Safeguarding patient and personnel safety and improving care quality has emerged as a critical priority for healthcare systems globally. In response to persistent challenges in healthcare delivery, many countries have adopted clinical governance frameworks and organisational learning processes to strengthen accountability and promote continuous improvement. Robust clinical governance frameworks provide the processes and accountability measures necessary to foster a culture of knowledge-sharing and evidence-based decision-making, all of which are key characteristics of a learning organisation. This study seeks to investigate the role of clinical governance in improving hospital performance through three interconnected sub-studies. The first sub-study will explore how non-clinical managers in selected public sector hospitals leverage clinical governance to improve hospital performance. The second sub-study will evaluate the impact of clinical governance interventions on clinical outcomes and identify opportunities for organisational learning within these hospitals. The third sub-study will serve as an embedded experimental component, monitoring changes in complaint resolution indicators before and after interventions to assess improvements in clinical governance through both intra- and inter-hospital comparisons. Qualitative data will be analysed using NVivo version 15, with inductive thematic analysis employed to uncover emergent patterns and interpretive themes.

Background: Wound dressing is an integral part of wound care protocol. However, the cost of dressing changes with the associated wound aetiology has not been well studied. The study investigates the cost implications of wound dressing across wound aetiology among hospitalized patients. Methods: The study followed a descriptive cross-sectional research design to determine the cost of dressing changes and the associated wound aetiology among hospitalized patients. Study sites included medical-surgical units in three selected hospitals in southwest Nigeria. The study was conducted between May to July 2021. One hundred and ninety patients were recruited for the study. The eligibility criteria focused on patients hospitalized for at least four weeks or about to be discharged. Data collection was via a researcher-administered questionnaire. Ethical approval was received from the university and each of the hospitals. Results: The finding shows that 34.2% of the respondents had road traffic accidents, followed by cancers, 22.6%, and surgical wound infections, 16.8%. Most patients were involved in daily (41.6%) or alternate-day (38.4%) wound dressing. Over 50% of the respondents earn less than US$30 per month, 34.7% earn between US$30 – US$60, while only 3.2% earn more than US$ 120. Also, 55.7% require 1–5 moderate or significant dressing packs per week. 75% had wound care paid for by relatives. The average burn injuries cost of wound dressing per week is estimated to be $8.42, while falls ($5.31), occupational injuries ($3.77), gunshot injuries ($3.74), and road traffic accidents ($3.49). The average cost of hospitalization for burn injuries per week was estimated to be $22.35, while for falls, road traffic accidents, and surgical wound infections, was $19.58, $19.32, and $18.37, respectively. Conclusions: The cost requirements for prosperous wound dressing place a high financial burden on hospitalized patients in Nigeria. There is a need to scale Nigeria’s health insurance database to include the low socioeconomic class.

Background: Household contacts of smear-positive tuberculosis (TB) patients face an elevated risk of infection and disease progression, particularly young children and individuals living in overcrowded households. Despite WHO recommendations for systematic contact screening and provision of TB preventive therapy (TPT), implementation remains suboptimal in high-burden rural areas. This study aimed to develop a practical framework for identifying and prioritizing high-risk families by examining demographic predictors, household clustering, and machine learning-based risk models. Methods: A total of 437 household contacts linked to smear-positive index cases were assessed and classified as high or low risk. Statistical analyses included descriptive measures, χ² tests, Z-tests for age-group differences, and multivariable logistic regression. Household-level vulnerability patterns were explored using network visualizations, clustered heatmaps, and risk-ranking charts. Three machine learning models, logistic regression, random forest, and gradient boosting, were trained using demographic and household variables with 5-fold cross-validation and an 80/20 hold-out test split. Model performance was evaluated using the AUROC, AUPRC, accuracy, F1-score, calibration curves, and decision curve analysis. Results: Of the 437 contacts, 290 (66.4%) were classified as high risk. A younger age was strongly associated with high-risk status (χ² = 16.61, p = 0.005), with children aged 0–4 years being significantly more likely to be in a high-risk category (Z = 2.706). Gender showed no significant association (p = 0.523). Logistic regression identified younger age (aOR = 2.41, 95% CI: 1.48–3.94) and larger household size (aOR = 1.12 per additional member, 95% CI: 1.01–1.25) as independent predictors of the outcome. Visual analytics revealed apparent clustering of high-risk individuals within “hotspot families,” enabling prioritization through composite risk scores. Gradient boosting achieved the strongest performance (AUROC = 0.65; AUPRC = 0.76), with acceptable calibration (Brier score = 0.21) and a positive net clinical benefit in the decision curve analysis. Conclusions: TB risk is highly clustered at the household level, with large families and young children carrying disproportionate vulnerability. Combining demographic risk assessment, household-level visualization, and predictive modeling provides a practical, data-driven approach to prioritizing households during contact investigation. These findings support the WHO’s family-centered strategy and underscore the need to strengthen clinical governance and community-engaged education to optimize TB prevention in resource-limited rural settings.

