Journal articles on the topic 'Zambia – Medical policy'

Applying bioethical principles can be difficult in resource-poor environments, particularly for Western doctors unfamiliar with these limitations. The challenges become even greater when clinicians must make rapid critical decisions. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances.

Background: The Scanning Ears for Child Health (SEARCH) system is a biometric patient identification tool which uses a pattern recognition algorithm to translate an image of the ear into a unique identifier. If integrated into an electronic medical records (EMR) system, it would provide a patient identification solution that replaces unreliable paper, under-five card (UFC), or number-based identifiers. This study aims to understand the relative advantage of the biometric system, the sociocultural and pragmatic compatibility, and the extent of UFC deterioration over time. Methods: Interviews on impressions of the novel biometric patient identification tool were conducted in urban and rural settings in Zambia. Focus group discussions included 59 participants and key informant interviews included 5 healthcare workers and 2 government officials. Transcripts were coded into thematic categories for analysis. We sought to understand 1) the perceived relative advantage of a biometric system over the traditional UFCs among Zambian mothers, 2) the perceived sociocultural compatibility of a biometric system in the healthcare setting, and 3) pragmatic compatibility of the proposed system. Results: We found that the current UFC system presents issues for continuity of care and quality of data management, therefore posing disadvantages relative to the proposed system. Sociocultural and pragmatic barriers to acceptance included the existing fear of Satanism and electrical power issues throughout Zambia. Mothers and healthcare workers expressed that adoption of the biometric system could be successful given efforts to sensitize the community. Conclusions: Switching to an EMR backed by biometric identification would fill a critical gap in Zambian healthcare information systems and has numerous perceived advantages in both urban and rural settings. We determine that strategies for implementation should be localized, context informed, and conducted by trusted community members with knowledge of best approaches to diffusing information and a deep understanding of the novel biometric system.

The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR.

Purpose Cancer is becoming an urgent problem in low- and middle-income countries as the global burden of disease shifts from infectious to noncommunicable diseases. Whereas cervical cancer and breast cancer are preventable and treatable, these diseases are the leading causes of women’s cancer deaths in low-resource settings, mostly because of late-stage presentation and limited diagnostic and treatment capacities. Methods Using the Breast Health Global Initiative resource-stratified guidelines and a phased implementation approach, countries with resource constraints have designed and implemented breast cancer interventions that allow for a balanced, efficient, and equitable use of limited resources. Results Tanzania, Zambia, and a rural area of Colombia serve as examples of evidence-based approaches to the implementation of breast cancer control programs, leveraging the successes and experiences of existing care platforms—mostly cervical cancer and HIV—while creating a solid foundation for country ownership and sustainability. Tanzania used a top-down approach, investing in understanding the needs through a breast health care assessment to inform policy and practice, as well as building a national policy framework. Zambia analyzed the successes and experiences of their public Cervical Cancer Prevention Program to introduce breast cancer education, detection, and surgical treatment, and to improve the time of diagnosis for breast cancer using the single-visit approach recommended by WHO for cervical cancer. A rural community in Colombia has focused on mitigating some of the most common barriers that women face during their cancer journey by improving the cancer education of medical personnel, providing technology for early diagnosis, and implementing an outreach and navigation program that has significantly reduced waiting times from screening through diagnosis and treatment. Conclusion What are key characteristics that guarantee success? Country ownership is crucial, with political, institutional, and community ownership; capabilities; and accountability. Under these four dimensions and a phased implementation framework, we explain the approach that civil society, ministries of health, and stakeholders have taken to implement these programs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Anna Cabanes Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mary Rose Giattas Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mavalynne Orozco Urdaneta Stock or Other Ownership: Celgene, Johnson and Johnson Armando Sardi Stock or Other Ownership: Celgene, Johnson and Johnson

