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Patient knowledge and care of surgical site infections at a selected regional hospital in KwaZulu-Natal Province, South Africa
(2026-07-27) Naidoo, Niroshni; Adam, Jamila Khatoon; Moodley, Y; Kader, S S
Background: Surgical site infection (SSI) is a common post-operative complication and can develop after a patient has been discharged from the surgical ward. Being comfortable with their SSI knowledge can empower patients and encourage them to engage in healthy behaviours that could lower the risk of this complication. Poor knowledge of wound care practice (WCP) among surgical patients could place them at risk of SSI, particularly once they have been discharged from hospital and are expected to care for their own surgical wounds. The study aimed to establish South African surgical patient knowledge and awareness of surgical site infections and wound care practices at a regional hospital in KwaZulu-Natal Province, South Africa. Methods: This prospective cross-sectional study involved two quantitative questionnaire surveys of general surgery patients at a regional hospital in Durban, South Africa (7 January 2025 - 24 April 2025). Each survey consisted of a socio-demographic questionnaire, and an adaption of a pre-existing questionnaire assessing comfort with SSI knowledge or assessing WCP. Univariate and multivariate data analyses, namely chi-squared tests and logistic regression, was used to test potential associations between patient characteristics and comfort with SSI knowledge or poor WCP knowledge. Results: Of the 255 survey participants included in the analysis, 48.2% did not feel comfortable with their SSI knowledge. Comfort with their SSI knowledge was predicted by: healthcare workers discussing SSI with them on two or more occasions (Odds Ratio, OR: 8.93), receipt of an informational flyer on SSI while in hospital (OR: 11.40), learning about SSI outside hospital via another clinic/healthcare worker (OR: 7.37), and learning about SSI outside hospital via another non-healthcare source (OR: 5.18). Of the 255 participants, 23.92% had poor WCP knowledge, the univariate analysis finding two potentially important patient characteristics being associated with poor knowledge: Black African race (p=0.153), and completion of high school education (p=0.001). When they were entered into a multivariate logistic regression model, only completion of high school was found to be a statistically significant predictor of poor WCP knowledge (OR: 0.34, p=0.001). Conclusion: Patients knowledge of SSI requires improvement, as it has implications for their wound care knowledge and practices, improving their quality of life and preventing avoidable illness and premature deaths. Measures to improve both should focus on providing verbal and hard copy messages while patients are still in hospital to enable them to ask questions and take information home.
Assessment of Beta-2 Microglobulin, serum creatinine and creatinine clearance in chronic kidney disease patients in KwaZulu-Natal
(2026-03-12) Mtshali, Phumlani; Benjamin, Sherilene; Assounga, A G; Madala, N D
Background: Chronic kidney disease (CKD) is a major and escalating global health burden, affecting 8-16% of the population and disproportionately impacting low and middle-income countries such as South Africa. KwaZulu-Natal, in particular, bears a high CKD prevalence, with 67% of patients hypertensive, 24% diabetic, and 23% HIV-positive in this cohort. Conventional biomarkers like serum creatinine (sCr) are late indicators of renal dysfunction, often rising only after substantial nephron loss. Beta-2 microglobulin (B2M), a low molecular weight protein filtered by the kidneys and independent of muscle mass, may provide earlier detection of kidney impairment and improved risk stratification, but its clinical utility remains underexplored in routine clinical practice and in African populations. Aims and Objectives: This study aimed to assess the clinical utility of B2M, alongside serum creatinine and creatinine clearance, for the diagnosis and staging of CKD in KwaZulu Natal. The specific objectives were: (1) to evaluate the association between B2M levels and leading CKD aetiologies (hypertension, diabetes and HIV); and (2) to determine the correlation between B2M levels and estimated glomerular filtration rate (eGFR) calculated with the CKDEPI 2021 equation. Materials and Methods: A retrospective cross-sectional study was performed on 173 CKD patients (53% female, mean age 54.3±15.8 years) from the Clinical Medicine Research Laboratory, University of KwaZulu-Natal. Serum samples were analysed for B2M concentrations using enzyme-linked immunosorbent assay (ELISA). Clinical and biochemical data, including sCr and eGFR, were extracted from laboratory databases. Participants were stratified by key comorbidities (hypertension, diabetes, and human immunodeficiency virus). Statistical methods included descriptive statistics, ANOVA, bivariate and multivariable regression, and correlation analysis to explore associations between biomarkers, CKD stages, and clinical variables. Results: B2M concentrations demonstrated a distinctive J-shaped distribution across CKD stages: elevated in Stage 1 (mean 0.19±0.32 μg/mL), dipping in Stage 2 (0.12±0.21 μg/mL), and rising sharply in Stage 3 (0.30±0.41 μg/mL) and Stage 4 (0.52±0.46 μg/mL) (p = 0.032). B2M showed a robust inverse correlation with eGFR (r = -078, p = 0.001), particularly in ii hypertensive (r = -0.20, p = 0.034) and diabetic (r = -0.36, p = 0.021) subgroups. By contrast, serum creatinine showed significant increases only at advanced stages of CKD. Multivariable regression confirmed CKD stages 3-4 as independent predictors of higher B2M after adjusting for demographic and clinical covariates. B2M was not significantly influenced by sex or muscle mass. HIV-positive patients exhibited higher B2M, but without a significant correlation to eGFR. The overall pattern supports B2M as a more sensitive marker for early nephron stress and risk stratification in multi-morbid cohorts. Conclusion: B2M is a sensitive, early-stage biomarker for CKD in KwaZulu-Natal, outperforming sCr in early detection and disease monitoring, particularly among hypertensive and diabetic patients. Its independence from demographic confounders and strong association with CKD severity support its integration into local diagnostic pathways. Routine B2M testing could enable earlier intervention, improved risk stratification, and optimisation of outcomes in high-risk, resource-constrained settings. Further research is warranted to validate B2M’s predictive value and cost-effectiveness in larger, prospective cohorts and to define its role in multi-marker diagnostic panels.
