Examining the efficacy of the legal framework governing the management of greywater in South Africa's informal settlements.

The management of greywater and sanitation in South Africa's urban informal settlements is a pressing concern. This review critically examines the legal framework that governs greywater management in South Africa's informal settlements, aiming to shed light on the existing regulations, gaps, and opportunities for sustainable greywater reuse. By scrutinizing the legal framework, the review identifies gaps and challenges in the regulatory environment, including inconsistencies, lack of clarity, and limited enforcement mechanisms. It explores the potential for international best practices to inform possible amendments to the existing legal framework. This was a quantitative research design utilizing a cross sectional survey model. Questionnaires were administered electronically to a sample of 17 municipal leaders from the City of Tshwane, City of Johannesburg and Buffalo City municipalities whose responsibilities were on water management. Descriptive statistics were employed in analysis of the data. Outcomes were reviewed against the alignment or the lack thereof with the SANS 1732:201x standards. This paper underscores the critical need for a coherent and robust legal framework to support responsible greywater management in South Africa's informal settlements. The paper's insights contribute to the ongoing discourse on water governance, shedding light on the pathways toward a more equitable water future.

Aetiology of pleural effusions in children living in a high TB endemic setting.

Confirming the aetiology of pleural effusion in children may be difficult in TB-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies.This is a cross-sectional post-hoc analysis among children with pleural effusion in a tertiary hospital in South Africa, incorporating new data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation.Ninety-one children were enrolled; the median age 31 months (IQR 12-102). The aetiology of pleural effusion was 40% (36/91) bacteria, 11% (10/91) TB, 3% (3/91) viruses, 11% (10/91) polymicrobial and 35% (32/91) had no pathogen identified. The most common pathogen was Staphylococcus aureus (27/91, 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (12/91, 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1,716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%).PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion..

Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers.

Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user-centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design.

Occupational Health Barriers in South Africa: A Call for Ubuntu.

Many low- and middle-income countries (LMICs) grapple with shortages of health workers, a crucial component of robust health systems. The COVID-19 pandemic underscored the imperative for appropriate staffing of health systems and the occupational health (OH) threats to health workers. Issues related to accessibility, coverage, and utilization of OH services in public sector health facilities within LMICs were particularly accentuated during the pandemic. This paper draws on the observations and experiences of researchers engaged in an international collaboration to consider how the South African concept of Ubuntu provides a promising way to understand and address the challenges encountered in establishing and sustaining OH services in public sector health facilities. Throughout the COVID-19 pandemic, the collaborators actively participated in implementing and studying OH and infection prevention and control measures for health workers in South Africa and internationally as part of the World Health Organizations' Collaborating Centres for Occupational Health. The study identified obstacles in establishing, providing, maintaining and sustaining such measures during the pandemic. These challenges were attributed to lack of leadership/stewardship, inadequate use of intelligence systems for decision-making, ineffective health and safety committees, inactive trade unions, and the strain on occupational health professionals who were incapacitated and overworked. These shortcomings are, in part, linked to the absence of the Ubuntu philosophy in implementation and sustenance of OH services in LMICs.

The Durban University of Technology Faculty of Health Sciences Decentralized Clinical Training Project: Protocol for an Implementation Study in KwaZulu-Natal, South Africa.

BACKGROUND: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. OBJECTIVE: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. METHODS: Participatory action research comprising various designs-namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design-will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs-namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue-will be part of the project's pilot phase. Findings from the project's pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university's strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. RESULTS: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. CONCLUSIONS: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52243.

Time trends in the mortality of testicular cancer across the BRICS: an age-period-cohort analysis for the GBD 2019.