IntroductionZambia is one of the few countries in Africa to permit termination of pregnancy (TOP) on a wide range of grounds. However, substantial barriers remain to TOP and postabortion care (PAC).MethodsWe conducted a census of 153 facilities between March and May 2016. We defined facilities according to whether they met basic and/or comprehensive signal functions criteria for TOP and PAC. We linked our facility data to census data to estimate geographic accessibility under different policy scenarios.ResultsOverall, 16% of facilities reported they had performed a TOP and 39% performed a PAC in the last year. Facilities were twice as likely to use medical methods for TOP compared with surgical methods, and four times more likely for PAC. Considerably more facilities had performed TOP or PAC than met the basic or comprehensive signal functions criteria, indicating services were being performed in facilities below essential quality standards. Under current Zambian law for non-emergency scenarios, 21% of women in Central Province lived within 15 km of a facility with basic capability to provide TOP; if midlevel providers were trained to provide TOP, this would increase to 36%.ConclusionA supportive legislative framework is essential, but not in itself sufficient, for adequate access to services. Training midlevel providers, in line with WHO guidance, and ensuring equipment is available in primary care can increase accessibility of TOP and PAC. While both medical and surgical methods need to be available, medical abortion is a safe and effective method that can be provided in low-resource settings.

Background: Universities present the foundation for socio-economic and political development. Without structures and processes to fight HIV, there is no prospect of enhancing treatment, prevention, care and support services. Copperbelt University HIV and AIDS response was initiated in 2003 with the aim of building capacity of students and employees in HIV and AIDS. Objectives: The main objective of this paper is to demonstrate how the CBU HIV response has evolved over time and provide a timeline of important milestones in the development process. Method: Peer educators and counsellors conduct sensitization campaigns through one on one discussion, workshops, and drama performances, distribution of Information, Education and Communication (IEC) materials. Results: HIV Programme has been set up with players from policy, programme and community levels. Strategic processes, collaborations, funding, medical insurance schemes, prevention, treatment, care and support services, training of peer educators and counsellors have been established. Conclusion: Copperbelt University HIV initiative has demonstrated potential to reduce new infections in the university, and is currently expanding her programme to encompass wellness and also spearhead the integration of HIV in the university curriculum.

Background and context: Cancers of the breast, uterine cervix, and oral cavity are the 3 most common malignancies in India. Overall, they comprise around one third of >1 million cases diagnosed with cancer in India each year. An effective operational framework (OF) for early detection and screening programs should play a key role in reducing and managing the cancer burden in India. Aim: i. To provide guidelines to the clinicians, and public health practitioners for screening and early detection of breast, uterine cervix, and lip or oral cavity cancers in India. ii. To build guide/roadmap for policymakers involved in developing and implementing strategies for cancer control in India. Strategy/Tactics: In collaboration with the Center for Global Health at the U.S. National Cancer Institute, 25 scientific experts comprising researchers, public health leaders, medical and dental professionals from France, India, United States, and Zambia met at Indian Council of Medical Research (ICMR)-National Institute of Cancer Prevention and Research, to summarize the feasible options and relevant evidence for screening and early detection of common cancers in India. They came out with the operational framework Program/Policy process: Recognizing the key role that effective early detection and screening programs could have in reducing the cancer burden, the ICMR-National Institute of Cancer Prevention and Research, in collaboration with the U.S. National Cancer Institute Center for Global Health, held a workshop to summarize feasible options and relevant evidence for screening and early detection of common cancers in India. Outcomes: a. A publication in Lancet: Rajaraman P, Anderson BO, Basu P, et al: Recommendations for screening and early detection of common cancers in India. Lancet Oncol 16(7):e352-e361, 2015. b. State and PHC level trainings on operational framework started in each state for the primary health care providers. What was learned: The OF acts as a guide for policymakers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control. Common and consistent OF will go a long way to chart out the intensity of the problem and to rectify it.

Objective - to analyze the structure of motivational attitudes of nurse personnel and their career orientations. Materials and methods. The study was conducted on the basis of three multidisciplinary medical organizations in St. Petersburg. Nurses were asked to complete two questionnaires, including an assessment of motivation and career orientations. The total number of questionnaires processed was 162. The average length of service of the respondents was 10.5 years. According to age, the respondents were distributed as follows: 62.0% were people aged 20-29 years, approximately equal shares were people 30-39 years old (18.6%) and 40 years and older (19.4%). The study of the motivation of professional activity was carried out according to the methodology of K. Zamfir (modified by A. Rean). Also, the methodology used to diagnose the value orientations in the career was ''Career Anchors'' (the method of E. Shein in adaptation by V.A. Chiker and V.E. Vinokurov). The questionnaires contain certain points and clues, allowing one to evaluate, respectively, the nature of motivation and preferred orientations. The statistical processing of collected data was performed with the Microsoft Office 2016 programs: Microsoft Word, Microsoft Excel. Results. It was established that in the structure of motivation, 40.2% is an external positive motivation (positive incentives in the organization), 30.1% is an internal motivation (satisfaction with work and its results), 19.7% is an external negative motivation (punishment). The main value orientations in a career are as follows. In the first place - the integration of lifestyles (in 73.2% of cases, this orientation scored maximum points); on the second -stability of work (62.0%); in the third place - ministry (52.4%). The ratio of value orientations varies somewhat among people of different ages. Conclusion. The identified features of motivation and value orientations of nurses should be taken into account both as a whole (to develop a system of motivation in the organization) and personally, taking into account the individual characteristics of each employee. The study of motivation should be carried out by psychologists of medical organizations, and the results should be transmitted to managers to form a reasonable personnel policy.

