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Background: Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. Methods: The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. Results: The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. Conclusion: Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area. Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa. [ABSTRACT FROM AUTHOR]

The church has a key role to play in addressing the chronic levels of grief and trauma experienced by the youth in South Africa. It has a biblical mandate to bring hope and healing and has a unique station within South African society that positions it to bring about real transformation. 'Sinawe' (Zulu for [we are with you]) is a programme developed by Scripture Union South Africa to equip local churches as change agents through a relational youth ministry model that engages trauma, grief and holistic needs, both physically and spiritually. This is an important first step for churches wanting to reach and minister to young people. The South African church has an important and legitimate role to play in the lives of young people. Research indicates that although the church is considered by local residents as an important community resource, it remains ineffectual in intentional community-based youth ministry that leverages significant opportunity. This research identifies the church as an important community change agent and encourages church leaders to step into the open gap to reach local young people while providing the methodology with which to do so. This research paper examines the current South African social context, outlines a theological mandate for church involvement and presents a methodology for a supportive and effective approach to community engagement in the lives of young people led by local churches. Interdisciplinary: The article is relevant to the following disciplines within theology; missiology, family and youth ministry and pastoral care. It also has interfaces with education and sociology. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane's Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal. Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants' median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists. [ABSTRACT FROM AUTHOR]

Background: Great strides have been made in decreasing paediatric human immunodeficiency virus (HIV) infections, especially in sub-Saharan Africa. In South Africa, new paediatric HIV infections decreased by 84% between 2009 and 2015. This achievement is a result of a strong political will and the rapid evolution of the country's prevention of mother-to-child transmission (PMTCT) guidelines. Objectives: In this paper we report on the implementation of a large PMTCT programme in Soweto, South Africa. Methods: We reviewed routinely collected PMTCT data from 13 healthcare facilities, for the period 2002–2015. Antiretroviral therapy (ART) coverage among pregnant women living with HIV (PWLHIV) and the mother-to-child transmission (MTCT) rate at early infant diagnosis were evaluated. Results: In total, 360 751 pregnant women attended the facilities during the review period, and the HIV prevalence remained high throughout at around 30%. The proportion of PWLHIV presenting with a known HIV status increased from 14.3% in 2009 when the indicator was first collected to 45% in 2015, p < 0.001. In 2006, less than 10% of the PWLHIV were initiated on ART, increasing to 88% by 2011. The MTCT rate decreased from 6.9% in 2007 to under 1% from 2013 to 2015, p < 0.001. Conclusion: The achievements in decreasing paediatric HIV infections have been hailed as one of the greatest public health achievements of our times. While there are inherent limitations with using routinely collected aggregate data, the Soweto data reflect progress made in the implementation of PMTCT programmes in South Africa. Progress with PMTCT has, however, not been accompanied by a decline in HIV prevalence among pregnant women. [ABSTRACT FROM AUTHOR]

This paper shows how Calvin's ideas about the Old Testament concept of Israel's election can be dangerous when they are applied uncritically. The main illustration material is drawn from a context the author was himself part of, notably the South African apartheid theology of Calvinist provenance. The paper begins with documenting Calvin's views on Israel and Israel's election in the Old Testament, moving to a consideration of how this motif was connected to the idea of predestination and construed to become an instrument to defend apartheid in what may be called a substandard theology. It is suggested that a glance at the English-speaking world shows surprising similarities that justify further consideration. In this title several dimensions are present that need to be explicated. [ABSTRACT FROM AUTHOR]

This article is based on a paper delivered at a Lutheran Missionary Conference in Bleckmar, Germany. The request was to give an overview of the development and the state of Reformed missiology with special reference to South Africa in order to stimulate the missiological debate in the German-Lutheran church. Within the space of an hour, one could only concentrate on the struggles and concerns of one's own church and its missionary institute. The border lines of the article are laid down by the major themes of Reformed theology and missiology, such as 'the Word alone', 'conversion', 'the formation of congregations', 'the glory of God' and 'ongoing reformation'. Readers are introduced to a few Reformed missiologists who had a decisive influence on the development of Reformed missiology, such as Gisbertus Voetius, Hendrik Kraemer, Arnoldus van Ruler, Johannes Verkuyl and Jürgen Moltmann. The initial Lutheran audience was informed about the self-caused problems in the Reformed tradition. Both the audience and the readership are cautioned not to withdraw from the basic Lutheran theologoumena, such as the 'two-kingdom theory'. The next decade will be a decisive period for the missionary efforts of the churches. Ecumenical solidarity and cooperation will be needed to work out new strategies whereby churches will be enabled to continue with missionary work on a new financial basis. [ABSTRACT FROM AUTHOR]