Testicular cancer (TCa) is a rare but impactful malignancy that primarily affects young men. Understanding the mortality rate of TCa is crucial for improving prevention and treatment strategies to reduce the risk of death among patients. We obtained TCa mortality data by place (5 countries), age (20-79 years), and year (1990-2019) from the Global Burden of Disease Study 2019. Age-period-cohort model was used to estimate the net drift, local drift, age effects, period and cohort effects. In 2019, the global mortality of TCa increased to 10842 (95% UI 9961, 11902), with an increase of 50.08% compared to 1990.The all-age mortality rate for TCa in 2019 increased from 0.17/100,000 (95% UI 0.13, 0.20) in China to 0.48/100,000 (95% UI 0.38, 0.59) in Russian Federation, whereas the age-standardized mortality rate in 2019 was highest in the South Africa 0.47/100,000 (95% UI 0.42, 0.53) and lowest in the China 0.16/100,000 (95% UI 0.13, 0.19). China's aging population shifts mortality patterns towards the elderly, while in Russian Federation, young individuals are primarily affected by the distribution of deaths. To address divergent TCa mortality advancements in BRICS countries, we propose a contextually adaptive and resource-conscious approach to prioritize TCa prevention. Tailoring strategies to contextual diversity, including policy frameworks, human resources, and financial capacities, will enhance targeted interventions and effectiveness in reducing TCa mortality.

Morbidity amongst South African Hajj pilgrims in 2023-a retrospective cohort study.

South Africans are not accustomed to the dry arid climate and sweltering heat in Saudi Arabia. We conducted a retrospective cohort study to identify the common health conditions pre-Hajj, during the 5 days of Hajj and on return to South Africa from Hajj amongst the 2023 pilgrims. A QR code and a mobile link to a self-administered questionnaire was sent to all 3500 South African pilgrims. Five hundred and seventy-seven pilgrims returned the completed surveys. Mean age of the participants was 48 years (SD 12) with a higher female representation (3:2). Forty eight percent (279) had pre-existing chronic conditions. Forty five percent (259) reported being ill during their stay in the Kingdom, 20% (115) reported having an illness during the main 5 days, whilst 51% (293) reported having an illness within 7 days of returning to South Africa. Only six pilgrims were admitted to hospital after their return home. Respiratory tract linked symptoms were the most frequently reported (95% pre Hajj and 99% post Hajj). Participants who reported having a chronic condition (AOR 1.52 95% CI 1.09-2.11) and engaging in independent exercising prior to Hajj (AOR 1.52-1.07-2.10) were at an increased likelihood of developing an illness within 7 days of returning home. Post travel surveillance swabs to identify potential pathogens that the returning pilgrims are incubating should be explored to guide further interventions.

Public healthcare disparities in Africa: the food production systems and its dichotomy in a South African context.

One of the major concerns of development in Africa is the issue of public health. In Africa, public healthcare has been and still is a problem most African countries are faced with. The problem of public healthcare seems to be unabated even though there are measures that are put in place for its effectiveness. There is hunger, malnutrition, high mortality rate, illnesses and deterioration of life expectancy in most developing countries of Africa. The dramatic unprecedented public health disparity has become a scourge in developing countries where it has purportedly impaired the developmental efforts, economic growth and prosperity. As a result, there is a need to scrutinize possible causes that exacerbates public health issues in developing countries. The paper argues that the current food production system (conventional) contributes to current status of public health as compared to the previous food production system (organic). The purpose of this paper is to conceptualize public healthcare disparities, juxtaposing organic and conventional food production that result as human food consumption. The paper employs literature-based analysis as a methodology to assemble data in respect of public healthcare disparities and food production systems.

Cultural adaptation and Sepedi translation of the Activities-specific Balance Confidence scale.