<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Antipsychotics in anxiety disorders</strong></p><p>Christer Allgulander</p><p><strong>2. Anxiety in somatic disorders</strong></p><p>Christer Allgulander</p><p><strong>3. Community rehabilitation of the schizophrenic patient</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera</p><p><strong>4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care</strong></p><p>David Blackbeard</p><p><strong>5. The emotional language of the gut - when 'psyche' meets 'soma'</strong></p><p>Helen Clark</p><p><strong>6. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>7. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia</strong></p><p>Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund</p><p><strong>9. The importance of relapse prevention in schizophrenia</strong></p><p>Robin Emsley</p><p><strong>10. Mental Health care act: Fact or fiction?</strong></p><p>Helmut Erlacher, M Nagdee</p><p><strong>11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital?</strong></p><p>Lennart Eriksson</p><p><strong>12. The incidence and risk factors for dementia in the Ibadan study of ageing</strong></p><p>Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona</p><p><strong>13. Is depression a disease of inflammation?</strong></p><p><strong></strong>Angelos Halaris</p><p><strong>14. Paediatric bipolar disorder: More heat than light?</strong></p><p>Sue Hawkridge</p><p><strong>15. EBM: Anova Conundrum</strong></p><p>Elizabeth L (Hoepie) Howell</p><p><strong>16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit</strong></p><p>Bernard Janse van Rensburg</p><p><strong>17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges</strong></p><p>Yasmien Jeenah</p><p><strong>18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia</strong></p><p>Gerhard Jordaan, D G Nel, R Hewlett, R Emsley</p><p><strong>19. Anxiety disorders: the first evidence for a role in preventive psychiatry</strong></p><p>Andre F Joubert</p><p><strong>20. The end of risk assessment and the beginning of start</strong></p><p>Sean Kaliski</p><p><strong>21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda</strong></p><p>E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel</p><p><strong>22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape</strong></p><p>N K Kirimi, C Visser</p><p><strong>23. Mental Health service user priorities for service delivery in South Africa</strong></p><p>Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium</p><p><strong>24. The nature and extent of over-the-counter and prescription drug abuse in cape town</strong></p><p>Liezl Kramer</p><p><strong>25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital</strong></p><p>Christa Kruger</p><p><strong>26. Suicide risk in Schizophrenia - 20 Years later, a cohort study</strong></p><p>Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos</p><p><strong>27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal</strong></p><p>Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution</p><p><strong>28. Mental health aspects of South African emigration</strong></p><p>Maria Marchetti-Mercer</p><p><strong>29. What services SADAG can offer your patients</strong></p><p>Elizabeth Matare</p><p><strong>30. Culture and language in psychiatry</strong></p><p>Dan Mkize</p><p><strong>31. Latest psychotic episode</strong></p><p>Povl Munk-Jorgensen</p><p><strong>32. The Forensic profile of female offenders</strong></p><p>Mo Nagdee, Helmut Fletcher</p><p><strong>33. The intra-personal emotional impact of practising psychiatry</strong></p><p>Margaret Nair</p><p><strong>34. Highly sensitive persons (HSPs) and implications for treatment</strong></p><p>Margaret Nair</p><p><strong>35. Task shifting in mental health - The Kenyan experience</strong></p><p>David M Ndetei</p><p><strong>36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>37. Integrating to achieve modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic</strong></p><p>A Parkinson</p><p><strong>39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research</strong></p><p>Charles Parry</p><p><strong>40. Global mental health - A new global health discipline comes of age</strong></p><p>Vikram Patel</p><p><strong>41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa</strong></p><p>Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium</p><p><strong>42. Personality disorders -The orphan child in axis I - Axis II Dichotomy</strong></p><p><strong></strong>Willie Pienaar</p><p><strong>43. Case Studies in Psychiatric Ethics</strong></p><p>Willie Pienaar</p><p><strong>44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications</strong></p><p>Janus Pretorius</p><p><strong>45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials</strong></p><p>Suvira Ramlall, Jennifer Chipps</p><p><strong>46. Biological basis of addication</strong></p><p>Solomon Rataemane</p><p><strong>47. Genetics of Schizophrenia</strong></p><p>Louw Roos</p><p><strong>48. Management of delirium - Recent advances</strong></p><p>Shaquir Salduker</p><p><strong>49. Social neuroscience: Brain research on social issues</strong></p><p>Manfred Spitzer</p><p><strong>50. Experiments on the unconscious</strong></p><p>Manfred Spitzer</p><p><strong>51. The Psychology and neuroscience of music</strong></p><p>Manfred Spitzer</p><p><strong>52. Mental disorders in DSM-V</strong></p><p>Dan Stein</p><p><strong>53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study</strong></p><p>Ugashvaree Subramaney</p><p><strong>54. Eating disorders: An African perspective</strong></p><p>Christopher Szabo</p><p><strong>55. An evaluation of the WHO African Regional strategy for mental health 2001-2010</strong></p><p>Thandi van Heyningen, M Majavu, C Lund</p><p><strong>56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia</strong></p><p>Jacques J M van Hoof</p><p><strong>57. The origin of mentalisation and the treatment of personality disorders</strong></p><p>Jacques J M Hoof</p><p><strong>58. How to account practically for 'The Cause' in psychiatric diagnostic classification</strong></p><p>C W (Werdie) van Staden</p><p><strong>POSTER PRESENTATIONS</strong></p><p><strong>59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>61. Lessons learnt from a modified assertive community-based treatment programme in a developing country</strong></p><p>Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen</p><p><strong>62. Perceptions of psychologists regarding the use of religion and spirituality in therapy</strong></p><p>Ottilia Brown, Diane Elkonin</p><p><strong>63. Resilience in families where a member is living with schizophreni</strong></p><p>Ottilia Brown, Jason Haddad, Greg Howcroft</p><p><strong>64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme</strong></p><p>Volker Hitzeroth</p><p><strong>67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series</strong></p><p>Terri Henderson</p><p><strong>68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature</strong></p><p>Bernard Janse van Rensburg</p><p><strong>69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios</strong></p><p>Bernard Janse van Rensburg</p><p><strong>70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population</strong></p><p>Marinda Joubert, J L Roos, J Jordaan</p><p><strong>71. A role for structural equation modelling in subtyping schizophrenia in an African population</strong></p><p>Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley</p><p><strong>72. Caregivers of disabled elderly persons in Nigeria</strong></p><p>Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley</p><p><strong>73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>75. 'The Great Suppression'</strong></p><p>Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes</p><p><strong>76. Not being allowed to grow up - The Mastersonian approach to the borderline personality</strong></p><p>Daleen Macklin, W Griffiths</p><p><strong>77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study</strong></p><p>Daleen Macklin, Loray Daws, M Aronstam</p><p><strong>78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p><strong></strong> T G Magagula, M M Mamabolo, C Kruger, L Fletcher</p><p><strong>79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p>M M Mamabolo, T G Magagula, C Kruger, L Fletcher</p><p><strong>80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines</strong></p><p>Carina Marsay, C P Szabo</p><p><strong>81. Reported rapes at a hospital rape centre: Demographic and clinical profiles</strong></p><p>Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat</p><p><strong>82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry</strong></p><p>Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan</p><p><strong>83. Trends of suicide in the Transkei region of South Africa</strong></p><p>Banwari Meel</p><p><strong>84. Functional neuro-imaging in survivors of torture</strong></p><p>Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal</p><p><strong>85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care?</strong></p><p>Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner</p><p><strong>86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa</strong></p><p>Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales</p><p><strong>87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience</strong></p><p>Ugashvaree Subramaney</p><p><strong>88. Drugs and other therapies under investigation for PTSD: An international database</strong></p><p>Sharain Suliman, Soraya Seedat</p><p><strong>89. Frequency and correlates of HIV Testing in patients with severe mental illness</strong></p><p>Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh</p><p><strong>90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital</strong></p><p>Stephan van Wyk, Zukiswa Zingela</p><p><strong>91. A brief report on the current state of mental health care services in the Eastern Cape</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso</p><p><strong>92. An integrated mental health care service model for the Nelson Mandela Bay Metro</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri</p><p><strong>93. Traditional and alternative healers: Prevalence of use in psychiatric patients</strong></p><p>Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauche</p>

