology practices listed on Medpages were contacted telephonically on three separate occasions between 01 and 31 August 2023. Using a standardised script, appointment availability was requested for a fictitious patient under three clinical scenarios: a routine skin check, a changing pigmented lesion suggestive of possible melanoma and a cosmetic consultation for neurotoxin injection. A total of 192 dermatologists were included. The national median waiting time was 15 days (interquartile ranges [IQR] 5-48.3 days) for a routine skin check, 5 days (IQR 1-14 days) for suspected melanoma and 12 days (IQR 4-33.8 days) for cosmetic consultation. Waiting times varied widely across provinces, ranging from same-day access to delays exceeding 1 year. The longest median waiting time for routine consultations was observed in the Northern Cape (227 days), while the shortest was in Limpopo (2 days). Consultation fees also showed substantial interprovincial variation. While overall waiting times appear acceptable at a national level, marked provincial disparities exist. Urgent cases are generally prioritised, yet prolonged delays in certain regions may compromise timely care, underscoring the need for targeted, context-specific interventions. This study provides the first national overview of private-sector dermatology waiting times in South Africa. It highlights significant geographic disparities in access to care within the private healthcare system and generates evidence to inform health service planning, workforce distribution and strategies to improve equitable access to dermatological services.

Climate change involves rising temperatures and altered precipitation patterns which lead to the contraction, expansion or shift in the ranges of biodiversity. This study employed MaxEnt to predict current and future distributions of three bird species native to South Africa and one invasive species. Future scenarios were modelled for 2050 and 2070 using three pathways: SSP1-2.6, SSP2-4.5 and SSP5-8.5 and four bioclimatic variables. The models showed good performance, with AUC values above 0.7, indicating high predictive accuracy. Comparisons between current ranges and future predictions show species, such as P. purpureus and L. torquatus, moving south-westwards and crossing into new biomes in response to changing climatic conditions. Meanwhile, U. angolensis shows drastic range contraction, with A. tristis showing expansion into arid environments. Across all concentration pathways, for both time periods, all species show expansion into southern arid regions of the Northern Cape. The models suggest that bird species are not only moving to different geographic areas, but are also likely to cross biome boundaries, which may have ecological implications. The study highlights how climate change is a significant driver of changes in bird species distributions and their entry into new biomes. These findings underline the importance of adaptive conservation strategies that consider the dynamic nature of species distributions under climate change.

IntroductionHistoplasma capsulatum naturally occurs in cave soil enriched by bat guano. South African caves are documented as probable sources of exposure for speleologists, casual visitors, or guano miners with several outbreaks of acute pulmonary histoplasmosis reported since 1977. Sporadic cases of disseminated histoplasmosis occur in South Africans living with advanced HIV disease. However, detection from the environment has not been confirmed. We used molecular assays to detect and confirm the presence of H. capsulatum in regularly-explored caves.MethodsEnvironmental samples were collected by a speleologist from seven South African caves from December 2020 to September 2021 in the Gauteng, Northern Cape and Western Cape provinces of South Africa and stored at 2–8 °C. DNA was extracted directly from the samples using DNeasy PowerSoil Pro Kit. In-house internal transcribed spacer (ITS) panfungal polymerase chain reaction (PCR), pan-dimorphic reverse transcriptase-quantitative (RT-q) PCR and nested Hc100 PCR assays were used to detect H. capsulatum. Sequence identity was confirmed using the National Centre for Biotechnology Information (NCBI) BLAST tool following Sanger sequencing of the Hc100 nested-PCR product.ResultsH. capsulatum was detected in five of the seven caves. Of 56 samples tested, 18 (32%) were positive from three caves in Gauteng Province [cave 1 (3/10); cave 2 (7/10); cave 3 (5/10)], one cave in the Western Cape Province [cave 4 (2/5)] and one cave in the Northern Cape Province [cave 6 (1/10)]. These samples were positive either by RT-qPCR or Hc100 PCR assays. Both RT-qPCR and Hc100 PCR assays were positive in 21% (12/56) samples. Seven percent (4/56) of samples were only RT-qPCR assay-positive and 4% (2/56) only Hc100 PCR-positive. Phylogenetic analysis of the Hc100 gene product from 10 samples (with good-quality sequences) identified four groups. Group 1 consisted of three samples from caves 1, 3, and 6 (Gauteng/ Northern Cape); Group 2 included four samples from caves 1, 2, and 3 (Gauteng); Group 3 had one sample from cave 4 (Western Cape); and Group 4 included two samples from caves 1 and 3 (Gauteng). None of the 56 samples tested positive with the ITS PCR assay.ConclusionsH. capsulatum is probably present in several regularly-explored caves with bat populations. This finding should be confirmed by culture. The RT-qPCR and the Hc100 PCR assays could be useful tools for wider environmental surveillance.