BACKGROUND:  The Activities-specific Balance Confidence (ABC) scale is a widely used measure to identify older adults with balance difficulties. However, its applicability in the diverse South African context is hindered by cross-cultural and linguistic differences. Limited research exists on the use of the ABC scale in native South African languages. OBJECTIVES:  This study aimed to translate and culturally adapt the ABC scale into Sepedi, evaluate its reliability and determine self-perceived balance confidence among elderly individuals in a rural community. METHOD:  The ABC scale was translated and culturally adapted into Sepedi. Two trained raters administered the Sepedi version of the ABC (ABC-S) scale to 32 individuals aged between 60 and 88 years. Test-retest reliability and inter-rater reliability were determined, with one rater re-administering the scale 2 weeks later. RESULTS:  Ten items from the original ABC scale were modified because of cultural, semantic or contextual inappropriateness. The ABC-S scale demonstrated very good intra- and inter-rater reproducibility, with an average intraclass correlation coefficient (ICC) of 0.85 and 0.81, respectively. The self-perceived balance confidence among elderly Sepedi individuals, as evaluated by the ABC-S scale, was high, with an average score of 81.3 and a range of 58.1 to 95.9. CONCLUSION:  The ABC-S scale is a reliable measurement tool to investigate balance confidence in Sepedi-speaking older adults.Contribution: The ABC-S scale is a valuable screening tool for the identification of balance difficulties in Sepedi-speaking older adults as well as research settings.

'[M]y own pace and space, without the pressures': Online learning experiences of audiology students.

BACKGROUND:  Online learning has been used to improve students' learning experiences and to allow students to engage with their own learning in various spaces. However, there is a dearth of literature on students' experiences with online learning in the field of audiology. OBJECTIVES:  This study aimed to describe the conditions of online learning, explore the challenges and benefits of online learning and determine strategies that students employ while engaging with online learning. METHOD:  An exploratory qualitative research design was employed. Audiology students from the second to the fourth year participated in the study. Qualitative data were collected online via MS Teams using a semi-structured interview schedule with the participants. Thematic analysis was used to analyse the participants' interviews. RESULTS:  Most of our participants were females in their fourth year of study. The students accessed the online learning platforms procured by the university from their homes, with reported benefits such as the flexibility and independence of learning, and time and cost-effectiveness. However, challenges such as limited internet connectivity, issues with time management and inconsistent power supply restricted positive experiences with online learning. CONCLUSION:  The online learning benefits that were reported by the students and the compensatory strategies they employed facilitated self-regulated learning. The study's findings highlighted the need for continuous checking-in with students regarding their experiences with the learning approaches intended to improve engagement with their courses. These results could be used as a guide for curriculum planning that is student-focused.Contribution: Students' experiences explored in our study provided a guide for online learning approaches that were suitable for audiology students. Student-centred and self-regulated learning practices were highlighted and future studies may further explore these frameworks and theories.

Operational nursing managers' experiences of clinical supervision at a Johannesburg Hospital.

BACKGROUND:  Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers' context to define existing challenges and propose suitable recommendations. OBJECTIVES:  This study aimed to explore and describe operational nursing managers' experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision. METHOD:  An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two. RESULTS:  Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate. CONCLUSION:  Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations.Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

Cardiovascular risk among community members in three communities in the Cape Metropole of the Western Cape.

BACKGROUND:  Cardiovascular diseases pose a risk to population health in South Africa and are responsible for almost one in six deaths (17.3%). AIM:  To determine the cardiovascular risk among community members who attended a community outreach programme. SETTING:  Three communities in the Cape Metropole of the Western Cape. METHODS:  A health survey was conducted with 783 participants, 18 years and older, conveniently sampled. The survey included questions about cardiovascular risk factors, and biometric measurements of blood pressure (BP), height and weight were conducted. RESULTS:  A total of 777 participants were included in the study. Most participants were female (529, 68.1%), with an average age of 42.3 years (s.d. 14.2). Risk behaviours reported included smoking (216, 27.8%), consuming more than two drinks of alcohol daily (78, 10%), low physical activity (384, 49.4%), being stressed on most days (436, 56.1%) and unhealthy eating habits (253, 32.6%). More than half of the participants (402, 51.7%) had a body mass index (BMI) ≥ 30, 26.0% (202) had a systolic BP of ≥ 140 mm Hg and 22.4% (174) had a diastolic BP of ≥ 90 mm Hg; 16.6% (130) had a cardiovascular disease (CVD) risk of 10-20 and 19.3% (150) had a CVD risk of 20%. CONCLUSION:  Nearly a fifth of the participants had a significant probability of developing heart disease or experiencing a stroke over the next 10 years.Contribution: There is an urgent need for comprehensive health promotion and behaviour change interventions focused on reducing CVD risk factors at the community level.