Factors influencing elderly patient perceptions and experiences of clinical service quality in a private and a public radiology facility in the eThekwini District
(2025-05-25) Seeparsad, Nikita Shah; Khoza, Thandokuhle Emmanuel
Background: Over the years, South Africa’s ageing population has grown, resulting in vulnerable elderly individuals who require frequent use of healthcare. It is therefore important to ensure that these citizens receive the correct level of health services as they generally need more attention, effort and compassion in ensuring a pleasant healthcare experience. In line with the above, radiology healthcare specifically can be a more intensive process to the elderly individual. Hence it is important to know the elderly patient's clinical service requirements in order to improve their experiences when visiting radiology facilities. With a lack of literature on elderly patient satisfaction with clinical service quality in private and public radiology facilities specific to the Ethekwini district, the current study used the SERVQUAL model's five dimensions (tangibles, reliability, responsiveness, assurance and empathy) as the theoretical framework to quantify the service delivery of private and public radiology facilities, thereby attaining elderly patients’ perceptions and experiences. Aim: This research study aimed to determine the factors influencing elderly patient perceptions and their experiences of clinical service quality in a private and a public radiology facility in the Ethekwini district in order to identify, improve and enhance clinical care for elderly individuals. Methodology: A quantitative research methodology with a descriptive research design and a positivist paradigm was used in this study. A convenience sampling technique of all the elderly patients was used to collect data that was analyzed using the latest version (26) of SPSS (the Statistical Package for the Social Sciences). The tests used were the t-test, one sample t-test, paired sample t-test, independent sample t-test, the Analysis of Variance Model (ANOVA), Cronbach’s alpha and the Mann Whitney U test. Results: An independent sample t-test was performed across demographics and payment types, revealing that the gap for all items under tangibles for expectations and experiences was far greater for outpatients than for inpatient respondents, and those paying cash perceive the gap between their experiences and expectations to be significantly larger than those who use medical aid in private. Paired t-tests and Cronbach's alpha were used to assess each individual question's expectations and experiences across all domains and to determine internal consistency. A paired t-test was then performed on the entire domain, revealing a significant difference in the elderly's expectations and experiences with private and public radiology facilities, as well as their degree of clinical service quality. A one-sample t-test was used to analyze composite variables to determine significant differences in each overall domain, which revealed that the "mean" values were higher for the gap in expectations of elderly people, implying that while the elderly population agrees to some extent with the help/services they receive, their expectations are still higher than their experiences. A Mann-Whitney U test was used to compare each item within each domain across facilities. The mean rank values for these items with significant p-values were greater in private facilities than in public facilities, indicating that private facilities have a better level of agreement. To compare expectations and experiences across domains, the Mann-Whitney test was used for each item, comparing mean rankings rather than mean scores. All but two dimensions vary considerably amongst facilities: EXPECT_TAN (.058) and EXPECT_ASS (.146). The private Radiology facility had a greater agreement than the public Radiology facility. For each domain, the Mann Whitney test was used to compare the mean ranks of private and public facilities. According to the p-value, four significant results were found: GAP_TAN (.044), GAP_REL (.010), GAP_ASS (.013) and GAP_EMP (.006) demonstrated a considerable discrepancy between the public and private facilities. In all categories, individuals who use public facilities perceive a substantially larger difference between what they get and what they anticipate obtaining than those who use private facilities. Conclusion: The conclusion based on the first objective was that while there may be various factors impacting elderly patients’ perceptions of clinical care quality, not all of them can be addressed as some are influenced by personal socio-economic conditions. The second objective result was that while the six domains of healthcare quantification may be applicable to current healthcare systems to some extent, there are still areas for development.