An in-depth geochemical analysis of dolomite and banded iron formation in the Northern Cape, South Africa

Single-ventricle physiology is a critical cardiac condition requiring early diagnosis and intervention. The objectives of this study were to report on the management and outcomes of patients diagnosed with single-ventricle physiology in central South Africa. This study was a retrospective, observational analysis of patients presenting with single-ventricle physiology at the Universitas Academic Hospital in central South Africa between November 1997 and June 2021. Patients were referred from the Free State (54%) and Northern Cape (29%) provinces and Lesotho. One hundred and fifty-four patients presented with single-ventricle physiology: 114 received interventions and 40 were not eligible for intervention. Patients presented for the first time at a median age of 34.5 days, with patients from nearby districts presenting within a few days of birth. However, patients from outlying areas presented much later. Eighty-seven patients received systemic-to-pulmonary artery shunting or pulmonary artery banding. Sixty-three patients proceeded to bidirectional Glenn procedures, and 30 patients (26%) had full palliation to Fontan. Twenty-one patients died after stage 1, six after the Glenn procedure and two after the Fontan procedure. Overall, 34 (29.8%) patients were lost to follow up. Patients in our study presented late and follow up of these patients was a challenge. The highest mortality rate occurs during the first stage of palliation. Outcomes from this study are comparable to other sub-Saharan studies.

The Northern Cape province of South Africa remains one of the most spatially marginalized and economically underdeveloped regions, plagued by low educational attainment, poor infrastructure, and unsustainable land use. This study investigates the transformative power of spatial intelligence through a GIS-enhanced curriculum aimed at fostering sustainable planning and socio-economic revitalization. Grounded in Place-Based Experiential Learning Pedagogical Framework, the research explored how geospatial technologies can be integrated into education to cultivate critical spatial reasoning, local agency, and sustainability-driven development. A systematic literature review methodology was employed to consolidate existing research on GIS in education, sustainable regional planning, and rural transformation. Scholarly databases such as Scopus, Web of Science, and ERIC were queried using a structured keyword strategy, yielding 67 peer-reviewed sources. Findings reveal that GIS-integrated education enhances learners’ spatial awareness, problem-solving skills, and engagement with community development, but its effectiveness is hindered by digital divides, inadequate teacher training, and fragmented policy support. To harness its full potential, the study recommends the establishment of a state-of-the-art eco-tourism resort that leverages the province’s unique ecological and cultural heritage, and the development of an additional public university dedicated to Social Sciences, Medicine, Law, Engineering, Built Environment and Veterinary Sciences. Future research could develop localized, multilingual GIS modules co-designed with indigenous knowledge holders and educators to assess culturally responsive applications of spatial intelligence in curriculum development. This approach would help address epistemic inequities in knowledge production and contribute to decolonial pedagogies in geospatial education.