Background: Prostate cancer remains a significant public health burden globally, particularly in sub-Saharan Africa, where rising incidence rates are compounded by limited screening, late-stage diagnosis and disparities in healthcare access. In South Africa, the Eastern Cape Province reports high prostate cancer prevalence, with many patients presenting at advanced stages. Understanding the epidemiological profile of affected individuals is critical for developing targeted health strategies. Objectives: This sub-study aims to describe the epidemiological characteristics of patients diagnosed with prostate cancer, using secondary data from Nelson Mandela Academic Hospital (NMAH), focusing on patients seen between March 2020 and November 2021. Methods: A quantitative cross-sectional study design is employed. De-identified secondary data extracted from clinical records of male patients diagnosed with prostate cancer and managed at NMAH during the study period. Variables include demographic information, clinical characteristics, health service utilization indicators. Analysis: Data will be captured and coded in Microsoft excel 2013 (Microsoft corporation, Seattle, WA, USA). The data will then be exported to STATA 18 for analyses. Descriptive statistics will be used to summarize the data. Inferential analyses such as logistic regression and chi-square tests will be used to explore associations between variables and treatment outcomes. The study provides insights into the demographic and clinical profiles of prostate cancer patients in a high-burden setting. It is anticipated that findings will highlight the age distribution, stage at diagnosis, and treatment patterns among patients diagnosed with prostate cancer. This will inform future prevention and intervention strategies in the Eastern Cape Province. Conclusions: By mapping out the epidemiological patterns of prostate cancer in the Eastern Cape through this sub-study, the research contributes to evidence-based planning and resource allocation, ultimately supporting efforts to reduce prostate cancer morbidity and mortality in rural South Africa.

Introduction: Disability in South Africa remains a key driver of socioeconomic inequality, affecting labour market participation, income security, and access to social protection. Conventional fiscal instruments, including medical tax credits and deductions, favour formally employed, higher-income taxpayers, leaving many persons with disabilities fiscally excluded. This study used a mixed-methods secondary analysis of peer-reviewed literature, policy documents, labour force data, disability grant records, and household cost estimates to develop a conceptual framework for disability-responsive fiscal inclusion. Results: Labour force data indicate that 10.2% of individuals outside the labour force are due to illness or disability, while discouraged jobseekers rose from 15.2% (2016) to 20.6% (2025). Households with severe disabilities face opportunity costs estimated at R2441 per month from lost earnings, caregiving, transport, and medical expenses. Disability grant patterns show male dominance in permanent disability grants for ages 18–45, with females surpassing males at 50–60. Temporary disability grants follow similar trends, with male predominance in the 18–35 age range and female predominance in the 40–60 age range. These findings reveal systematic gender- and age-related inequities in access to fiscal relief. Conclusions: Existing tax measures insufficiently address the financial burden of disability, disproportionately favouring urban, formally employed households. Implementing refundable tax credits, simplifying administrative processes, and adopting gender- and age-sensitive policies can enhance fiscal inclusion, reduce inequities, and strengthen economic participation for persons with disabilities in South Africa. This study proposes a framework to guide policymakers in implementing refundable disability tax credits, simplifying administrative processes, and targeting vulnerable groups, including older women, rural households, and low-income earners, to enhance fiscal inclusion, equity, and access to essential services.

Circumcision is a long-standing and frequently performed surgical procedure which holds significant cultural significance among AmaXhosa people in South Africa. Due to cultural reasons in some parts of Africa, the integration of medical male circumcision with traditional manhood initiation rituals still lacks acceptance. This study examined the level of knowledge and acceptance of voluntary male medical circumcision (VMMC) among young males in a selected high school in the Nyandeni District of the Eastern Cape Province, South Africa. A descriptive, quantitative, cross-sectional study was conducted, and a self-administered questionnaire was used to obtain information on sociodemographic characteristics, knowledge of VMMC, percep-tions of VMMC, and circumcision practices. One Hundred participants were recruited from both grades 11 and 12, and 82% of the participants indicated that they had received information about VMMC. Most of the respondents (88%) preferred traditional male circumcision (TMC) and only 12% of respondents preferred VMMC. The participants displayed a good understanding of the distinction between VMMC and TMC. However, results from the study showed that most re-spondents exhibited low acceptability towards VMMC. These findings highlight the need to develop evidence-based strategies to enhance learners’ knowledge and acceptance of VMMC.