Background Burnout-related symptoms among nurses are a growing concern globally and may affect workforce well-being, patient care, and health system performance. In resource-constrained rural stableettings, heavy workloads, staffing shortages, and limited organisational support may increase nurses’ vulnerability to burnout-related symptoms. Evidence from rural district hospitals in South Africa remains limited. Objective To examine burnout-related symptoms, workplace and organisational factors, and nursing workforce retention indicators among nurses at St Elizabeth Hospital in the Eastern Cape Province, South Africa. Methods A quantitative cross-sectional study was conducted among 210 nurses working in selected clinical departments at St Elizabeth Hospital. Participants were selected using stratified random sampling from an eligible population of 362 nurses. Data were collected using a structured self-administered questionnaire incorporating the Burnout Assessment Tool (BAT-12), selected Maslach Burnout Inventory personal accomplishment items, and workplace-related measures informed by the Job Demands–Resources (JD–R) model. In addition, aggregate nursing workforce and retention indicators were collected from Human Resources records using a structured data extraction tool. Descriptive statistical methods were used to summarise survey data, while Human Resources data were analysed separately. Results High frequencies of burnout-related symptoms were reported, particularly exhaustion. Mental exhaustion was reported often or always by 71.0% of participants, difficulty recovering energy after work by 71.9%, and physical exhaustion by 72.4%. Heavy workload (78.6%), inadequate staffing (68.6%), regular overtime (68.1%), inadequate equipment (67.1%), and limited access to wellness services (48.6%) were common workplace challenges. Human Resources records indicated a 12-month nursing workforce retention rate of 90,49% and a turnover rate of 9,51%. Conclusions Burnout-related symptoms were common among nurses in this rural Eastern Cape district hospital, driven by high workplace demands and limited resources. Organisational improvements, such as better staffing, stronger workplace support, and access to wellness services, could improve nurse well-being and workforce sustainability. The study also highlights the need for longitudinal research on burnout and staff retention while contributing context-specific evidence from an under-researched rural South African setting.

Background: Maternal healthcare access is a critical determinant of women’s and neonatal health, especially in rural areas of low- and middle-income countries. Despite high reported utilization in South Africa, rural communities continue to experience adverse childbirth outcomes. Objective: To evaluate the association between maternal healthcare access and childbirth outcomes in Ingquza Hill Local Municipality, Eastern Cape Province of South Africa. Methods: A cross-sectional study was conducted among 213 pregnant and postpartum women receiving maternal healthcare services at St Elizabeth Hospital, a regional referral hospital serving multiple primary healthcare clinics across the municipality. Data were collected using structured questionnaires and maternity access indicators (including ANC attendance, timing of first ANC visit, number of visits, physical accessibility, and place of delivery), and childbirth outcomes. Logic regression analyses were performed to identify associations between access indicators and unfavorable childbirth outcomes. Results: Utilization of maternal healthcare services was high, with 96% of participants reporting ANC attendance, 92% receiving skilled care during pregnancy, and 91% delivering in a health facility. Unfavorable childbirth outcomes were observed in 12% of participants. Conventional indicators of maternal healthcare access, including ANC attendance, number of visits, physical accessibility, and place of delivery, were not statistically associated with childbirth outcomes in regression analyses. However, initiation of antenatal care was notably delayed, with a mean gestational age at first ANC visit of 21.7 weeks. The limited number of adverse outcomes constrained statistical power to detect modest associations. Conclusions: High maternal healthcare utilization alone did not ensure improved childbirth outcomes in this rural setting. Delayed initiation of antenatal care emerged as a critical gap that may limit the effectiveness of subsequent care, highlighting the limitations of coverage-based access indicators. Strategies to improve maternal and neonatal outcomes should prioritize early antenatal engagement, quality and continuity of care, and move beyond utilization metrics toward measures of effective coverage in rural and resource-limited contexts.

Background: Women with previous caesarean deliveries (CD) contribute to rising CD rates globally, yet limited evidence exists from rural South African district hospitals. The social value of this study lay in understanding delivery outcomes and safety of vaginal birth after caesarean (VBAC) in a resource-limited, generalist clinician setting. The study addressed a knowledge gap regarding VBAC practices and feasibility outside tertiary centres in rural South Africa. Methods: A descriptive study using a retrospective chart review was conducted at Zithulele Hospital, Eastern Cape. Women with previous CD who delivered at the hospital were included. Data were extracted using a data collection form and analysed using descriptive statistics and comparative tests to identify trends and outcomes in the cohort. Results: A total of 195 records were analysed. The overall hospital CD rate was 23.1%, with women with scarred uteri (Robson group 5) accounting for 25% of all CD. Forty-six per cent achieved VBAC, while 54% delivered by repeat CD; all women with two or more previous CD delivered by CD. Successful VBAC was associated with prior VBAC (p = 0.001) and advanced cervical dilatation at presentation (p < 0.001). Maternal complications occurred in 13% of studied population, with 69% following CD. Conclusion: Vaginal birth after caesarean was feasible, safe and moderately successful in this rural setting. Caesarean delivery contributed disproportionately to overall CD rates, largely because of scar-related indications. Contribution: This study provides evidence from a rural clinical context supporting VBAC in district hospitals, highlighting practical factors that strengthen counselling and clinical decision-making within district-level obstetric practice.