The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa. The guidelines were developed by updating the Canadian ... Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts. The recommendations in these guidelines are: 1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5% (conditional recommendation: moderate-quality evidence). 2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence). 3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence). 4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence). Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities. more

This document sets out, therefore, to explain the socioeconomic value of investing in the fight against NTDs and highlights priorities for global investment attention. Our work was guided by the need not only for additional funding and funders but also for the need to understand the current funding ... climate, in which value for money and the efficient use of resources to fill the most critical of gaps are more relevant than ever. more

As a lower-middle-income country (LMIC), South Africa (SA) bears the burden of maternal and neonatal mortality similar to other sub- Saharan African countries. According to the Saving Mothers Report 2017/19, there has been a progressive and sustained reduction in institutional maternal mortality ... (iMMR) in the past three triennia (2010-2019), from 320 per 100,000 live births to 120 per 100,000 live births. According to the Rapid Mortality Survey, the country’s infant mortality rate has declined from 29 deaths per 1000 live births in 2014 to 25 deaths per 1,000 live births in 2018. The institutional neonatal death rate showed a slight decrease from 12,7 deaths per 1,000 live births in 2016 to the current level of 12 per 1,000 live births and has remained static at this level for the past three years (saDHIS). Working towards the Sustainable Development Goal (SDG) of reducing maternal mortality to below 70 per 100 000 live births and neonatal mortality to 12 deaths per 1000 live births, South Africa aims to reduce institutional maternal mortality, neonatal mortality and stillbirths by 50% by 2030. This Maternal, Perinatal and Neonatal Health Policy provides a framework for the delivery of quality, comprehensive, and integrated MNH services and will guide the development and review of guidelines and related MNH interventions, including strengthening of the service delivery platform, governance, leadership and accountability for the provision of quality MNH services, development of advocacy messages, and guiding civil society priorities and community initiatives. The policy will also guide the development and review of academic curricula and the setting of research priorities. more