UNASSIGNED: South Africa was the country worst affected by the Covid-19 pandemic in Africa. There is a paucity of data on the clinical characteristics and mortality of Covid-19 from the Eastern Cape province of South Africa. We report on the demographic and clinical characteristics as well as the mortality of patients admitted to the Covid-19 ward of Nelson Mandela Academic Hospital (NMAH), Mthatha, during three waves of the Covid-19 pandemic in South Africa.
UNASSIGNED: We conducted a single centre retrospective observational study of patients admitted for Covid-19 in a tertiary hospital in the rural Eastern Cape of South Africa. Data were collected from patient files, electronic databases and the National Health Laboratory Services (NHLS) database. The outcomes were duration of admission and in-hospital mortality.
UNASSIGNED: There were 371 patients admitted across all three waves with a mean age of 52.2 ± 16.3 years. The proportion of females across the three waves is 61.2%. The commonly associated comorbidities, irrespective of the wave, were hypertension, diabetes and HIV infection. The median duration of admission was six days, with an overall mortality of 31%. The mortality for first, second and third wave were 29.3%, 31.5% and 37.9% respectively.
UNASSIGNED: Admissions for Covid-19 were predominantly in females and middle-aged. One third of the admitted patients died. Diabetes, hypertension and HIV infection were the most commonly associated comorbidities.

Mangrove habitats support taxonomically diverse benthic communities, yet their effects on microphytobenthos remain understudied. This study investigated the benthic diatom community structure of 17 microtidal mangrove estuaries situated along the east coast of South Africa. High sediment organic content (≤ 18.1 %) and clay fraction (≤ 17.5 %) measured in the Avicennia marina and Rhizophora mucronata habitats favoured diverse communities (H\' > 3) and the presence of unique benthic diatom species such as Gyrosigma balticum. The habitat complexity and stabilisation provided by the mangrove forests served as microrefugia for colonisation of benthic diatoms. Taxa displayed a broad range of nutrient tolerance, with some nutrient tolerant species (e.g., Halamphora acutiuscula, Navicula clausii, Navicula gregaria, and Navicula radiosa) dominating the communities in the Mbashe and Mnyameni estuaries. The presence of these nutrient tolerant taxa in relatively pristine systems serves as an early warning for possible anthropogenic nutrient enrichment.

South Africa faces the urgency to comprehensively understand and manage its methane (CH4) emissions. The primary aim of this study is to compare CH4 concentrations between Eastern Cape and Mpumalanga regions dominated by cattle farming and coal mining industries, respectively. CH4 concentration trends were analyzed for the period 2019 to 2023 using satellite data. Trend analysis revealed significant increasing trends in CH4 concentrations in both provinces, supported by Mann-Kendall tests that rejected the null hypothesis of no trend (Eastern Cape: p-value = 8.9018e-08 and Mpumalanga: p-value = 2.4650e-10). The Eastern Cape, a leading cattle farming province, exhibited cyclical patterns and increasing CH4 concentrations, while Mpumalanga, a major coal mining province, displayed similar increasing trends with sharper concentration points. The results show seasonal variations in CH4 concentrations in the Eastern Cape and Mpumalanga provinces. High CH4 concentrations are observed in the northwestern region during the December-January-February (DJF) season, while lower concentrations are observed in the March-April-May (MAM) and June-July-August (JJA) seasons in the Eastern Cape province. In the Mpumalanga province, there is a dominance of high CH4 concentrations in southwestern regions and moderately low concentrations in the northeastern regions, observed consistently across all seasons. The study also showed an increasing CH4 concentration trend from 2019 to 2023 for both provinces. The study highlights the urgent need to address CH4 emissions from both cattle farming and coal mining activities to mitigate environmental impacts and promote sustainable development. Utilizing geographic information system (GIS) and remote sensing technologies, policymakers and stakeholders can identify and address the sources of CH4 emissions more effectively, thereby contributing to environmental conservation and sustainable resource management.

