Browsing by Author "Maswime, Salome"

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    Determining stillbirth data reporting systems in Africa
    (2025) Gumede, Simphiwe W; Maswime, Salome; Kinney, Mary; Pule, Mosonngwa
    Background Stillbirths are an important public health concern, with an estimated 1.9 million stillbirths occurring globally each year, more between 2020-2021 data. However, the recording, investigation, and classification of stillbirths vary across countries, leading to inconsistencies in data collection and analysis. This study aimed to assess the current data systems and practices regarding stillbirth recording, data collection, analysis, and utilization in African countries. Study design The study used a descriptive research design with a quantitative approach, involving the surveillance of national data systems and other existing systems in African countries. Method The study was undertaken in African countries by University of Cape Town in collaboration with the Africa Centres for Disease Control and UNICEF. The study involved a survey of the national data systems recording stillbirths in the African countries and other reporting systems that countries use. Results A survey of 55 African countries (34 respondents) revealed critical insights into stillbirth reporting and data management. Among responding countries, 76% defined stillbirth using a gestational age threshold of ≥28 weeks, while 48% used a birth weight criterion of ≥1000 grams. Significant policy gaps were identified: 47% lacked mandates for stillbirth classification, and only 57% integrated stillbirth targets into national health strategies. Despite 88% of countries routinely collecting stillbirth data, methods varied (paper-based vs. digital), and 54% reported no data quality assessments in the past decade. Classification systems for causes of death varied, with ICD-PM and ICD-10 each used by 35% of countries. Nurses/midwives were primarily responsible for data entry (73%), yet challenges persisted, including inadequate health worker capacity (53%) and poor infrastructure (42%). Only 42% of countries disseminated stillbirth reports publicly, often relying on aggregated tables rather than interactive formats. Regional disparities underscored systemic issues in healthcare access, data standardization, and governance, emphasizing the urgent need for policy harmonization and strengthened health information systems. Conclusion The persistent inconsistencies in the recording, investigation, and classification of stillbirths and perinatal deaths across African countries-evident in different gestational age (20-28 weeks) and birth weight thresholds (<500g to <1000g), ambiguous civil registration laws (82% of countries), and fragmented national policies (only 27% with stillbirth-specific targets) highlight an urgent need for standardised definitions and consistent legal frameworks. These gaps perpetuate unreliable data, obstructing targeted interventions and accountability mechanisms. To address this, governments must adopt WHO-aligned criteria, integrate stillbirth reduction into national health strategies, and strengthen cross-sector collaboration for robust civil registration systems. Prioritizing these steps, alongside research into context-specific barriers (e.g., stigma, resource limitations), will not only improve data accuracy but also catalyse actionable insights to reduce preventable stillbirths and advance maternal and newborn health outcomes globally.
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    Emergency vs elective surgery ratio in the cape metro area
    (2025) Heynes, Alana; Nicol, Andrew; Maswime, Salome; Peters, Shrikant
    Background: South Africa is classified as an upper middle-income country based on the World Bank classification. The access and delivery of surgical care in South Africa is only recently being investigated and understood. One study by Chu et al showed that while more than 80% of South Africans had two-hour access to district level hospitals, just over half of these hospitals had surgical capacity(1). The emergency to elective surgery ratio (Em:El), which measures the number of emergency surgeries per 100 elective surgeries has been used as a metric to assess the delivery of surgical care. This metric was based on a 2018 study, Emergency-to-Elective Surgery ratio: A global indicator of access to surgical care(2). In this study, the Em:El ratio was assessed pre-the COVID-19 pandemic, as a baseline of service delivery, as well as during the COVID-19 pandemic to assess how the ratio was affected as a result of the pandemic. Methods: A retrospective audit of the computerised database (Clinicom) and the logbooks of Groote Schuur (GSH), a tertiary referral centre and Victoria Wynberg hospital (VWH), a medium district hospital. Data was captured for all patients who underwent elective and emergency surgeries from January 2019 to June 2019 (pre- pandemic) and January 2021 to June 2021(during the pandemic). Results: Pre-pandemic GSH had an Em:El ratio of 60 emergency surgeries per 100 elective cases. During the phase out of lockdown restrictions in 2021 the Em:El ratio increased by 10% to 70 emergency cases per 100 elective cases, indicating the effect the pandemic had on the access to care. Excluding the trauma burden in South Africa and accounting for the positive effect of lockdown on the trauma rate in South Africa, the ratio would have been 28 per 100 cases in 2019 vs 56.9 per 100 cases in 2021, which better reflects the effects on access to surgical care during the Pandemic. VHW showed a doubling in the Em:El ratio when comparing pre-covid vs post-pandemic statistics. Conclusion: Compared to comparative data in high income countries in Europe where the Em:El ratio was 5.5, South Africa has poor access to surgical care as evident by our high Em:El ratio of 60 and 73.2 at GSH and VHW respectively. It is also evident from this study that the Covid pandemic significantly decreased the access to surgical care by increasing this ratio to 70 and 146 at GSH and VHW respectively.
