Prevalence of brain fag syndrome and its correlation with stimulant use and socioeconomic/demographic characteristics among university undergraduate students in Nigeria

Background: Brain Fag Syndrome (BFS) is a culture-bound syndrome characterized by cognitive and somatic symptoms, commonly reported among African students. This study aimed to determine the prevalence of BFS among Nigerian university students and examine its associated factors. Methods: A cross-sectional survey was conducted among undergraduate students from a university in the northwest region of Nigeria. The study utilized a self-administered questionnaire to collect data on socio-demographic characteristics, stimulant use, course of study, and academic performance. The presence of BFS was assessed using standardized diagnostic criteria. Results:The study included a total of 625 participants, in their young adulthood. The prevalence of BFS among Nigerian university students was found to be 62.7%. The majority of affected students were aged 20-30, male, and from the Hausa ethnic group. No significant association was found between stimulant use and BFS. However, there was a significant relationship between the course of study and the occurrence of BFS. Academic performance (CGPA) showed a weak negative association with BFS. Other socio-demographic factors such as age, gender, ethnicity, relationship status, birth position, type of home, and family income did not predict the occurrence of BFS. Conclusion: The high prevalence highlights the need for attention to mental health issues among this population. The results emphasize the importance of considering the course of study and academic performance when studying BFS. Further research is warranted to explore the underlying mechanisms and develop effective interventions for students affected by BFS.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

Assessment of the prevalence of depression and the use of antidepressants in a study population

The World Health Organization (WHO) has reported that there is an increasing burden of depression and other mental health conditions globally. WHO global health estimate for depression reports a prevalence of 5.4% in Sub-Saharan Africa. Pharmacological therapy still remains the most popular treatment for diagnosed depression. The aim of this study was to determine the prevalence of clinically diagnosed depression and outcomes of antidepressants among final year undergraduate students in a Federal University. A descriptive cross- sectional study was carried out at University of Benin, Benin City. A validated questionnaire was distributed to the 319 final year clinical students of the College of Medicine, School of Dentistry and Faculty of Pharmacy. Data obtained were organized and analysed with Microsoft Excel and SPSS version 25. Descriptive statistics was done; frequencies and percentages were used to summarize variables of interest. Ethical considerations were observed. All the questionnaires used were valid for analysis. About 90.0% of the respondents were knowledgeable about depression. Symptoms of depression were reported in 20.0% of the respondents with 16.6% having moderate symptoms of depression and 3.4% having moderately severe symptoms of depression. The same 20.0% used antidepressants and 14.7% did not adhere to their regimen. Side effects were experienced by majority of respondents (16.3%) on antidepressants. There was a low prevalence of depression in the study population. Adherence to drug therapy was poor. Side effects to treatment were reported by majority of students receiving antidepressants. Majority of patients claim to be better now that they are using antidepressant treatment as the symptoms of the disease are resolving.

Secondary trauma amongst administrative support staff working with traumatic incident dockets within the South African Police Service in Johannesburg, South Africa

Background: Secondary trauma is trauma experienced by those in close contact with the victims of trauma. Research shows that some individuals exposed to photographs or video presentations of traumatic events may experience secondary trauma. This includes administrative staff within the South African Police Service (SAPS), who work with trauma dockets. Objectives: We explored the effects of secondary trauma on administrative support staff within the SAPS, their access to psychological support in the SAPS, and their use of the employee health and wellness (EHW) services in the SAPS. Methods: An exploratory qualitative study was conducted among administrative support staff from one of the four Johannesburg clusters of the SAPS. In-depth interviews took place with seven staff members. The data were analysed using Atlas.ti. Results: Administrative support staff are exposed to trauma through incident dockets, victim statements, and gruesome images. The study participants indicated that they experienced trauma daily, and symptoms of trauma such as flashbacks, anxiety, sadness, nightmares, paranoia, avoidance, recurrent thoughts, and fear of death. They were overprotective of their loved ones and paranoid. They were not utilising the EHW services due to lack of access to appropriate services, or the stigma attached to seeking help from mental health professionals. Conclusion: The SAPS needs to develop and implement a strategy to mitigate the impact of secondary trauma on its personnel, which include administrative support staff. Evidence-based interventions, such as resilience training, should be considered as part of the strategy

