Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.

Background: Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs).Objectives: To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country.Method: A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40–70 years.Results: The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas.Conclusion: Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

Background: Disparities in MR access between different countries and healthcare systems are well documented. Determinants of unequal access within the same healthcare system and geographical region are poorly understood.Objective: An analysis of public sector MR utilisation in South Africa’s Western Cape province (WCP).Methods: A retrospective study of WCP MR and population data for 2013 and 2018. MR units/106 people, studies, and studies/103 people were calculated for each year, for the whole province and the ‘western’ and ‘eastern’ referral pathways, stratified by age (0–14 years, 14 years)Results: Between 2013 and 2018, the WCP population increased 8% (4.63 vs 5.08 × 106 people) while MR resources were unchanged (‘western’ = 2 units; ‘eastern’ = 1), equating to decreasing access (units/106 people) for the province (0.65 vs 0.59; –9.2%), the ‘western’ (0.97 vs 0.9; –7.2%) and ‘eastern’ (0.39 vs 0.35; -10.3%) pathways. In 2013, 40% (4005/10 090) of studies were in the ‘eastern’ pathway serving 55% (2 066 079/4 629 051) of the population. Between 2013 and 2018 ‘eastern’ population growth (n = 286 781) exceeded ‘western’ (n = 168 469) by 70% (n = 118 312). By 2018, 38% (7939/12 848) of studies were performed in the ‘eastern’ pathway, then serving 56% (2 849 753/5 084 301) of the population. Among 0–14-year-olds, ‘western’ utilisation (studies/103 people) exceeded ‘eastern’ by a factor of approximately 2.4 throughout. In patients 14 years, the utilisation differential increased from 1.78 to 1.98 in the review period.Conclusion: Ensuring equitable services on the same healthcare platform requires ongoing surveillance of resource and population distribution. MR access can serve as a proxy for equity in highly specialised services.

Intimate partner violence is any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. A study was conducted to assess IPV and to find the association between IPV and selected demographic variables. Majority of the samples experienced IPV. Duration of marital life, age of the woman, spouse's occupation, family monthly income were associated with IPV.

Background There are marked disparities in radiological resources globally, particularly between metropolitan and rural populations. The World Health Organization (WHO) suggests that 90% of low- and middle-income country (LMIC) imaging needs can be addressed by one X-ray and ultrasound machine for every 50000 people. However, this figure is untested, as limited work on radiological resources and service utilization patterns globally, particularly in LMICs exists. The aim was to analyze provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province (WCP) of South Africa (SA) for 2017, utilizing databases of the WCP Department of Health and Stats SA. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the province, metropolitan and rural areas. Results Metropolitan population density exceeds rural (1682 vs 19 people/km 2 ; 89:1). Rural imaging facilities by population are double the metropolitan (19 vs 11/10 6 people). Provincially, there are 36 X-ray and 18 ultrasound units/10 6 people. Rural X-ray (39.3 vs 33.6/10 6 people), ultrasound (24.7 vs 14.5/10 6 people) and mammography (14 vs 5 units/10 6 women > 40 years) resources exceed metropolitan by 17, 70 and 180 percent, respectively. Metropolitan personnel resources by population (n = 112 vs 53/10 6 people) and equipment unit (1.7 vs 0.7/10 6 people) are double the rural. Provincial imaging studies totalled 1.2778 million, averaging 262 examinations/10 3 people and 1.3 investigations/patient. Radiography (n=935607,73%) and ultrasound (n=202639,16%) together constituted 89% (n=1138246) of studies. Population-based utilization of imaging services was 30% higher in the metropole (279 vs 214 studies/10 3 people), with mammography (24 vs 5 studies/10 3 woman >40 years; 517%) and CT (21 vs 6/10 3 people; 380%) recording the highest differentials and plain radiography (203 vs 171/10 3 people; 19%) the lowest. Conclusion Our findings support the WHO contention that approximately ninety percent of a population’s diagnostic imaging needs can be met by plain radiography and ultrasound and underscore the complexity of achieving equitable utilization of services between rural and metropolitan areas.