Background Paper-based clinical records remain widely used in South African public hospitals despite ongoing challenges related to healthcare information management. There is limited evidence regarding the usability of paper-based clinical records in South African hospitals. Aim This study assessed the usability of paper-based clinical records for patient care in four selected South African referral hospitals. Methods A quantitative cross-sectional record review was conducted in four referral hospitals located in the Eastern Cape and Mpumalanga provinces of South Africa. A standardised questionnaire developed from the Canadian Institute for Health Information (CIHI) Quality Framework was used to assess clinical record usability. The usability dimension comprised four constructs: record accessibility and filing, temporal documentation usability, legibility and readability, and communication usability. A total of 255 clinical records were reviewed. Data were analysed using descriptive statistics, the Kruskal–Wallis test, and Fisher’s Exact test, with statistical significance set at p < 0.05. Results Overall usability demonstrated moderate performance, with a mean score of 53.1% (SD: 13.3). Temporal documentation usability achieved the highest performance (mean: 96.6%; SD: 11.2), followed by record accessibility and filing (mean: 74.9%; SD: 21.2). Legibility and readability performed poorly (mean: 32.6%; SD: 45.1), while communication usability demonstrated the lowest performance (mean: 8.4%; SD: 20.2). Significant differences in usability construct scores were observed across hospitals (p < 0.05). Overall, 65.1% of reviewed records were classified as having poor usability. Conclusion Paper-based clinical records in the reviewed hospitals demonstrated substantial usability limitations, particularly regarding legibility and communication. Strengthening clinical documentation practices and improving health information management systems are necessary to enhance patient care quality, continuity of care, and healthcare service delivery in South African hospitals.

Background According to research in medical education, medical curriculum needs to address the health system and its issues. In 2014, the Faculty of Health Sciences at Walter Sisulu University introduced a 20-week Integrated Longitudinal Clinical Clerkship rotation block as part of its commitment to Community Based Education and social responsiveness, with an emphasis on how the curriculum needs to be developed to address the challenges of the country's health system. The study's aim was to explore if the ILCC can be a transformative learning tool used to understand the complex health needs of society. Methods A cross-sectional, exploratory study was conducted using qualitative research methods. Data was collected in hospitals where the students were housed during their 20-week community clerkship. Using interview guides, six focus group discussions were held, and they were furthered by field notes, observations, an interview, and journal entries. The focus group discussions were tape-recorded, then transcribed. Results The study identifies three phases of students' transformation during ILCC rotation: social and personal transformation, shift in understanding of community needs, and response to community needs. Conclusion The study found that factors like adaptability, program duration, community skills, and peer relationships influenced students' transformation during the Integrated Longitudinal Clerkship, although not all experienced significant changes.

Background: Cancer is a rising public health concern in South Africa, with varying incidence and prevalence trends between provinces. Objectives: This study aimed to investigate the approach to estimating and ranking common cancers in South Africa’s Eastern Cape and Mpumalanga provinces through a patient survey in three referral hospitals. Methods: A quantitative cross-sectional design was employed from 1 April 2022 to 31 July 2022. A total of 425 patients were recruited to participate in this study. Patients were purposively sampled. Pretests were conducted to determine the reliability and validity of the instruments. Data were coded in Microsoft Excel and Stata; version 18 was used for data analysis. Ethical principles were observed and ensured throughout the study. Results: The results show the highest prevalence as breast cancer with 37.65% representing 160 cases, followed by cervical cancer with 19.06% (81 cases), and prostate cancer with 12.00% (51 cases). Conclusions: This study provided valuable insights into the prevalence and distribution of common cancers in the Eastern Cape and Mpumalanga provinces of South Africa based on data collected from patients across three referral hospitals.