Abstract Background While HIV programmes have started millions of persons on life-saving antiretroviral therapy in Africa, longitudinal health information systems are frail and, therefore, data about long-term survival is often inaccurate or unknown to HIV programmes. The ‘Better Information for Health in Zambia’ (BetterInfo) Study – a regional sampling-based survey to assess retention and mortality in HIV programmes in Zambia – found both retention and mortality to be higher than prevailing estimates from national surveillance systems. We sought to understand how Zambian health decision-makers at different health system levels would respond to these new data, with a view to informing research translation. Methods We interviewed 25 purposefully sampled health decision-makers from community, facility, district, provincial and national levels. During the interviews, we shared retention and mortality estimates from both routine programme surveillance and those generated by the study. Transcripts were analysed for inductive and deductive themes, the latter drawing on Weiss’s framework that policy-makers interpret and apply evidence as ‘warning’, ‘guidance’, ‘reconceptualisation’ or ‘mobilisation of support’. Findings All decision-makers found study findings relevant and important. Decision-makers viewed the underestimates of mortality to be a warning about the veracity and informativeness of routine data systems. Decision-makers felt guided by the findings to improve data monitoring and, acknowledging limitations of routine data, utilised episodic patient tracing to support improved data accuracy. Findings catalysed renewed motivation and mobilisation by national level decision-makers for differentiated models of HIV care to improve patient outcomes and also improved data management systems to better capture patient outcomes. Inductive analysis highlighted a programmatic application data interpretation, in which study findings can influence facility and patient-level decision-making, quality of care and routine data management. Conclusions New epidemiological data on patient outcomes were widely seen as informative and relevant and can potentially catalyse health system action such as using evaluations to supplement electronic medical record data to improve HIV programmes. Formative evidence suggests that targeting research dissemination at different levels of the health system will elicit different responses. Researchers supporting the translation of evidence to action should leverage all relevant levels of the health system to facilitate both policy and programmatic action.