Occupational health and safety challenges among artisanal and small-scale diamond miners in Kimberley, South Africa

Background: Artisanal and small-scale mining (ASM) is a laborious process often executed with rudimentary low-technology mining equipment. It exposes miners to a myriad of occupational hazards, which may increase health and safety disparities between them and formally employed mine workers. Objectives: The objectives of the study were to identify workplace hazards and the associated risks; and to assess the effects of mining activities on the health and environment of artisanal diamond miners in Kimberley, Northern Cape province. Methods: This was an interdisciplinary observational ethnographic study. A workplace assessment was undertaken at seven sites in Kimberley. Participants were conveniently selected; snowballing was used to recruit additional participants. Field notes were recorded from observations. Interview questions included those about the duration of artisanal mining, and the risks faced in the workplace. Data collection included photographic documentation. An inductive and deductive process was used to analyse the data and thematic analysis was conducted. Results: The observed occupational hazards included physical (ultraviolet radiation exposure, injuries due to trauma), respiratory (silica dust exposure), biomechanical (heavy lifting, repetitive movement), and psychological (work-related stress, anxiety) hazards. There was a paucity of access to, and use of, personal protective equipment (PPE). Workers improvised ways to protect themselves, e.g. by using cloths as masks. There was no recourse to formal occupational health services and social safety networks. Conclusion: Occupational health and safety challenges included physical, biomechanical, respiratory, and psychosocial hazards. The mining activities had a detrimental impact on the environment.

COVID-19 pandemic and factors influencing depression in residents of the Democratic Republic of Congo

Background: The COVID-19 outbreak caused the border closure, martial law declaration, and lockdown to prevent the spread of the disease. These policies caused reduced interaction among people,social isolation, and higher levels of anxiety and depression. Objectives: This study aimed to examine changes in depressive symptoms of residents of the Democratic Republic of Congo (DRC) that may have arisen due to the COVID-19 and lockdown measures and to identify relevant influencing factors. Methods: This cross-sectional study involved 300 residents of the DRC. An online survey tool investigated general and public health characteristics and included the Patient Health Questionnaire-9 for measuring depressive symptoms. The study was conducted from April 7­30, 2020. Results: The average depression score was low at 2.74±3.33. Factors influencing depression were the number of family members, probability of death due to COVID-19, knowledge of COVID-19, and time at home. The factor that most significantly influenced depression and these variables accounted for 26.9% of the influence of COVID-19 on depression (F= 9.936, p<.001). Conclusion: This study investigated the influence of COVID-19 outbreak on depression in DRC. Levels of depression increased for individuals who were living alone, had low levels of knowledge of COVID-19 and awareness of the disease severity, and spent a long time at home.

The impacts of COVID-19 pandemic on mental health: A scoping review

Background: This scoping review assessed the COVID-19 impacts on mental health and associated risk factors. Methods: A literature search for relevant articles published between March 2020 and July 2022, was conducted in the APA PsychInfo, JBI Evidence Synthesis, Epistemonikos, PubMed, and Cochrane databases. Results: The article inclusion criteria were met by 72 studies. The commonly used mental health assessment tools were the Patient Health Questionnaire (41.7%), Generalized Anxiety Disorder Scale (36%), 21-item Depression, Anxiety, and Stress (13.9%), Impact of Event Scale (12.5%), Pittsburgh Sleep Quality Index (9.7%), Symptom Checklist and the General Health Questionnaire (6.9% each). The prevalence rate of depression ranged from 5-76.5%, 5.6-80.5% for anxiety, 9.1- 65% for Post-Traumatic Stress Disorder, 8.3-61.7% for sleep disorders, 4.9-70.1% for stress, 7-71.5% for psychological distress, and 21.4-69.3% for general mental health conditions. The risks included female gender, healthcare related/frontline jobs, isolation/quarantine, poverty, lower education, COVID-19 risk, age, commodities, mental illness history, negative psychology, and higher social media exposure. The incidence of mental disorders increased along with the increasing cases of COVID-19 and the corresponding government restrictions. Conclusion: Standard mental health assessment tools were used in these studies conducted during COVID-19. Mental health disorders like depression, anxiety, and stress increased during the COVID-19 pandemic and lockdowns. Various factors impacted the prevalence of mental health disorders. Policymakers need to provide social protective measures to improve coping in critical health events. Further studies should investigate the effectiveness of interventions for reducing the prevalence and risk factors for mental health conditions during a public health emergency.