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    Management of Myelomeningocele in Namibia
    (2025) Sallah, Aminata; Maswime, Salome; Lakhoo, Kokila
    There is a lack of information on the surgical management of myelomeningocele (MMC) in Namibia. We had three objectives (1) Determine the occurrence of Spina Bifida (SB) in Namibia from 2017 to 2021, (2) Determine the management and outcomes of babies born with MMC/SB, (3) Determine the extent of multi-disciplinary team engagement in the management of MMC and referrals in hospital and at discharge. Methodology: This was a retrospective observational study conducted in Windhoek, Namibia from 2017 to 2021 at Windhoek Central Hospital (WCH) and Katutura Intermediate Hospital (KIH). Data was collected from theatre books and patient files. Records of the MMC affected patients were collected and analysed, including demographic and peri- and post-operative care records. Results: 27 cases were operated during the 5 year study period, 15 (55.6%) and 12 (44.4%) from KIH and WCH respectively. Average age of operation were mean 7.61months , median 7.0 months (range 0.07-24 months), 15 (55.6%) of the patients were female. Mode of delivery was available in 3 (11.1%) of cases, with 2 (66.7%) normal deliveries and 1 (33.3%) caesarean section. Majority of the cases with origin reported were from Oshakati, 6 (55.5%) followed by Keetmanshoop, Mariental and Windhoek which each contributed 2 (13.3%) cases. With regard to regional distribution, reported and combined, North and South regions contributed the most, at 8 (53%) and 4 (26.6%) patients respectively. Myelomeningocele repair operations were 19 (70.3%)followed by Myelomeningocoele plus Shunt insertion (hydrocephalus) 5 (18.5%). The average operating time duration reported for all the operations (20 patients )was 181.5 minutes (Range 75-400 minutes), for MMC only operation (12 patients) was 136.4 minutes (Range 75-230 minutes). The location of the MMC was only reported on in 7 (25.9%) cases. Complications or none were reported on in 9 (33.3%) of the total cases, with 4 (44.4%) experiencing complications or 14.8% of the total. Anaemia was reported in 2 (22%) difficulty passing urine in 1 (11.1%) and septic wound in 1 (11.1%) of the cases. There were records of multi-disciplinary referral in only 2 (7.4%) of the total patients in files. There is no report on the extent of folate fortification in the Namibian diet. Discussion/Conclusion In this study of the management of MMC in Namibia, we described demographics, management, captured gaps and limitations. The age of repair needs to be improved upon to approach international gold standards of 72 hours. Operating time is close to worldwide averages. Postnatal management is substantially more expensive than prevention of MMC. Food fortification information was not readily available. A national strategy to close gaps will improve both prevention and management, from preconception through postnatal and lifelong MMC care in Namibia.
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    Postoperative outcomes associated with surgical care for women in Africa: an international risk-adjusted analysis
    (2022) Paterson, Amy Frances; Maswime, Salome; Biccard, Bruce
    Background There is an increasing call for a broader approach to women's surgical care in low- and middle-income countries, beyond access to caesarean section. While obstetric outcomes in Africa are well described, outcomes following non-obstetric surgical care for women in Africa are relatively unknown. Methods We did a secondary analysis of the African Surgical Outcomes Study (ASOS) focusing on severe postoperative complications (defined as death and severe complications) in females following non-obstetric, non-gynaecological surgical procedures. ASOS was a seven-day, African multi-centre prospective observational cohort study of adult (≥18 years) patients undergoing surgery in 25 African countries. These African outcomes were compared to international outcomes from the International Surgical Outcomes Study (ISOS) in a riskadjusted logistic regression analysis. Findings There were 1498 African participants and 18449 international participants who met the inclusion criteria. The African cohort were younger than the international cohort (47 (17) years versus 57 (17); p= <0·0001) and had a lower preoperative risk profile. Severe complications occurred in 41 (2·8%) of 1471 patients of the African cohort, and 431 (2·3%) of 18449 patients in the ISOS cohort, with in-hospital mortality following severe complications of 20/41 (48·8%) in ASOS and 78/431 (18·1%) in ISOS. The adjusted odds ratio for a woman in Africa developing a severe postoperative complication following elective non-obstetric, non-gynaecological surgery compared to the international incidence was 2·114 (95% CI 1·468 - 3·042, p<0·0001). Interpretation: Women living in Africa have double the odds of severe postoperative complications following elective non-obstetric, non-gynaecological surgery compared to the international incidence.
