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Private medical aids are essentially non-profit organisations that aim to deliver speedy treatment and should prevent members from unexpected, out of pocket expenses for medical care. However, although the latest statistics show that 16.2% of individuals in South Africa were members of medical aid schemes, making the promise of private healthcare accessible to a small percentage of the population, they are not without their own unique set of challenges. The restrictions that exist within the private sector have a direct bearing on the types of healthcare services patients can access, which in turn impacts on the fundamental right to access healthcare. Using a recent High Court Case decision, this article seeks to explore whether there is justice in the provision of healthcare services, specifically within the private sector in South Africa.

Erosion is a problem that affects many districts and cities in the world. This problem is associated with the type of relief and the influence of natural and human agents. Erosion is a natural geological process, it cannot be avoided, but it can be minimized. The city of Mocuba in Mozambique has suffered from the effects of this problem, with a large number of people affected by erosion. In this context, this research was developed, of which the objective is to design a Geographic Information System for the forecast and control of erosion in the Marmanelo and Caminhos de Ferro de Mocambique neighbourhoods in the Municipality of Mocuba. After conducting the research through the qualitative and quantitative methodology, it was found that the erosion stage in the study area is intermediate, but with a medium-high vulnerability, influenced mainly by human activities. Corrective actions are short-lived and spend large amounts of money, so it is advisable to use preventive actions. To forecast and control this problem, a geographic information system was designed. This system will help authorities to plan occupation areas and control erosion not only in the neighbourhoods concerned, but also in the city of Mocuba and in the world in general.

Indiscriminatory in its spread, COVID-19 has engulfed communities from all social backgrounds throughout the world. While healthcare professionals work tirelessly testing for the virus and caring for patients, they too have become casualties of the pandemic. Currently the best way to attempt to curb the spread of the virus, echoed by almost all nation leaders, is to distance ourselves from one another socially or physically. However ideal this may seem, social distancing is not always practical in densely populated lower-income countries with many citizens below the breadline. With the majority of South Africans living in poverty, communities in overcrowded households are unable to distance themselves from one another appropriately. In addition, as a nation we struggle with high HIV and tuberculosis rates, malnutrition and an already overburdened healthcare system, emphasising the extreme vulnerability of our people. These factors, coupled with the fact that many of our healthcare professionals lack the necessary personal protective equipment to prevent them from contracting the virus themselves, highlight the gravity of the damaging repercussions that we may face in the coming months, after the complete national lockdown in force at the time of writing is lifted and we move towards a partial lockdown state. Nationally, there needs to be a shift in mindset towards exploring alternative technology-based preventive measures that may empower the healthcare sector in the long term and enhance social distancing.

Background. The prevention of healthcare-associated infections has become a health priority globally. Patients in intensive care units (ICUs) are at high risk of acquiring these infections, and infection control is particularly important in this environment. Hospital infection control managers as well as ICU nurses and clinical managers have a vital role to play in ensuring good infection control practices within the ICUs. Objective. To explore the challenges with infection control practices among managers in ICUs in South Africa. Methods. An explorative qualitative design was used. Semi-structured interviews were conducted with 11 nurse intensive care managers, 6 clinical intensive care managers, and 5 hospital infection control managers. Content analysis was used to identify themes and sub-themes. Results. Four themes were identified from the data: challenges with human resources, leadership and governance, infrastructure and equipment, and discrepancies between different categories of healthcare workers. Infection control and nurse managers felt overburdened with work responsibilities which took their time away from infection control in the ICU. Shortage of clinical and nursing staff , insufficient isolation rooms and equipment also presented challenges to implementing adequate infection control measures. Many participants viewed doctors as not being adherent to infection control practices. Conclusion. We identified modifiable challenges to infection control in the intensive care setting. Strategies such as ongoing and regular in-service training on infection control for all cadres of healthcare workers is one of the interventions that can be applied to improve infection control in ICUs. The issue of staff shortages and inadequately trained staff must be addressed at a provincial and national level. It is imperative that hospital managers work with their staff to develop strategies to overcome the challenges in implementing and maintaining good infection practices in ICUs.