The mental health and wellbeing of healthcare workers during COVID-19 in South Africa

Background: Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts. Aim: The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa. Setting: This study's sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa. Methods: The authors used a qualitative survey design exploring participants' general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis. Results: The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves. Conclusion: An overarching thread of uncertainty seems central to HCWs' experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic. Contribution: These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.

Development of a digital mental health platform in the era of COVID-19 pandemic in Kenya: findings and implications

Introduction: COVID-19 global pandemic exposed mental health gaps that have been salient among adolescents and young people. The glaring gaps include lack of information, undefined referral systems, and inadequate human resources for mental health. We aimed to develop a digital web-based platform to support young people's mental health and psychosocial needs during the COVID-19 pandemic. Methods: we adopted a mixed methods action research approach to design and pilot a digital mental health intervention for young people during the pandemic. We piloted the platform between Oct 2020 and July 2021, and recruited a sample of 150 young people through the community gathering spaces in three informal settlements in Nairobi City County using a convenient sampling method. Results: overall, participants reported that information provided to them via the platform was pertinent and beneficial, and that the self-assessments improved their mental health and psychosocial awareness and signposted them to available support and services. The support services consisted of informative weekly bulk emails and short motivational messages related to mental health, with a total of, 1343 short messages distributed through the short message service (SMS). Moreover, more than half the participants completed online self-assessments and participated in 19 online sessions. Conclusion: findings from this pilot study demonstrate that digital mental health systems are feasible and have the potential to improve access to mental health and psychosocial services. This is especially crucial during times of public health crisis, such as the COVID-19 pandemic. The realization of such systems requires swift multistakeholder partnership approach and investment.

Psychosocial factors associated with psychiatric morbidity in higher institution students in Nigeria

Introduction: Mental health disorders in undergraduates are often undetected and may predispose to other academic and social complications. The objective of the study is to determine the prevalence of probable psychiatric morbidity among students of University of Ilorin, Nigeria and the psycho-social factors that are associated with psychiatric morbidity in them. Methods: Socio-demographic questionnaire and the 12-item General health questionnaire (GHQ-12) were administered to 3,300 undergraduate students to assess psychosocial variables and psychiatric morbidity respectively. Results: About 23.5% of respondents scored >3 using the GHQ-12 questionnaire, signifying a likehood of psychiatric morbidity. Students from polygamous families were 1.3 times more likely to have GHQ scores of >3 than those from monogamous (OR=1.276, P=0.026). Those who had unemployed fathers were twice more likely to have a GHQ > 3 than those with employed fathers. (OR=2.084, P=0.005).Those who lived in houses with shared toilet facilities were 1.3 times more likely to have GHQ >3 (OR=1.310, P=0.028) Conclusion: This study calls for a careful consideration and modification of the various psychosocial factors associated with pschiatric morbidity in order to ensure a mentally healthy and vibrant student community

Quality of life group of cameroonian patients aged over 65 years in an urban setting: A cross-sectional study