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    Prevalence of babies born with neural tube defects and geospatial mapping of therapeutic services: a systematic review
    (2025) Zolo Ossou, Andre Yvan; Maswime, Salome; Isiagi, Moses
    Introduction: Neural tube defects (NTDs) are an important global health concern with high morbidity and mortality. Enhancing access to healthcare for children born with NTDs is crucial for improving health systems and service delivery. Methods: We conducted a systematic review to assess the global prevalence of NTDs and the accessibility of healthcare services. Our search spanned databases like PubMed, EMBASE, and Scopus, focusing on NTD prevalence, healthcare service mapping, and access barriers. We followed a standardized data extraction process, and the study is registered with PROSPERO (CRD42023425843). Results: From 3 067 records, 65 studies met our inclusion criteria, mainly focusing on newborns. The study durations range from six months to 40 years. The NTD prevalence was between 0.4 and 215.13 per 10 000 births, with Spina Bifida, Anencephaly, and Encephalocele being the most common. The African Region was the WHO region with the highest prevalence while the Western Pacific Region had the lowest prevalence. One study used geospatial mapping to identify healthcare access barriers. Conclusion: Our study revealed wide disparities in the prevalence rates of neural tube defects with the African region having the highest prevalence. Geospatial mapping was not used to assess access to healthcare services for children born with NTDs in almost all the studies. This underscores the global challenge of access to surgical care for children born with NTDs and the need for strengthening healthcare services in settings with high prevalences.
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    Shaping the aspirational healthcare system: undergraduate exposure in South Africa and the role of global surgery
    (2024) Francis, Peace; Maswime, Salome; Gordon Chivaugn
    Global Surgery is a burgeoning field especially in the low-and-middle-income country (LMIC) context. While exposure is increasing, research shows students are often exposed incidentally and not through the formal curriculum. Research also shows that there is no coherent pedagogy around Global Surgery education. In this qualitative, phenomenological study, nine final and penultimate year medical students were interviewed in semi-structured interviews to unpack their understanding of and exposure to Global Surgery. Five themes were extracted from the data – understanding of global surgery and its principles, undergraduate exposure to global surgery, benefits of global surgery, perceived flaws related to global surgery and roles for medical students in global surgery. Participants in this study had a systemic understanding of Global Surgery – they identified clear benefits of Global Surgery including its ability to strengthen health systems through multidisciplinary approaches. Participants also spoke to a lack of Global Surgery exposure in formal curriculum despite seeing many contextual benefits of exposure. As a new field we see the current lack of exposure and lack of established pedagogy as an opportunity for LMICs to define a Global Surgery pedagogy that can shape an aspirational healthcare system.
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    Survey of Ocular Trauma at Groote Schuur Hospital in Cape Town, South Africa
    (2023) Logday, Zahra; Maswime, Salome; Minnies Deon
    Background. Ocular trauma is an important cause of unilateral blindness around the world. There have been a few studies around South Africa that demonstrate the causality and outcomes, however, to date, no single study has been done that represents all ocular trauma cases that present to the trauma unit of Groote Schuur Hospital in Cape Town, South Africa. Objectives. To investigate the epidemiology of ocular trauma cases that present to Groote Schuur Hospital in Cape Town, South Africa from 1 December 2019 to 31 May 2020. Methods. This was a retrospective cohort study of all ocular trauma cases seen at C14 Trauma Unit of Groote Schuur Hospital over a 6-month period. Results. There was a total of 1301 trauma cases that presented to C14 and a total of 47 ocular trauma cases, representing 3.6% of total trauma cases. Assault was the most common manner of trauma. Most cases involved males and those aged 18-30. Most cases were referred from primary healthcare facilities and 47% of cases required medical management only. During COVID-19, there was a significant decline in the number of ocular trauma cases. Conclusion. Assault is the most common cause of ocular trauma and is preventable. Many cases can be managed at a primary level of health care by upskilling peripheral health centers in ocular trauma. Active engagement is needed on a multisystem level to mitigate the general level of violence.