Burnout among community service doctors in South Africa.

BACKGROUND:  Burnout in doctors is an important issue with far-reaching consequences. Community service doctors may be particularly vulnerable because of their specific roles (rural settings, junior positions and reduced supervision). AIM:  This study aimed to determine the prevalence of burnout among community service doctors in South Africa (SA), the potential contributory and protective factors and the consequences thereof. SETTING:  This was a national study of community service doctors in SA. METHODS:  A quantitative, descriptive cross-sectional study was performed. The Maslach Burnout Inventory was used to measure burnout. The online questionnaire also included demographic data, workplace and individual characteristics. RESULTS:  Of the 208 community service doctors analysed, 89% and 94% had high emotional exhaustion and depersonalisation, respectively, while 97% had a low personal accomplishment. Mental illness, financial difficulties, unmanageable volume of patients and female gender were found to be potential contributory factors. Having manageable patient volumes, satisfaction with their decision to study medicine, talking to colleagues and feeling supported by healthcare facility management were among the significant potential protective factors. Significant potential consequences of burnout included: leaving the government sector, ever being diagnosed with a mental illness, using alcohol as a coping mechanism and possible current major depression. CONCLUSION:  Burnout among community service doctors in SA is highly prevalent with significant potential consequences. There are a number of modifiable possible contributory and protective factors identified that may be targets for mental health interventions.Contribution: Healthcare burnout research is lacking in the African and specifically SA context. This void includes community service doctors.

Relationships between moderate vigorous physical activity, motor- and health-related fitness and motor skills in children.

BACKGROUND:  Childhood is an important transitional period for the development of healthy physical activity (PA) behaviours, so it is important to understand its impact on a healthy lifestyle. AIM:  This study aimed to determine the influences of sex, socioeconomic status (SES) and body composition (BC) on the relationships between PA, motor skills, motor- and health-related physical fitness in 5-8-year-olds. SETTING:  Participants were a subsample consisting of 299 children (150 boys, 149 girls, mean age 6.83 ± 0.96 years) from the Exercise, Arterial Modulation and Nutrition in Youth South Africa study (ExAMIN Youth SA). METHODS:  Anthropometric measures, health-related physical fitness (HRPF), motor-related physical fitness (MRPF), objectively measured PA and demographic information were determined. RESULTS:  Only 66% achieved the recommended 60 min of daily moderate vigorous physical activity (MVPA) with 19% classified as having unhealthy body composition (11% overweight, 8% obese). Fat-free mass and SES revealed small-to-moderate influences on the relationship between MVPA, standing broad jump (SBJ; r = 0.32), predicted VO2max (r = 0.28) and beep levels (r = 0.22). For MRPF, the quality of running (r = 0.12) and balancing were associated with MVPA. Adjusting for sex, BC and SES in the relationship between PA with HRPF and MRPF, reductions in most correlations were observed. CONCLUSION:  Moderate vigorous physical activity levels were positively associated with HRPF, MRPF and some motor skills in 5-8-year-olds. Socioeconomic status (lower parental income, employment and education negatively influenced the association between MVPA and fitness [beeps, SBJ, O2max]).Contribution: This study provides knowledge with regard to the use of accelerometer for baseline data for PA, MRPF, HRPF as well as motor skills in South African children.

Factors contributing to rise in teenage pregnancy in Sekhukhune district, Limpopo province.