Background. The quality of life of the elderly can be compromised by several chronic diseases. This has a considerable impact on their physical and mental capacities.This study aimed to evaluate the quality of life of the elderly at the Yaoundé Central Hospital. Methods.We carried out a cross-sectional study of elderly patients who consulted at the Yaounde Central Hospital forfive months. Sociodemographic characteristics were taken, and we also took data concerning their chronic conditions and depressive symptoms. The presence of any cognitive impairment was evaluated using the Mini-mental state Examination (MMSE). Their functional capacity was assessed with the six-minute walk test. Quality of life was evaluated using the older people's quality of life questionnaire (OPQOL). The multivariate analysis was done on the logistic regression model, and the p values < 0.05 were considered statistically significant. Results.66 participants were included (35 women) with a median age of 70 (IQR: 67 -75) years. About 87.8% had at least one chronic condition, and 47% had two or more. The most prevalent chronic condition was hypertension (71.2%), followed by abdominal obesity (40.9%) and heart failure (24.2%). Mild depressive symptoms were present in 1.5% of our study population. Fourteen participants (21.2%) had a poor quality of life. The factors associated with a poor quality of life was a distance covered in the 6 MWT less than 350m (OR: 3.7, p < 0.05). Conclusion.There is a high prevalence of poor quality of life among elderly patients consulting at the Yaoundé Central Hospital. A distance covered in the 6MWT less than 350m is associated with poor quality of life.

Introduction. La qualité de vie des personnes âgées peut être compromise par la survenue de plusieurs pathologies chroniques. Cela a un impact considérable sur leurs capacités physiques mais aussi sur leurs capacités mentales. Le but de cette étude était d'évaluer la qualité de vie des personnes âgées suivies à l'Hôpital Central de Yaoundé. Méthodologie. Nous avons réalisé une étude transversale analytique sur des patients âgés ayant consulté à l'hôpital central de Yaoundé pendant une période de cinq mois. Les caractéristiques sociodémographiques ont été prises, ainsi que leurs différentes comorbidités. La présence d'un déficit cognitif a été évaluée à l'aide du Mini Mental State Examination(MMSE). Leur capacité fonctionnelle a été évaluée à l'aide du test de marche de six minutes. La qualité de vie a été évaluée à l'aide du score OPQOL.. L'analyse multivariée a été effectuée sur le modèle de régression logistique et les valeurs de p < 0,05 ont été considérées comme statistiquement significatives. Résultats. 66 participants ont été inclus (35 femmes) avec un âge médian de 70 (IQR : 67 -75) ans. Parmi eux, environ 87,8 % avaient au moins une maladie chronique et 47 % en avaient deux ou plus. L'affection chronique la plus répandue était l'hypertension artérielle (71,2 %), suivie de l'insuffisance cardiaque (24,2 %) et de l'arthrose (12,1 %). Des symptômes dépressifs légers étaient présents chez 1,5 % de la population de notre étude. 14 participants (21,2 %) avaient une mauvaise qualité de vie. Les facteurs associés à unemauvaise qualité de vie étaient une distance parcourue dans le 6MWT inférieure à 350m (OR : 3,7, p < 0,05). Conclusion. Il existe une forte prévalence de la mauvaise qualité de vie chez ce groupe de patients âgés camerounais dont le facteur associé retrouvéest une distance parcourue durant le 6MWT inférieure à 350m.Ceci confirme le bénéfice de l'activité physique sur le plan physique et mental, indispensable pour une meilleure qualité de vie.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

Background: Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives: To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results: Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion: The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Consequences of COVID-19 on access and delivery of mental health care in two rural Ethiopian districts. A mixed method study