A 65-year-old man presented with 91% body surface area full-thickness burns that he sustained in a shack fire. It was suspected that the patient, who was an epileptic, had a seizure, fell, and knocked a paraffin stove over, setting the shack alight. He arrived at the hospital 2 h later in a critical condition. A full blood count (FBC) performed on an Advia® 2120i (Siemens Healthineers, Erlangen, Germany) automated haematology analyser revealed marked thrombocytosis (1157 × 109/L), leucocytosis (18.58 × 109/L) and a normal haemoglobin level (143 g/L). The red blood cell (RBC) indices showed macrocytosis (mean corpuscular volume 101.6 fL) and hypochromia (mean corpuscular haemoglobin 26.2 pg), while the RBC distribution width was elevated (24.4%). Review of his peripheral blood film showed no apparent increase in platelets. However, the erythrocytes displayed marked anisopoikilocytosis with numerous spherocytes, microspherocytes, microdiscocytes and irregular fragments of cytoplasm, with budding from erythrocytes being apparent. Echinocytes were prominent, likely due to his acute kidney injury (figure, all panels, Wright's stain, objective ×50 lens). Neutrophils were increased with toxic granulation and vacuolation (bottom left panel, objective ×50 lens). The patient succumbed to his injuries 4 h after the accident and no repeat FBC or film could be obtained. These photomicrographs illustrate the distinctive RBC morphology that may be seen with severe burns, usually within the first 4 h following the injury. Thermal injury disrupts the RBC membrane resulting in budding (bottom middle panel), which is typically detected as microspherocytes (all panels) and microdiscocytes (small round schistocytes that retain their central pallor) (top panels).1 These microspherocytes and microdiscocytes may be incorrectly counted as platelets by automated FBC haematology analysers, resulting in pseudothrombocytosis.2, 3 A similar artefact may occur in thrombotic microangiopathies if schistocytes and microspherocytes are erroneously counted as platelets, masking the thrombocytopenia that characterizes these disorders. Likewise, in a patient with severe burns, the thrombocytopenia that occurs with disseminated intravascular coagulation may be masked. These limitations are classically associated with automated haematology analysers that rely on impedance to count platelets. Analysers that count platelets after fluorescent RNA labelling (Sysmex) or immunolabelling (Abbott) usually avoid this trap.3 Optical analysers such as the Advia® 2120i, which measure platelet volume and composition simultaneously, are theoretically able to differentiate platelets from RBC fragments due to diffraction analysis.3 However, as this case clearly demonstrated, the Advia® 2120i may not be exempt from generating spuriously elevated platelet counts in patients with severe burns. Pseudothrombocytosis should be considered in any patient with severe thermal injuries when an FBC is performed on an automated haematology analyser, particularly those that rely on impedance or optical light scatter to count platelets. This case underscores the importance of a blood film review for any abnormal platelet count. The author would like to acknowledge Dr. Mellisa Bergman, who identified this case in the laboratory. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Ethical clearance for this case study was obtained from the Health Science Research Ethics Committee of the University of the Free State (UFS-HSD2025/0296/2705). Permission was obtained from the Northern Cape Department of Health. Informed consent for publication of this peripheral blood film image could not be obtained from the patient who demised from his injuries 2 h after admission to the hospital. Attempts to locate the next of kin to obtain permission to publish this report were unsuccessful. No patient identifying information is provided. The Health Science Research Ethics Committee of the University of the Free State granted a waiver of consent.