BACKGROUND. Intensive care services are one of the largest cost drivers in a hospital. Increasing life expectancy and comorbidities have resulted in an increased need for intensive care beds. OBJECTIVES. To conduct a cost analysis of intensive care services at a central hospital in the public sector in South Africa (SA). METHODS. A retrospective cost analysis for the 2015/16 financial year was conducted across two intensive care units (ICUs), a trauma ICU (10 beds) and a combined ICU for neurosurgery, medicine and surgery (18 beds). A mixed-methods costing approach was used based on the availability of data. The bottom-up approach was used to calculate the cost of clinical support, pharmaceuticals, consumables and human resources. The top-down approach was used to allocate the cost of equipment and goods and services. RESULTS. There were 544 admissions resulting in 4 987 inpatient days during the study period. The total estimated inpatient cost across the two ICUs was ZAR114 055 104, with a cost per patient day of ZAR22 870. The combined ICU cost per patient day was 58% higher than the cost per patient day in the trauma ICU (ZAR26 954 v. ZAR17 021). The mean cost per admission was ZAR157 883 in the trauma ICU and ZAR245 087 in the combined ICU. Human resources costs were the highest ICU cost driver (55%), followed by direct patient activity costs (medical consumables, pharmaceuticals, laboratory tests, radiology and blood products), which contributed 24%. CONCLUSIONS. This is the first reported cost analysis of intensive care services in SA. Our cost per patient day was higher than that reported in other lower-income countries, but lower than that in high-income countries. These costs vary owing to the different types of ICUs, wide spectrum of disease presentation and availability of diagnostic and treatment options. This study provides useful data that could assist in the planning and provision of intensive care services.

In Uganda and other sub-Saharan African countries women’s gender roles center on marriage and motherhood. According to these roles women’s duties include caring for other members of the household tending to household chores and caring for the sick. Women are expected to consult with their husbands and obey their husbands’ decisions in all matters. A man’s primary role is to be the head of the family. Men are expected to bring in income to pay for shelter food and school and they are expected to represent the family. Unlike women who are expected to be faithful or monogamous men are expected to have multiple partners (wives or girlfriends) thus signaling their masculinity. As other investigators have observed these gender roles interfere with HIV prevention efforts. Gender roles may also constrain women’s access to health services including those for the prevention of mother-to-child transmission of HIV (PMTCT). Globally all countries are working toward achieving the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. PMTCT programs in sub-Saharan Africa have had difficulty pursuing this goal owing to countries’ weak health systems and a variety of individual interpersonal and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma fear of divorce or abandonment upon HIV disclosure side effects of ART lack of funds for transport to the clinic negative interactions with health workers and lack of male involvement. Most studies of barriers to PMTCT were conducted prior to the implementation of Option B+ which places HIV-positive pregnant or breastfeeding women on lifelong ART at diagnosis. By examining how gender interacts with individual interpersonal health system and community factors that cause people to discontinue PMTCT this study fills an important gap in knowledge about Option B+ programs. In partnership with the Child Health and Development Centre at Makerere University MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Fund for AIDS Relief (PEPFAR)—conducted qualitative research at eight health facilities (four urban and four rural) and their surrounding communities from 2015 to 2016. The purpose of this study was to describe gender-related factors at the individual interpersonal and programmatic or systemic levels that influence women’s participation in the elimination of mother-to-child transmission of HIV (EMTCT) program in Uganda. We used in-depth interviews and focus group discussions (FGDs) to obtain data from women participating in EMTCT (n=32) women who were lost to follow-up (LTFU) (n=16) health workers involved in providing EMTCT services (n=8) stakeholders in organizations supporting EMTCT services (n=8) and men in the community (8 focus group discussions (FGDs) n=73 participants).