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Abstract Background Pre-eclampsia is a pregnancy complication characterised by high blood pressure and multi-organ dysfunction in the mother. It is a leading contributor to maternal and perinatal mortality, with 99% of these deaths occurring in low- and middle-income countries (LMIC). Whilst clear guidelines exist for management of early-onset (< 34 weeks) and term (≥ 37 weeks) disease, the optimal timing of delivery in pre-eclampsia between 34+ 0 and 36+ 6 weeks is less clear. In a high-income setting, delivery may improve maternal outcomes without detriment to the baby, but this intervention is yet to be evaluated in LMIC. Methods The CRADLE-4 Trial is a non-masked, randomised controlled trial comparing planned early delivery (initiation of delivery within 48 h of randomisation) with routine care (expectant management) in women with pre-eclampsia between 34+ 0 and 36+ 6 weeks’ gestation in India and Zambia. The primary objective is to establish whether a policy of planned early delivery can reduce adverse maternal outcomes, without increasing severe neonatal morbidity. Discussion The World Health Organization recommends delivery for all women with pre-eclampsia from 37 weeks onwards, based on evidence showing clear maternal benefit without increased neonatal risk. Before 34 weeks, watchful waiting is preferred, with delivery recommended only when there is severe maternal or fetal compromise, due to the neonatal risks associated with early preterm delivery. Currently, there is a lack of guidance for clinicians managing women with pre-eclampsia between 34+ 0 and 36+ 6 weeks. Early delivery benefits the mother but may increase the need for neonatal unit admission in the infant (albeit without serious morbidity at this gestation). On the other hand, waiting to deliver may increase the risk of stillbirth, fetal growth restriction and hypoxic brain injury in the neonate as a result of severe maternal complications. This is especially true for LMIC where there is a higher prevalence of adverse events. The balance of risks and benefits therefore needs to be carefully assessed before making firm recommendations. This is the first trial evaluating the optimal timing of delivery in pre-eclampsia in LMIC, where resources and disease burden are considerably different. Trial registration ISRCTN 10672137. Registered on 28 November 2019.