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    The association between maternal HIV and stillbirths in an era of universal art in pregnancy in the Western Cape, South Africa
    (2025) Lubinda, Elizabeth; Kalk, Emma; Maswime, Salome
    BACKGROUND: Annually, approximately 1.9 million stillbirths occur globally, with a rate of 13.9 per 1000 births. The devastating aftermath affects around 4.2 million mothers, and 75% of stillbirths are concentrated in South Asia and sub-Saharan Africa (SSA) particularly, with a rate of 32.2 per 1000 births in SSA. South Africa reported a stillbirth rate of 16.3 per 1000 births in 2019, despite global efforts to reduce stillbirth rates. SSA also faces the highest global HIV prevalence at 20%. South Africa, home to 8.4 million people living with HIV, grapples with a 30% prevalence among pregnant individuals. Antiretroviral therapy (ART) coverage for pregnant individuals reached 97% in 2019, especially in the Western Cape with an HIV prevalence of 17.9% among antenatal individuals. Quality antenatal care (ANC) is crucial, with research showing a lower stillbirth rate for those receiving higher quality ANC. The COVID-19 pandemic in 2020 introduced new challenges, potentially influencing stillbirth rates through factors like lockdowns and limited healthcare access. Pregnant individuals contracting SARS-CoV-2 faced an increased likelihood of stillbirth. In this context, our cohort study in the Western Cape, South Africa, utilized routine health data to investigate the contemporary relationship between pregnant individuals with HIV and stillbirths in the era of universal ART during pregnancy. The study explores associations with demographic and clinical variables, including the quality of ANC. METHODS: Utilizing data from the Western Cape Pregnancy Exposure Registry (PER) between 2017 and 2021, this cohort study focused on pregnant women attending antenatal care (ANC) at the Gugulethu Midwife Obstetrics Unit (GMOU) and Worcester Midwife Obstetrics Unit (WMOU) in South Africa. Integrated information from the Provincial Health Data Centre (PHDC) was used to create a linked database for cohort generation. The cohort included women aged 18 or older, with known HIV status and a recorded pregnancy outcome after 20 weeks of gestation. The primary outcome was stillbirth, with maternal HIV status serving as the primary exposure. ANC quality, based on WHO guidelines, was assessed by considering variables such as ANC timing, the number of visits, and various healthcare parameters. ANC quality was categorized using both the old WHO guidelines (at least 4 visits) and the new WHO guidelines (at least 8 visits), with a good ANC quality score requiring 7 or more out of 11 quality ANC variables. Statistical analyses, including logistic regression, were conducted to explore associations between maternal HIV status, ANC quality, and stillbirth prevalence. The study also collected data on maternal characteristics to provide a comprehensive understanding of contributing factors. RESULTS: The study included 15,123 participants: 4,773 women living with HIV (WLHIV) and 10,350 women without HIV. WLHIV had a median age of 28 years, while women without HIV had a median age of 31 years. The overall stillbirth rate was 15 per 1,000 births (95% CI: 13.1-16.9). Stillbirth rates were higher among WLHIV at 17 per 1,000 births (95% CI: 13.34-20.66) compared to women without HIV at 14 per 1,000 births (95% CI: 11.75-16.25). Maternal HIV- positive status (AOR = 1.15, 95% CI: 0.87-1.52, p = 0.34) did not show a statistically significant association with stillbirths. Women with prior diabetes exhibited a significant increase in stillbirth odds (AOR = 2.63, 95% CI: 1.06-6.52, p = 0.04). Women without HIV but with a history of diabetes had a stillbirth prevalence of 4.08%, compared to 3.80% for WLHIV. WLHIV with good-quality ANC had fewer stillbirths (4 visits: 5.06%, 8 visits: 2.53%) than women without HIV (4 visits: 11.56%, 8 visits: 5.06%). ART for ≥100 weeks among WLHIV showed a protective effect, with 47% lower stillbirth odds than ART <20 weeks (AOR = 0.53, p = 0.01) and 45% lower stillbirth odds than ART <20 weeks (AOR = 0.55, 95% CI: 0.33-0.91, p = 0.02). Despite higher stillbirth odds for WLHIV, no significant association was found between maternal HIV status and stillbirths after adjustment (AOR = 1.15, 95% CI: 0.87-1.52, p = 0.34). CONCLUSION: This study, utilizing routine program data, revealed no statistically significant difference in the prevalence of stillbirths between women living with and without HIV. Despite the lack of a statistically significant association between the quality of antenatal care (ANC) and stillbirths, the study underscores the importance of adhering to WHO recommendations and utilizing databases such as the Pregnancy Exposure Registry for evidence-based decision-making. Although the overall stillbirth rate slightly exceeded global targets, there was noticeable improvement following the universal rollout of antiretroviral therapy (ART). Notably, among women living with HIV (WLHIV), a longer duration of ART was linked to a significant reduction in the odds of stillbirth, highlighting the critical role of sustained access to ART. Despite its limitations, these findings contribute to global health objectives, particularly those aimed at eliminating preventable newborn deaths by 2030. ART emerges as a pivotal factor in decreasing stillbirth rates among women living with HIV.