Background Neonatal mortality remains a significant public health challenge in South Africa, particularly in rural settings where health outcomes continue to reflect structural inequities rooted in the apartheid era. This study aimed to describe maternal and neonatal characteristics among neonatal deaths at a rural hospital in the Eastern Cape from 2019 to 2025. Methods This retrospective descriptive study used data extracted from routinely collected maternal and neonatal records and analysed using IBM SPSS version 30. During the study period, 28,107 live births and 252 neonatal deaths were recorded, corresponding to a neonatal mortality rate (NMR) of 9.0 per 1,000 live births. Of the identified neonatal deaths, 200 records contained sufficient information for analysis. Results Most neonatal deaths occurred among preterm neonates (64.8%), low birth weight infants, and male neonates (58.1%). Most deaths occurred during the early neonatal period, particularly within the first three days of life in this facility. Birth asphyxia (49.7%), hypothermia (33.3%), and neonatal infection or sepsis (17.1%) were among the most frequently documented clinical conditions. Among mothers with available records, late antenatal booking and infrequent antenatal care attendance were commonly documented. Conclusion These findings provide a descriptive profile of neonatal deaths at a rural district hospital and highlight patterns requiring further investigation and quality improvement initiatives. The study also demonstrates the importance of improving data completeness and routine neonatal surveillance in rural healthcare settings. Ethics approval was obtained from Walter Sisulu University (WSU HREC 110/2025) and the Eastern Cape Health Research Committee (EC_202507_061).

Background Neonatal mortality remains a major public health challenge in low- and middle-income countries. Although the clinical causes of neonatal deaths are well documented, less is known about the health system and clinician-related challenges associated with neonatal deaths in rural South African hospitals. Aim To describe the documented health system and clinician- related challenges among neonatal deaths at a rural district hospital in the Eastern Cape between 2019 and 2025. Methods A retrospective descriptive study was conducted using routinely documented data from neonatal and maternal records, as well as Perinatal Problem Identification Programme (PPIP) audits for neonatal deaths between 2019 and 2025. All in-hospital neonatal deaths of patients who died in the labour ward and those admitted to the nursery were included. Data were extracted and analysed using IBM SPSS version 30. Denominators varied due to missing or incomplete records; only valid cases were analysed for each variable. Results Among 28,107 live births, 252 neonatal deaths were recorded. The identified documentation challenges form a backdrop against which these patterns should be interpreted. Incorrect maternal management (29.7%), incorrect emergency management (22.3%), delayed clinician response (17.9%), and failure to act on clinical findings (16.4%) were the most frequently documented clinician-related issues. Health system weaknesses included insufficient doctors (18.5%), insufficient nurses (13.3%), limited theatre capacity, equipment shortages, and documentation failures. Hypothermia was significantly more common among neonates born outside the facility (p < 0.001) in the neonates who died. Conclusion Frequently documented clinician-related issues and health system weaknesses were staffing shortages, equipment limitations, and delayed clinician responses. These findings highlight areas for quality improvement initiatives in routine care processes and health system support in similar resource-limited settings. Ethics Approved by Walter Sisulu University (WSU HREC 110/2025) and the Eastern Cape Health Research Committee (EC_202507_061).

Background: Clinical documentation is fundamental to quality healthcare delivery, continuity of care, clinical governance, health information management, and medico-legal accountability. However, incomplete clinical documentation remains a persistent challenge in public healthcare settings, and evidence describing documentation completeness at the hospital level in South Africa remains limited. Aim: This study aimed to assess the completeness of paper-based clinical records in selected public hospitals in the Mpumalanga and Eastern Cape provinces of South Africa. Methods: A quantitative cross-sectional clinical record audit was conducted in four public hospitals located in the Ehlanzeni District of Mpumalanga Province and the OR Tambo District of the Eastern Cape Province. A total of 255 randomly selected patient records from major clinical departments were audited using a structured data extraction instrument. Documentation completeness was assessed across seven domains: patient identification, professional identification, record structure, timing documentation, consent documentation, form completion, and clinical care documentation. Descriptive statistics summarised documentation completeness. One-way analysis of variance (ANOVA) compared mean completeness scores between hospitals, while Fisher’s exact test examined associations between hospitals and overall completeness categories. Results: Overall clinical documentation completeness was moderate (mean = 54.5%, SD = 8.1). Timing documentation (96.6%) and clinical care documentation (90.3%) demonstrated the highest completeness, whereas professional identification (37.5%), consent documentation (0.4%), and completion of mandatory clinical forms (1.0%) showed substantial deficiencies. Overall completeness differed significantly between hospitals (F = 14.6, p < 0.001), with RFH and Themba Hospital achieving significantly higher mean completeness scores than NMAH and SEH. Most records (69.8%) were classified as having poor completeness, 29.8% demonstrated moderate completeness, and only one record (0.4%) achieved good completeness. Conclusions: The findings demonstrate that documentation completeness represents only one dimension of clinical record quality and highlight opportunities to strengthen documentation practices within the participating rural public hospitals. Future research should evaluate interventions that improve documentation completeness alongside other dimensions of clinical record quality.