Abstract Background Following the World Health Organization’s (WHO) 2015 guidelines recommending initiation of antiretroviral therapy (ART) irrespective of CD4 count for all people living with HIV (PLHIV), many countries in sub-Saharan Africa have adopted this strategy to reach epidemic control. As the number of PLHIV on ART rises, maintenance of viral suppression on ART for over 90% of PLHIV remains a challenge to government health systems in resource-limited high HIV burden settings. Non facility-based antiretroviral therapy (ART) delivery for stable HIV+ patients may increase sustainable ART coverage in resource-limited settings. Within the HPTN 071 (PopART) trial, two models, home-based delivery (HBD) or adherence clubs (AC), were offered to assess whether they achieved similar viral load suppression (VLS) to standard of care (SoC). In this paper, we describe the trial design and discuss the methodological issues and challenges. Methods A three-arm cluster randomized non-inferiority trial, nested in two urban HPTN 071 trial communities in Zambia, randomly allocated 104 zones to SoC (35), HBD (35), or AC (34). ART and adherence support were delivered 3-monthly at home (HBD), adherence clubs (AC), or clinic (SoC). Adult HIV+ patients defined as “stable” on ART were eligible for inclusion. The primary endpoint was the proportion of PLHIV with virological suppression (≤ 1000 copies HIV RNA/ml) at 12 months (± 3months) after study entry across all three arms. Viral load measurement was done at the routine government laboratories in accordance with national guidelines, annually. The study was powered to determine if either of the community-based interventions would yield a viral suppression rate drop compared to SoC of no more than 5% in its absolute value. Both community-based interventions were delivered by community HIV providers (CHiPs). An additional qualitative study using observations, interviews with PLHIV, and FGDs with community HIV providers was nested in this study to complement the quantitative data. Discussion This trial was designed to provide rigorous randomized evidence of safety and efficacy of non-facility-based delivery of ART for stable PLHIV in high-burden resource-limited settings. This trial will inform policy regarding best practices and what is needed to strengthen scale-up of differentiated models of ART delivery in resource-limited settings. Trial registration ClinicalTrials.gov NCT03025165. Registered on 19 January 2017