The status of cervical screening and breast cancer healthcare services among incarcerated women in Westville Correctional Facility KZN, South Africa
(2026-06) Dube, Lindokuhle Winnie; Pillay, P.; Mkhize, Brenda Thabisile
Background: Incarcerated women represent a vulnerable population with severe health problems, including a heightened risk of cervical and breast cancer. The provision of comprehensive healthcare, including cancer prevention services, within prisons is a critical yet often neglected issue. Aim: This study investigated the status of cervical screening and breast cancer healthcare services among incarcerated women at Westville Correctional Facility in KwaZulu-Natal, South Africa. Methods: A mixed-methods approach was utilised, including a cross-sectional survey of 145 incarcerated women, a retrospective review of 1,639 Pap smear results from Westville Correctional Facility laboratory records (2013–2022) and in-depth interviews with healthcare workers (HCWs). Data analysis included descriptive statistics, chi square tests, and thematic analysis. Results: Retrospective data had a high HIV prevalence (54%). Despite this risk, cervical screening was low, with only 21.4% of women receiving a Pap smear during incarceration and 43.4% with no screening history. Breast cancer screening was virtually non-existent (1.4%). Knowledge regarding both cancers was low, with most of the incarcerated women unaware of risk factors, symptoms, and screening methods. Retrospective data revealed an erratic, campaign-based screening pattern, with a screening rate of less than 5% per year. Critically, 23.3% of women with a clinically healthy cervix had a cytological abnormality. A significant association between a healthy cervix and antiretroviral (ARV) treatment (X² (8) =61.907, p<0.001) was found. Findings from HCWs contextualised these results, revealing severe structural barriers including skeletal staffing, outdated equipment, and a protracted referral process that forces a reactive, crisis-driven care model. Furthermore, HCWs reported internalised stigma among offenders, something which actively suppresses health-seeking behaviour. Conclusion: An implementation gap exists in cancer prevention services, driven by non-systematic screening, critical health literacy deficits, and a carceral environment that erodes patient agency. The rate of occult cytological abnormalities underscores the inadequacy of visual inspection.
Artificial intelligence in medical imaging : knowledge and perspectives of South African radiographers
(2026-03-12) Mutambara, Precious; Khoza, Thandokuhle Emmanuel
Background: This study focused on determining the perspectives of Radiographers in relation to the integration of AI into medical imaging. Artificial intelligence (AI) is the use of technology and computers to replicate intelligent behaviours and analytical thoughts that are similar to that of humans. Several studies indicate that medical imaging professionals, such as Radiologists and Radiographers, are seeing an increase in the use of AI applications in clinical settings. Diagnostic Radiographers are pivotal for the integration of AI systems into medical imaging as they serve as an interface between technology and patients. Although some studies have examined the perspectives of Radiographers on AI in some African countries, there is still no clear picture of the Radiographers’ perspectives towards AI in the most technologically advanced country in Africa. Aim of study: The study aimed to ascertain the knowledge and perspectives of South African Radiographers regarding the integration of AI in diagnostic imaging in order to provide unique recommendations to support the training of Radiographers. Methodology: A quantitative cross-sectional research design was used. Non-probability purposive sampling was employed as it is the most appropriate approach for a content analysis inquiry. A self-administered questionnaire containing closed-ended questions was used to collect statistical data from Radiographers that statistical data from Radiographers that met the requirements for participation. On completion of the questionnaires, the results were tabulated and graphically demonstrated. Data was analysed using the latest version 27 of SPSS (the Statistical Package for the Social Sciences). Findings: SPSS version 27 was used to analyse the data and various statistical tests such as Descriptive statistics, the Analysis of Variance Model, the Binomial test, Pearson's correlation coefficient, One-sample t-test, Cronbach alpha and Independent samples t-test were adopted to analyse the data yielded by the collection tool. The findings indicated that over 90 % of Radiographers in South Africa are aware of the concept of AI. The majority of Radiographers in South Africa have a positive attitude towards AI as there was significant agreement that AI is beneficial to the various aspects of diagnostic Radiography. While AI possesses many benefits, Radiographers also acknowledge the various barriers affecting the implementation of AI in the medical imaging profession. Conclusion: It can be concluded that Radiographers recognize general AI concepts and are aware of some of AI’s functional roles within the field but are unfamiliar with the more technical components of the technology. Therefore, the introduction of AI in the Radiography curriculum is pivotal to ensuring that Radiographers have a strong foundation for understanding AI. It was noted that Radiographers in South Africa believe that AI will have multiple benefits for their job performance. Inasmuch as AI is equipped with benefits for Radiographers, several barriers that hinder the implementation of AI in Radiography were also noted.