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Article History

Received: 1 April 2026

Accepted: 9 July 2026

First Online: 20 July 2026

Declarations

Ethics approval and consent to participate: Ethics approval for the use of the secondary database used to conduct this study was granted by the Faculty of Health Sciences Human Research Ethics Committee of the University of Cape Town – approval number HREC Ref: 606/2023. This study was performed in accordance with the Declaration of Helsinki. No individual consent was required as the research was based on anonymised secondary claims data. Data for the study were made available as part of NMG Consultants and Actuaries (NMG) commitment to support research initiatives with broader public health significance. The data were accessed in terms of and under the conditions set out in the agreement between NMG and the client schemes and between NMG and the researcher. The terms set out in these agreements ensured that the access to and use of the data is in full compliance with the requirements of the Protection of Personal Information (PoPI) Act in South Africa. All the data were provided in a de-identified format and aggregated at an individual level and the research team had no access to information that would enable the identification of any individual. All findings are presented at an aggregate level and no confidential member, health care provider or scheme information is disclosed. Individual consent for the data was therefore not required.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.