The main reason cited for the low participation rate in indexed insurance in Africa is the lack of farmers\' involvement in the initial conception. The main aim of this article was, therefore, to design an improved participatory methodology that would help farmers in South Africa gather information on the value they place in new crop insurance initiatives based on weather indices. The main objective of this study was to determine their willingness to pay (WTP) crop insurance in the Eastern Cape. The study adopted a cross-sectional design, and the respondents were selected by using a probability sampling procedure. A sample of 150 respondents was selected. The results from descriptive statistics showed that 62% of the smallholder irrigation scheme farmers were between 52 and above years of age, male and female: 87% and 13%, respectively. The results from the probit model revealed that out of nine variables included in the model, only four namely, logAge square, gender, marital status and age were significantly influencing the WTP index-based crop insurance at 1%, 5% and 10%, respectively. However, age was found to reduce the chances of participating in crop-based insurance. A large proportion of those who were willing to pay insurance had not previously experienced losses because of natural hazards. Therefore, it recommended that the government should use existing extension officers to educate the farmers and promote the importance and benefits of insurance products.
UNASSIGNED: The results are expected to contribute to the local government to improve disaster resilience through strengthening regional financial funding.

UNASSIGNED: Emergency departments are the primary entry point for emergencies in the public healthcare system. Resource constraints burden a large proportion of the public hospital emergency departments, which includes limited access to radiological services. Emergency point-of-care ultrasound provides a tool capable of bridging this gap. The Eastern Cape is yet to describe the utilisation of emergency point-of-care ultrasound in any of its emergency departments.
UNASSIGNED: Frere Hospital initiated a clinical audit to assess the utilisation of emergency point-of-care ultrasound in its emergency department in 2022. This study was a retrospective review of the audit between 01 November 2022 until 28 February 2023. Data from the handwritten register regarding patient\'s presenting complaints and provisional diagnoses was also captured during the study period to draw comparisons between burden of disease and use of emergency point-of-care ultrasound.
UNASSIGNED: A total of 9501 patients attended Frere Hospital\'s emergency department over the study period with 492 emergency point-of-care ultrasounds performed (overall utilisation rate 5.2 %). The five credentialed emergency point-of-care ultrasound providers performed the majority (n = 360, 73.2 %) of the applications, compared to 132 (26.8 %) performed by the seven non-credentialed providers. The extended focused abdominal sonography in trauma (eFAST) was the most frequently performed application (n = 140, 28.5 %).
UNASSIGNED: Emergency point-of-care ultrasound is underutilised in Frere Hospital\'s emergency department. The varied casemix requires upskilling of clinicians in emergency point-of-care ultrasound to suit the burden of disease experienced in the department. Ongoing emergency point-of-care ultrasound training, credentialing and research is important to ensure appropriate and quality emergency point-of-care ultrasound utilisation.

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.
CONCLUSIONS:  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.

This study assesses the prevalence of Vitamin D deficiency and its potential association with cardiometabolic risk factors among South African adults residing in the Eastern Cape province. In this cross-sectional study, 1244 healthcare workers (HCWs) completed a self-administered questionnaire and venous blood samples were drawn at two academic hospitals in the Eastern Cape. History of hypertension and diabetes mellitus were self-reported. Participants were categorised as obese if their body mass index (BMI) ≥ 30 kg/m2. Participants were classified as having metabolic syndrome if they had hypertension, diabetes mellitus and obesity. Vitamin D [25(OH)D] deficiency was defined as venous blood concentrations < 50 nmol/L. Associations between vitamin D deficiency and participants\' characteristics were assessed using multivariate logistic regression model analysis. The prevalence of vitamin D deficiency was 28.5% (n = 355), of whom 292 were female. Among the participants who were deficient in vitamin D, the prevalence of obesity, diabetes mellitus, hypertension, chronic kidney disease, and metabolic syndrome was 64.9% (n = 230), 9% (n = 32), 16.6% (n = 59), 2.3% (n = 8) and 18% (n = 64), respectively. In the adjusted multivariate logistic regression model, black Africans (AOR = 2.87; 95% CI 1.52-5.43) and individuals ≥ 42 years (AOR = 1.37; 95% CI 1.07-1.77) were more likely to exhibit vitamin D deficiency. However, there was no significant association by age, sex, and cardiometabolic markers. More than one in four healthcare workers was deficient in vitamin D among the study sample, especially the black Africans and older individuals. Further studies are needed at the population level to elucidate on the vitamin D status in the region.