South Africa has one of the highest intimate partner violence (IPV) prevalence in Africa. Studies have linked IPV with negative health and socio-economic outcomes, especially during pregnancy which often led to termination of pregnancy (TOP). However, sub-national differences in the relationship between IPV and TOP have not been adequately examined in South Africa. The study aimed to examine subnational variations of the association between IPV and TOP in South Africa. Data were extracted for 2354 ever-in-union women aged 15–49 years with valid and complete information on the domestic violence module in the 2016 South African Demographic and Health Surveys dataset. The exposure variable was IPV, operationally defined as ever-experienced at least one of the physical, sexual, emotional violence, and partner controlling behaviour IPV forms. The logistic regression analysis was employed, to examine the association between IPV and TOP, while the odds ratios including their 95% confidence interval were reported. Overall, 15.3% had ever terminated pregnancy ranging from 9.5% in Northern Cape to 21.2% in Kwazulu-Natal. About 55.8% of the women had experienced IPV. The IPV, was strongly associated with about a 2-fold increase in TOP at national-level (aOR = 1.62; CI: 1.27–2.07). At subnational-level, women who had experienced IPV were associated with as high as a 2- and 8-fold significant increase in Limpopo and Kwazulu-Natal. The tendency of having a pregnancy terminated was significantly higher among ever-experienced physical violence women resident in Northern Cape (aOR = 4.26; CI: 1.28–14.16) and Kwazulu-Natal (aOR = 4.99; CI: 1.60-15.58) relative to their counterparts who had never experienced physical violence. Among women who had ever experienced emotional and partner control, Northern Cape and North West, and Kwazulu-Natal residents were at higher risk of pregnancy termination, respectively. There was evidence of varying strong associations between IPV, including its forms, and pregnancy termination in multiple provinces. Context-specific maternal health interventions targeted at curbing intimate partner violence may substantially reduce the burden of pregnancy termination in South Africa and other similar settings.

Conventional evaluation approaches are often designed for predictable, linear systems and fail to capture the non-linear dynamics of complex community health interventions. Health projects in mining-affected communities are typically fragmented, with limited coordination or responsiveness to socio-ecological realities. This study applied complexity theory, community-oriented primary care (COPC) principles, and used a transdisciplinary approach to assess a health and wellness project in such a setting. To describe and reflect on the methodology of a complexity-informed assessment of the coherence and contextual alignment of a health and wellness project in mining-affected communities. Health and wellness projects funded by the Sishen Iron Ore Company Community Development Trust (SIOC-CDT) and implemented across five municipalities in the Northern Cape and Limpopo provinces, South Africa. A complexity-informed, mixed-methods design was used. Data were gathered through document review, field observation, and 12 key informant interviews with implementing agents, health officials and traditional healers. Community-oriented primary care principles and complexity theory guided iterative analysis and were supported by digital tools. The study identified fragmented implementation, limited household engagement and weak data systems. Despite widespread activity, the lack of integration and adaptive strategy limited systemic effectiveness. However, transdisciplinary engagement, adaptive iteration and co-production of knowledge and reflection facilitated institutional learning and practical proposals for change that are integrated and context sensitive, responding to complexities. Sustainable health system change in complex settings requires integrated, reflexive and locally grounded approaches that move beyond project-based interventions.Contribution:This study demonstrated how complexity theory, transdisciplinarity, and community-oriented primary care principles offer a viable methodological framework for adaptive evaluation and systemic learning in community health and development, contributing to the journal's focus on primary care and community health systems in dynamic contexts.

Self-directed learning (SDL) is a process with many benefits, which include fostering learner-centred learning. Yet, literature frequently reports discrepancies between theory and practice regarding pedagogical approaches to facilitate active, learner centred learning. The problem is that the extent, as well as the nature of the discrepancies between teachers’ and teacher educators’ understanding and knowledge of SDL and the strategies for its implementation in educational practice, remains unclear. In this article we report on research in which we analysed and compared teachers’ and teacher educators’ knowledge and understanding of SDL. High school teachers from the Northern Cape province in South Africa (n = 100) and teacher educators from a South African university (n = 9) participated. Using an online questionnaire we explored participants’ knowledge and understanding of SDL. The questionnaire was included in the first phase of a more extensive longitudinal design-based research study, which was aimed at introducing and acquainting teachers in the Northern Cape to and with the principles and process of SDL. Content analysis, underpinned by constructivist theories about knowledge, learning and meaning-making, was applied to the data. The findings and results indicate that teachers had different perceptions of SDL than teacher educators. These discrepancies limited teachers’ application of SDL in practice and confirmed gaps between teacher educators’ theoretical preparation of student teachers for SDL and teaching practice. The implication is that teacher educators need to conduct further research to develop and improve strategies to bridge the theory-practice divide and support current and future teachers to be and to become increasingly more self-directed as facilitators of learning.