BACKGROUND:  The Department of Health in South Africa has reported an alarming total of 90 037 teenage girls between the ages of 10 years and 19 years who gave birth from March 2021 to April 2022, across all provinces and districts. The rise in teenage pregnancy is of serious concern as adolescents girls are more likely to experience difficult pregnancies and deliveries which could lead to detrimental effects on their health. OBJECTIVES:  The study aimed to explore and describe factors contributing to the increase in teenage pregnancy in the Sekhukhune district of Limpopo. METHOD:  The study was conducted in the healthcare facilities of Sekhukhune area. A qualitative, exploratory design was followed. Participants were purposively selected, and data were gathered through face-to-face individual interviews. Data analysis employed Tesch's inductive, descriptive coding method. RESULTS:  Negligence, peer pressure, ambiguity, choice, lack of contraceptive use, and lack of family attachment were identified as exacerbating factors in the district's surge in teenage pregnancy. CONCLUSION:  To reduce teen pregnancy, it is crucial to promote contraception, enhance cooperation between schools and the government, involve families in sexual and reproductive health discussions, prioritise a supportive home environment, advocate for child support grants, revitalise school health services, and empower teenagers to make informed choices and resist peer pressure.Contribution: The study will provide guidance to policy makers and other stakeholders in developing appropriate programmes to address the problem and improve the health and socioeconomic status of adolescents in rural areas. This will reduce healthcare costs associated with complications and premature birth.

Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal: A cohort study, 2018-2021.

BACKGROUND:  The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points. AIM:  We determined baseline glycaemic control and rates and predictors of becoming sub-optimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients. SETTING:  The setting of the study was eThekwini, KwaZulu-Natal, South Africa. METHODS:  We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan-Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported. RESULTS:  Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24-0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16-1.95; p-value = 0.002) versus monotherapy. CONCLUSIONS:  The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration.Contribution: Addressing identified shortfalls can assist programme implementation.

Corrigendum: Access to healthcare by undocumented Zimbabwean migrants in post-apartheid South Africa.

No abstract available.

The role of clinical associates in South Africa as a health workforce: A scoping review.

BACKGROUND:  South Africa's health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers. AIM:  This study mapped Clin-As' history and practice in South Africa, assessing their roles in the health workforce and offering recommendations. METHODS:  Following the framework outlined by Arksey and O'Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening. RESULTS:  Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As' perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation. CONCLUSION:  As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa's health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution: This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

The misuse of codeine containing medicines: Perceptions and behaviours of qualified pharmacy professionals.

BACKGROUND:  Pharmacy professionals working in community pharmacies frequently provide pharmacist-initiated therapy, including codeine-containing medicines. Codeine is an opioid with great potential for misuse, adding to the global opioid epidemic burden. Professional pharmacy personnel are the first intervention point in relation to management of codeine use. This study highlights the importance of pharmacy professionals' perceptions and behaviours in combatting the opioid epidemic. METHODS:  A descriptive cross-sectional study was conducted. Simple random sampling included pharmacy professionals in the metropolitan city of Johannesburg. An electronic questionnaire was distributed via e-mail and data analysed descriptively. RESULTS:  Findings indicate that pharmacy personnel routinely ask patients about codeine use (n = 48; 53.9%), avoid dispensing over-the-counter (OTC) codeine as an initial treatment (n = 61; 69%) and express confidence to identify and manage codeine misuse (n = 69; 77.5%). Despite this, increased patient demands for OTC codeine (n = 69; 77.5%) were concerning, highlighting the ease of availability from internet sources (n = 76; 85.4%) and multiple pharmacies (n = 84; 94.4%). Apprehension about the lack of patient awareness on adverse health consequences (n = 66; 74.2%) and the risk of codeine dependence (n = 79; 88.8%) was expressed. CONCLUSION:  Growing concern regarding availability and accessibility of codeine-containing medicines within the community pharmacy sector is highlighted. Adverse health consequences of codeine misuse and dependence are not understood by customers and the ineffective information provided by pharmacy personnel was highlighted as a concern.Contribution: The results of this study give insight to the influence of dispensing personnel's attitude towards the growing challenges with respect to codeine containing medication abuse.