RESUMEN Introducción En los países en desarrollo la problemática de cuerpos extraños (CE) en los Servicios de Otorrinolaringología está mal estudiada, la literatura sobre el tema es escasa. El estudio fue realizado para caracterizar el perfil epidemiológico en pacientes atendidos con CE en el Servicio de ORL/Hospital Central de Maputo (HCM) (período de 1983 a 2009). Objetivo El estudio fue realizado para caracterizar el perfil epidemiológico en pacientes atendidos con cuerpos extraños en el Servicio de ORL del Hospital Central de Maputo (HCM) en el período de 1983 a 2009. Material y Método Se realizó un estudio transversal utilizando datos retrospectivos de pacientes con cuerpos extraños atendidos en el HCM. Se recogieron datos demográficos, sobre CE, ubicación anatómica, tratamientos efectuados y complicaciones clínicas. Los datos se procesaron utilizando el SPSS-v15. Los resultados descriptivos se muestran en tablas y gráficos. Resultados Se incluyeron un total de 4.826 pacientes. Se observó predominio del sexo masculino y la mayoría pertenecía a la edad pediátrica. Los CE predominantes fueron los metales y la espina de pescado. La región anatómica más afectada fue el canal auditivo externo. Conclusión Este estudio presenta una compilación única que abarca un período de 26 años constituyendo una importante fuente de información al respecto. Demuestra la magnitud del problema en la edad pediátrica y presenta las características de los CE involucrados y las respectivas localizaciones anatómicas. ABSTRACT Introduction In developing countries, the problem of foreign bodies (FB) in ENT Services is poorly studied and the literature related to the subject is rare. This study was performed to characterize the epidemiological profile in patients treated with FB in ENT Department/Maputo Central Hospital (MCH) (1983-2009 period). Aim This study was performed to characterize the epidemiological profile in patients treated with foreign bodies in ENT Department of Maputo Central Hospital (MCH) in the 1983-2009 period. Material and Method A cross-sectional study was performed using the retrospective data from patients with FB treated at MCH. Demographic data were collected on FB, their anatomical location, any treatment, clinical complications among others. The data were processed using the SPSS-v15. Descriptive results were presented in tables and graphs. Results We included a total of 4826 patients. The most affected population groups were males and children under 14 years. The most frequent FB were metals. The most common anatomical locations of FB was the external ear canal. Conclusions This study presents a unique collection covering a period of 26 years, constituting, therefore, an important source of information on the subject. This study demonstrates the magnitude of the problem in the pediatric age and presents the characteristics of the FB involved and their anatomical locations. The evidence of this study are important to inform clinical prevention and training strategies to deal with this issue at the level of primary health care. This study is important to inform about strategies to prevent it, but also useful in the formation of clinics to better deal with this type of patients at the level of primary health care.

The Master of Applied Epidemiology Program is Australia's Field Epidemiology Training Program. It was established in 1991 and was run out of the National Centre for Population Health (NCEPH) at the Australian National University. The Program has a strong track record in using field-based training to produce competent applied epidemiologists who have contributed to public health in Australia and globally. A new funding model for the program was implemented in 2012, backed by funds from field placement partners and NCEPH. In this paper we review the program's origins and achievements, discuss the ongoing needs of the program and outline a vision for the future. Commun Dis Intell 2016;40(3):E326-E333.

The debate over whether there should be a property or non-property approach with regard to human tissue is only the tip of the iceberg, because the issues involved are very complex, reflecting profound considerations on the nature of the self and the structuring of society; the balance of power between the citizen, the government and commercial interests; and human beings' perceptions of themselves and their bodies. This article responds to a publication by Donrich Jordaan titled 'Social justice and research using human biological material: A response to Mahomed, Nöthling-Slabbert and Pepper' in the July 2016 SAMJ. The original article to which Jordaan's critique refers and that provides the source for his response appeared in the South African Journal of Bioethics and Law in 2013, titled 'The legal position on the classification of human tissue in South Africa: Can tissues be owned?'. It is our contention that Jordaan's critique is based on a misinterpretation of the issues raised relating to the ownership of human tissue, an issue extensively debated in the academic sphere for many years. Jordaan's critique focuses on selected aspects of the original article and draws unjustifiable inferences from these. The purpose of this article is to contextualise Jordaan's critique and reaffirm the validity of the arguments made in the original article in 2013. There are, however, certain aspects of Jordaan's critique that we as authors of the original article acknowledge and appreciate in the spirit of academic discourse.