Introduction: The impact of COVID-19 on people with Severe Mental Health Conditions (SMHCs) has been neglected. We aimed to describe the effect and explore the consequences of COVID-19 on people with SMHCs and mental health services in rural districts of Ethiopia. Methods: We conducted a mixed-method study nested within well-characterized population cohorts in Butajira and Sodo districts. We sampled 336 people (168 people with SMHCs, 168 comparisons) in a cross-sectional survey. We conducted qualitative key informant interviews with psychiatric nurses (n=3), primary health care workers (n=3), service users (n=4), family members (n=6) and community members (n=2). We assessed wellbeing (WHO wellbeing index), social support (Oslo social support scale; OSS) and food security quantitatively and used thematic analysis to explore impacts. Results: People with SMHCs reported significantly lower wellbeing (WHO wellbeing score 52 vs. 72; p<0.001), less social support (OSS score 8.68 vs. 9.29; p<0.001), worse living standards (47.0% vs. 29.0%; p<0.001) and increased food insecurity (26.0% vs. 12.5%; p<0.001). Household economic status worsened for over one-third of participants. Participants reported increased relapse, exacerbated stigma due to perceived susceptibility of people with SMHCs to COVID-19, and increased restraint. In mental healthcare settings, there was decreased patient flow but an increase in new cases. Innovations included flexible dispensing of medicines, longer appointment intervals and establishing new treatment centers. Conclusions: COVID-19 had negative consequences on people with SMHCs and mental health services, which must be anticipated and prevented in any future humanitarian crisis. Adaptive responses used during COVID may increase health system resilience

Support interventions for nurses working in acute psychiatric units: A systematic review

Diverse support interventions have been implemented to provide support for nurses working in acute psychiatric settings. These interventions aimed at modifying the psychological and social factors, as they either prevent stress responses or reduce its effects to improve the psychological well-being of staff. This study aimed to examine effective stress reduction interventions for nurses and to identify key elements of these successful interventions. Studies included in this review were conducted in acute psychiatric settings. A comprehensive search of electronic databases was conducted for support intervention studies between 2010 and 2021. The search yielded 315 studies that were reduced to seven studies after being reviewed by two independent reviewers. The studies were coded, and key elements were identified. Seven studies that were included consisted of a randomised controlled trial, quasi-experimental design and single-group design. Interventions included mindfulness-based stress reduction, burnout prevention programmes, communication skills, educational programme, group intervention, resilience training programme and stress management. Four key elements emerged from these interventions, namely, educational support, interpersonal skills, psychological support and adaptive coping. The findings highlighted the diverse interventions in supporting psychiatric nurses to cope with stress. However, there is a dearth of studies in acute psychiatric settings that were mostly done in emergency settings. Knowledge gained from this review may assist with practice improvement as managers can implement the identified interventions.

Perceptions and attitudes of black men in a rural district of south africa towards depression and its treatment

Depression is a major contributor to the overall global burden of disease, impacting social life, family life and occupational functioning if left untreated. Despite its high prevalence and morbidity, the evidence suggests that men are hesitant to seek help, with a large percentage remaining undiagnosed. This study aimed to determine the attitudes and perceptions related to depression and its treatment amongst black men in a rural district of South Africa.Methods: The design used was an exploratory descriptive qualitative design. Participants were selected by purposive sampling. Individual semistructured interviews were conducted, which were audio-recorded and transcribed verbatim. The data were subsequently analysed thematically to develop themes and subthemes.Results: Participants described depression as a psychological problem associated with lack of sleep, loneliness, feeling unwanted, increased stress, deep sadness, weight loss, forgetfulness, crying over small things and lack of concentration. Collectively, the interviews with participants showed a good understanding of the psychosocial determinants of depression but exposed a lack of awareness of its biological determinants. A large proportion (n = 13; 68.4%) of participants reported not having knowledge of available services in their area for people seeking treatment for depression. Barriers to help-seeking behaviours were fear of social stigma, fear of expressing their feelings, gender norms and stereotypes and lack of trust in others.Conclusion: Interventions such as support groups and mental health awareness programmes to counteract personal perceptions may help to improve and expand the effectiveness of depression treatment. The results highlight the future need to raise awareness of depressive symptoms and expand health outreach programmes.Keywords: depression; perceptions; attitudes; mental health; help-seeking; treatment; SouthAfrica.