BACKGROUND: The South African government implemented lockdown restrictions in order to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
OBJECTIVE: This study explored the effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual violence in the Eastern Cape province through the lens of healthcare workers\' (HCWs) experiences.
METHODS: A Thuthuzela care centre in the Eastern Cape province, South Africa.
METHODS: This qualitative study brings together the findings from thematic analysis of semi-structured interviews conducted among 11 purposively selected HCWs in May 2022.
RESULTS: Overall, three themes emerged from the study: the effects of COVID-19 on sexual violence, profile of the survivors and recommendations for combating sexual violence in the region. Most respondents believed that the COVID-19 pandemic caused a surge in the incidence of sexual violence, although all acknowledged that movement restrictions affected reporting. The participants treated mostly black women and children\'s survivors, who experienced physical injuries simultaneously. The respondents\' narratives revealed that educational campaigns targeting boys and men could reduce sexual violence in the region. In addition, it was recommended that stricter laws and harsher penalties would serve as deterrents for perpetrators of sexual violence in the country.
CONCLUSIONS: The COVID-19 lockdown restrictions exposed the vulnerabilities of black women and children to sexual violence in the study setting. Educational programmes aimed at re-orientating boys and men in both rural and urban communities should be implemented.Contributions: This study provides an insight into the perceived effect of the COVID-19 pandemic on sexual violence in the Amathole district and South Africa.

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) leads to immune suppression, and micronutrients play vital roles in human immune responses. Hence, this study aimed to evaluate the effects of viral load suppression in adult HIV-infected patients receiving antiretroviral therapy (ART) on micronutrient deficiency and its prevalence in selected rural districts in the Eastern Cape Province of South Africa. This cross-sectional study was conducted from February 2019 to February 2021 among 50 consenting HIV-infected patients attending community health centers within the three selected districts. The data were analysed with ArcGIS v.10.8 to create geospatial maps; the Global Positioning System (GPS) for analysis and presentation; and SPSS version 25 for inferential statistics involving the t-test and Fisher\'s exact test, with the level of significance set at p < 0.05. Of the 50 participants, a significant difference of p = 0.003 was observed in mean age among viral load-suppressed (42.9 ± 8.89 years) and unsuppressed (32 ± 6.3 years). In addition, significant differences in the mean viral load and CD4 counts (p < 0.05) were seen. Only iron micronutrient showed a statistically significant difference (p < 0.001) between the viral load-suppressed group (mean 14.8, SD 6.1) and the unsuppressed group (mean 8.1, SD 1.6). Of the 38 individuals from the OR Tambo district, overall micronutrient deficiency was 60.5% (13 (34.2%) deficient for zinc, 9 (23.7%) deficient for iron, 5 (13.2%) for folate, and 1 (2.63%) for vitamin D). In all three study districts, deficiencies in zinc, iron, and folate micronutrients exceeded 25%, particularly in those with an unsuppressed viral load. To address these micronutrient deficiencies, people living with HIV (PLHIV) require robust nutritional supplementation programs.

UNASSIGNED: A key feature of South Africa\'s state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level.
UNASSIGNED: Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis.
UNASSIGNED: The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users.
UNASSIGNED: This research provided first insights into facility managers\' and service users\' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.