ObjectiveWe aimed to assess the effect of the amended Public Health act of 2013 on facility-based HIV testing in Princess Marina Hospital.IntroductionHIV testing remains the mainstay of optimal HIV care and is pivotal to control and prevention of the disease, however efforts to attain optimal testing levels have been undermined by low HIV testing especially in developing countries. Botswana in response, amended its Public Health Act in September 2013 but the effect of this action on facility based HIV testing rates has not been evaluated.MethodsWe carried out an effect assessment using interrupted time-series analysis method, where we accessed electronic medical records of patients seen in Princess Marina Hospital from June 2011 to May 2015. Rates were developed from the proportion of patients that tested each month out of the number that registered, and that figure used that as our data point in the series. September 2013 served as our intervention period in the series. We ran the (i) crude and (ii) sex-stratified model regression models in stata® yielding Newey-West coefficients with their 95% confidence intervals. Graphical display of the models were also produced to visual appreciation and inspection.ResultsTwo hundred and twenty-nine thousand six hundred and ninety two patients were registered between June 2011 and May 2015. Of those tested the significant majority being females (65%). From the Newey-regression output there was no significant change in the level of HIV testing immediately after the intervention however there was a change in trend(p=0.002) post the intervention. Stratification by gender, revealed no statistically significant difference between males and females, either in the levels nor the trend post intervention compared to pre-intervention.ConclusionsThe amendment of the Public Health act of 2013, has brought about trend change in HIV testing however there has not been any apparent difference in the levels nor trends on HIV testing between males and females. Nationwide health facility-based studies could assist assess the overall effect of the amended act on HIV testing rates.References1. Provider Initiated HIV Testing and Counseling: One Day Training Programme, Field Test Version. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2011.2. Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. The Lancet. 2010;375(9731):2092-8.3. Lawn SD, Harries AD, Anglaret X, Myer L, Wood R. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. Aids. 2008;22(15):1897-908.4. McMahon JM, Pouget ER, Tortu S, Volpe EM, Torres L, Rodriguez W. Couple-based HIV counseling and testing: a risk reduction intervention for US drug-involved women and their primary male partners. Prevention science : the official journal of the Society for Prevention Research. 2015;16(2):341-51.5. Shan D, Duan S, Gao J, Yang Y, Ye R, Hu Y, et al. [Analysis of early detection of HIV infections by provider initiated HIV testing and counselling in regions with high HIV/AIDS epidemic in China]. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2015;49(11):962-6.6. Hensen B, Baggaley R, Wong VJ, Grabbe KL, Shaffer N, Lo YRJ, et al. Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider initiated testing & counselling. Tropical Medicine & International Health. 2012;17(1):59-70.7. Ijadunola K, Abiona T, Balogun J, Aderounmu A. Provider-initiated (Opt-out) HIV testing and counselling in a group of university students in Ile-Ife, Nigeria. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception. 2011;16(5):387-96.8. Baisley K, Doyle AM, Changalucha J, Maganja K, Watson-Jones D, Hayes R, et al. Uptake of voluntary counselling and testing among young people participating in an HIV prevention trial: comparison of opt-out and opt-in strategies. PloS one. 2012;7(7):e42108.9. Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE. Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bulletin of the World Health Organization. 2011;89(5):328-35A.10. Tlhakanelo JT, Mulumba-Tshikuka JG, Molefi M, Magafu MG, Matchaba-Hove RB, Masupe T. The burden of opportunistic-infections and associated exposure factors among HIV-patients admitted at a Botswana hospital. 2015.11. Bernard EJ. BOTSWANA’S DRACONIAN PUBLIC HEALTH BILL APPROVED BY PARLIAMENT, BONELA WILL CHALLENGE IT AS UNCONSTITUTIONAL ONCE PRESIDENT SIGNS INTO LAW (UPDATE 3). HIV justice Network. 2013.12. Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prevention science : the official journal of the Society for Prevention Research. 2000;1(1):31-49.

Aims: To review how social reintegration and rehabilitation processes are being executed among obstetric patients in Sub-Saharan Africa and highlight projects and programs involved.
 Methods: This is a systematic review involving a search of relevant literature from PubMed, Google scholar, PsychINFO, African Journals Online, Australian Journals Online, and open access journal of international organizations such as WHO, UNFPA, USAID, Engender Health, Fistula Foundation, and Fistula Care Plus published between 1978 to date. Of the 46 articles identified, 25 were suitable for achievement of this study’s purpose.
 Results: Sub-Saharan African countries have recognized the overall burden of obstetric fistula and have devised strategies for its’ holistic management. Most countries have National Obstetric Fistula Strategic Frameworks which emphasize multi-sectoral and multidisciplinary approaches other than medical paradigm. Extraordinary among others are: Nigeria, Uganda, Tanzania and Guinea while some countries such as Benin Republic, Chad, Malawi, Mali, and Zambia lack support the at policy level, and have inadequate community outreach programmes. Social reintegration and rehabilitation have been done through the identification of individual patient’s need/s. Upon discharge from hospital, they are counseled, given soap, clothes, transportation fund and are referred to community based projects for elementary education and skills development. Projects and programmes aiming to combat obstetric fistula and restore patients’ self-worth and dignity are: Lamaneh Suisse, and Delta Survie in Mali, Dimol in Niger, Medecins Sans Frontieres (MSF) in Burundi, FORWARD in Nigeria and Sierra Leone, Handicap International in Benin Republic, Women For Africa in Ghana and Liberia, TERREWODE and CoRSU both in Uganda, Hamlin Fistula Ethiopia in Ethiopia, and Safe Motherhood Initiative, Fistula Foundation, Fistula Care Plus, Engender Health, UNFPA, AMREF for Health, WHO and others which cut across the region.
 Conclusions: Most Sub-Saharan countries have registered progress in assuring effective social reintegration and rehabilitation of obstetric fistula patients although some are still grappling with the issue due to lack of political commitment and inadequate outreach programmes. There is scanty information regarding reintegration and rehabilitation before obstetric fistula repair and yet it would hasten physical and mental wellbeing of the patients as they await repair.

Abstract Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.