Late-life depression and the family physician

Late-life depression (LLD) is a common disorder seen in clinical practice. Depression in this population group is often left undetected and untreated. The majority of elderly individuals who seek help present to the primary health care setting. The family physician is ideally placed to screen for symptoms of LLD, given that they often have longitudinal knowledge of the patient's history, premorbid personality, functioning and overall health status. An understanding of risk factors, differential diagnoses, appropriate opportunistic screening toolsand decision-making around management plans can assist the family physician in the early detection and treatment of these patients. In doing so, this may lead to a decrease in mortality and morbidity and enhance the patient's quality of life.Keywords: Late life; depression; older; geriatric mental health; major depressive disorder; antidepressants; cognitive impairment; dementia.

War in the midst of a pandemic: the synergy accelerating mental health disorders

War and displacement can have long-term and disastrous repercussions on people's mental, emotional, and physical health. Bombardments, invasions, occupation desertion, and being forced to flee diminish people's sense of security. The risk of being hurt or maimed as a result of conflict causes acute dread, which sets in motion other cascades of mental illnesses such as depression, anxiety, and post-traumatic stress disorder. These mental and emotional impacts are exacerbated by a co-existing pandemic, as migration and populations forced into cramped, dangerous situations are likely to contribute significantly to disease spread, particularly given the current surge of the highly transmissible omicron variant of COVID-19. This threat to life and livelihood eventually leaves some survivors with mental health disorders.

Maternity healthcare providers' self-perceptions of well-being during COVID-19: A survey in Tshwane Health District, South Africa

Background: Mental health manifestations such as depression and anxiety disorders became more marked during the coronavirus disease 2019 (COVID-19) pandemic as frontline healthcare workers struggled to maintain high-quality intrapartum care and essential health services. Aim: This study aimed to identify maternity healthcare providers' self-perceptions of changes in their feelings of mental well-being. Setting: Ten midwife obstetric units and the labour wards of four district hospitals in Tshwane Health District, South Africa. Methods: We conducted an anonymous, cross-sectional survey amongst a convenience sample of 114 maternity healthcare workers to gauge the changes in healthcare workers' experience and perceptions of well-being during the COVID-19 pandemic. Four items measured the perceived changes on a scale of 0­10 for the periods before and during COVID-19, respectively, namely feelings of fear or anxiety, stress, depression and anger. Results: The majority of participants were professional nurses (37%) and advanced midwives (47%). They reported a significant change in well-being from before the pandemic to during the pandemic with regard to all four items (p < 0.0001). The biggest 'before-during' difference was in perceptions of fear or anxiety and the smallest difference was in perceptions of anger. A framework was constructed from the open-ended responses to explain healthcare workers' understanding and perceptions of increased negative feelings regarding their mental well-being. Conclusion: The observed trends in the changes in healthcare workers' self-perceptions of their mental well-being highlight the need for further planning to build resilient frontline healthcare workers and provide them with ongoing mental health support and improved communication pathways.

Medical internship training during the COVID-19 pandemic ­ A case of 'sacrificial pawns' or not?

Background: Newly qualified medical practitioners in South Africa (SA) are part of the frontline health care workers who face Africa's most severe coronavirus disease 2019 (COVID-19) pandemic. The experiences of interns during the pandemic reflect SA's preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contexts. Aim: To explore the strengths, weaknesses, opportunities and threats posed during the first wave of the COVID-19 pandemic as reflected on by interns within the clinical training platforms in SA. Setting: Public hospitals in KwaZulu-Natal. Methods: An online questionnaire consisting of eight open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. All data were collected remotely via social media platforms. Data were thematically analyzed. Results: Forty-six interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, communities of practice and the development and enhancement of clinical and non-clinical competencies. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback, broadening the intern curriculum and online training. Conclusion: Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic.

Prioritising maternal mental health and infant neurodevelopment research in Africa ­ A call for action amidst the backdrop of the COVID­19 pandemic

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