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Thyroid cancer pathology: Insights from a developing region
(South African Medical Association, 2025) Afrogheh Amir; Conradie Wilhelmina; Lübbe Jeanne
Background. The South African (SA) health sector and laboratories comprise a dual system that includes public and private providers. SA studies illustrate diverse thyroid cancer incidence across provinces, with papillary thyroid cancer (PTC) more prevalent in urban provinces than follicular thyroid cancer (FTC) and anaplastic thyroid carcinoma. Objectives. To provide a deeper insight into the geographic intricacies of thyroid cancer types from public and private provider perspectives. Methods. This study investigated thyroid cancer pathology in SA between 2015 and 2019, overall and by province and facility type (private, public). Laboratories provided data in different formats, requiring manual processing. The data extracted included date of birth, sex, province, specimen type and final histology results. Results. A total of 14 157 reports were included, of which 3 235 were thyroid cancers. Multiple challenges were experienced in terms of data processing. The public sector contributed 53.6% of thyroid cancer cases. Preoperative cytology was performed in 19.8% of thyroid cancers, and was diagnostic in 23.6%. There was significantly more FTC in the public sector (20.8% v. 5.6%), and more PTC in the private sector (87.1% v. 55.2%). T3 tumours were most prevalent in the public sector (52.3%), and T1 tumours in the private (38.8%). Conclusion. The dual SA health system and the geographical distribution of the population appear to influence the pathological landscape of thyroid cancer. Standardised thyroid cancer reporting across all public and private laboratories in the form of a prospective national thyroid registry would allow for a more accurate evaluation of thyroid disease, ultimately improving thyroid cancer care in SA.
Impact of thyroid dysfunction on clinical outcome in head and neck cancer: a systematic review and meta-analysis
(BioMed Central Ltd, 2025) Roberts, Tina S.; Opperman, Johan Frank; Sandeepa N.C.
Background: The influence of thyroid dysfunction on the clinical outcomes of head and neck cancer (HNC) patients remains an area of ongoing investigation, with previous studies yielding variable results. Treatments for HNC, particularly radiotherapy, frequently impact thyroid function. This meta-analysis aimed to synthesize the available evidence on the association between thyroid status (dysfunction vs. euthyroid) and survival outcomes in HNC patients. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Web of Science, Cochrane Library, Embase and Scopus were searched (January 2000-October 2024) for studies comparing survival outcomes (primarily Overall Survival) in adult HNC patients with thyroid dysfunction versus euthyroid patients. Two reviewers independently selected studies and extracted relevant data. The risk of bias for included studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Cochrane Risk of Bias 2 (RoB2) tool for randomized controlled trials. Hazard ratios (HRs) with 95% confidence intervals (CIs) comparing survival were pooled using both fixed-effect (common-effect) and random-effects (REML) models. Heterogeneity across studies was assessed using the I² statistic and Cochran’s Q test. Statistical analyses were performed using R with the meta package. Results: Six studies met the inclusion criteria for systematic review. Four of these studies, encompassing 671 participants, reported sufficient data (Hazard Ratios for Overall Survival) for meta-analysis. The fixed-effect model yielded a pooled HR of 0.99 (95% CI: 0.98, 1.00; p = 0.0013). However, significant heterogeneity was observed (I² = 81.5%, p = 0.0010). Consequently, the random-effects model, deemed more appropriate, yielded a pooled HR of 1.45 (95% CI: 0.66, 3.19; p = 0.3601), indicating no statistically significant association between thyroid status and overall survival in HNC patients. The estimated between-study variance (τ²) was 0.53. Conclusion: This meta-analysis revealed substantial heterogeneity among studies investigating the impact of thyroid status on HNC survival. When accounting for this heterogeneity using a random-effects model, no significant association was found. The findings highlight the need for further research with larger sample sizes, standardized definitions of thyroid dysfunction, consistent reporting of adjusted effect estimates, and exploration of heterogeneity sources. Trial registration: CRD42024535167.
Global prioritised indicators for measuring WHO’s quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus
(BMJ Group, 2025) Jackson, Debra; Day, Louise Tina; Vaz, Lara M E
Objectives The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels. Design Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels. Setting The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur. Participants The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts. Results The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9). Conclusions The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.
Mapping human fatalities from megafauna to inform coexistence strategies
(Scientific Reports, 2025) Mpakairi, Kudzai Shaun; Kavhu, Blessing; Mutema, Courage
Human fatalities from human–wildlife conflict (HWC) represent a critical dimension of conservation, often triggering retaliatory actions and post-traumatic stress in affected communities. However, most studies focus on the economic implications of HWC, neglecting human fatalities which may have far-reaching long-term implications. This study investigates the spatial and temporal patterns of human fatalities caused by megafaunal species in Zimbabwe, using data collected from 2016 to 2022. Through spatial and statistical analyses based on the Getis-Ord Gi* hotspot analysis and Mann–Kendall trend test, we assess fatalities caused by six megafaunal species: Nile crocodile (Crocodylus niloticus), African elephant (Loxodonta africana), hippopotamus (Hippopotamus amphibius), African buffalo (Syncerus caffer), African lion (Panthera leo) and spotted hyena (Crocuta crocuta). The results of the study showed that crocodiles and elephants account for over 80% of human fatalities in Zimbabwe. These fatalities also significantly increased over the study period (p < 0.03). In contrast, fatalities involving lions, hyenas, hippos, and buffaloes showed no significant increase, indicating more stable but still concerning risks. Fatality hotspots were concentrated in Kariba, Binga and Hwange districts in northern and western Zimbabwe, highlighting areas needing urgent interventions. These insights have broader implications for HWC management across Africa, where megafaunal species frequently interact with human populations. By adopting data-driven, species-specific strategies, other countries facing similar conflicts can foster human–wildlife coexistence and improve conservation outcomes.
Exploring the intended and achieved outcomes of the Life Orientation curriculum: A Case study of TVET college graduates in the Western Cape
(The University of the Western Cape, 2025) Somayah Achmat
In South Africa, one of the mandatory subjects in public Technical and Vocational Education and Training (TVET) colleges offered across all the National Certificate Vocational (NCV) programmes is Life Orientation (LO), which forms part of the compulsory fundamental component of the qualification at levels 2, 3 and 4. The LO curriculum intends to support learners in addressing personal and social issues relevant to their lives as South African citizens by effectively assisting their navigation through youth and, eventually, adulthood. Policymakers expect the LO subject to impact students' lives after college, affecting their professional and social interactions. However, limited research exists regarding the translation of LO curriculum objectives into lived experiences, an interest that underpins the study presented here. Using a case study and narrative life history approach, this research investigated TVET college graduate students' impressions of the LO programme they had been exposed to. Twelve recent college graduates were recruited using snowball sampling and were interviewed about their trajectories after graduation.