Research Articles (School of Health Systems and Public Health (SHSPH))

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Association of self-reported asthma symptoms and allergic rhinoconjunctivitis with truck traffic frequency and environmental tobacco smoke exposure among preschool children in Gauteng townships, South Africa
Bhuda, Mandla Freddy; Wichmann, Janine; Shirinde, Joyce (Springer, 2026-09-25)
BACKGROUND : This study aimed to investigate the association between self-reported asthma symptoms, allergic rhinoconjunctivitis, truck traffic frequency, and environmental tobacco smoke exposure among preschool children in Gauteng townships, South Africa. METHODS : This cross-sectional study was conducted in 42 randomly selected preschools in Mabopane and Soshanguve, Gauteng Province, South Africa. A total of 1844 questionnaires were returned, of which 1840 were included after data cleaning. Associations between demographic, behavioural, and environmental factors and respiratory and allergic health outcomes were assessed using mixed-effects logistic regression models with a random intercept for preschool to account for clustering. RESULTS : The prevalence of self-reported asthma and wheeze ever was 6.8% and 15.4%, respectively. Allergic rhinoconjunctivitis was present in 8.6% of the total study population and in 8.9% of participants with a classifiable outcome. Environmental tobacco smoke (ETS) exposure at home was associated with higher odds of self-reported wheeze ever (AOR = 1.75; 95% CI: 1.20–2.55; p = 0.004) and allergic rhinoconjunctivitis (AOR = 1.65; 95% CI: 1.01–2.68; p = 0.044), but not self-reported asthma (AOR = 1.36; 95% CI: 0.81–2.27; p = 0.242). ETS exposure at preschool, transport, and restaurants showed no significant associations with any outcome. Truck traffic frequency associations were inconsistent across categories, with some inverse associations and no clear exposure-response pattern. CONCLUSION : Household ETS exposure was linked to wheeze ever and allergic rhinoconjunctivitis, but not asthma; truck traffic associations were inconsistent, with no clear exposure–response pattern.
Disruption and recovery of maternal and child health services following COVID-19 emergency measures in Zimbabwe
Mutemeri, Tadiwanashe; Katandika, Neuville; January, James; Katena, Nyaradzai; Nyamasve, Juliet; Dewa, Evans; Marume, Anesu (Springer, 2026)
BACKGROUND : COVID-19 emergency measures disrupted access to essential health services in many low- and middle-income countries. In Zimbabwe, maternal and child health (MCH) services are central to primary healthcare, yet evidence on the magnitude of disruption and recovery remains limited. This study assessed changes in selected MCH service indicators before, during, and after COVID-19 lockdown measures across Zimbabwe’s ten provinces. METHODS : We conducted a secondary analysis of monthly provincial DHIS2 data from January 2016 to December 2024. Segmented interrupted time-series regression with generalized estimating equations with a Poisson distribution and log link to estimate immediate lockdown and post-lockdown recovery effects for first antenatal care (ANC) visits, completion of at least four ANC visits, institutional deliveries, newborn postnatal care within three days, primary immunisation course completion, and neonatal deaths. Models adjusted for province, calendar month, and within-province correlation. RESULTS : Completion of at least four ANC visits declined during lockdown (aRR 0.68, 95% CI 0.61–0.76), as did newborn postnatal care within three days (aRR 0.81, 95% CI 0.76–0.87). First ANC visits remained stable during lockdown (aRR 0.99, 95% CI 0.84–1.16) but increased post-lockdown (aRR 1.23, 95% CI 1.05–1.43). Institutional deliveries also increased during recovery (aRR 1.25, 95% CI 1.11–1.40), while neonatal deaths increased post-lockdown (aRR 1.38, 95% CI 1.17–1.62). Provincial patterns indicated heterogeneous disruption and recovery. CONCLUSIONS : COVID-19 lockdown measures disrupted selected routine MCH services, particularly continued antenatal and early postnatal care, whereas institutional deliveries and childhood immunisation were comparatively resilient. Strengthening emergency preparedness and recovery planning is essential to maintaining continuity of MCH services during future public health emergencies.
Air pollution and heat impacts on respiratory morbidity and mortality outcomes in Africa : a systematic review towards a meta-analysis
Wright, Caradee Yael; Kapwata, Thandi; Dikoko, Viwe; Howlett-Downing, Chantelle Margaret; Naidoo, Natasha (Springer, 2026-09-03)
PURPOSE OF THE REVIEW : This review synthesised evidence on associations between air pollution and respiratory morbidity in Africa. Following PRISMA guidelines, we systematically searched PubMed, ScienceDirect and Elicit for case-control studies published between 2015 and 2025. RECENT FINDINGS : Thirteen studies from ten African countries reported pollutant levels far exceeding WHO guidelines. Indoor PM₂.₅ in biomass-using homes ranged from 96 to 177 µg/m³, and ambient PM₂.₅ reached 259 µg/m³. Nitrogen oxides were consistently associated with reduced lung function in children, while household air pollution increased risks of under-five mortality and low birthweight. Associations with acute respiratory infections varied across settings. Vulnerability was greatest among young children, those with airway hyperresponsiveness, and households with poor ventilation. Only three studies included temperature, and none examined heat-respiratory interactions. Across African case-control studies, particulate matter and household air pollution remain consistently linked to adverse respiratory outcomes, highlighting urgent needs for cleaner fuels, improved ventilation, and stronger evidence on combined pollution and heat exposures.
Expanding the ethics horizon : integrating African canons for inclusive research ethics in Africa
Nel, Corne; Wolvaardt, Jacqueline Elizabeth (Liz); Du Toit, Pieter Hertzog (BioMed Central, 2026-06-12)
BACKGROUND AND INTRODUCTION : Society 5.0 envisions a future where technology and humanity integrate to address societal concerns. In an era marked by significant technological advancements, particularly in artificial intelligence, it is vital to uphold the core values of compassionate care and human connection. While the healthcare sector is central to this transformation, the prevailing research ethics frameworks remain dominated by Western individualism and positivism. OBJECTIVE : This conceptual paper aims to establish a case for integrating African research canons—ujamaa, utulivu, kujitoa, uhaki, and ukweli—into bioethical discourse to create a more inclusive, culturally relevant framework. As a conceptual review, this paper analyses existing Afrocentric paradigms and uses the Bachelor of Clinical Medical Practice (BCMP) curriculum as an illustrative case study of decolonised ethics in practice. CONCLUSION : Incorporating Ubuntu and specific African research canons challenges the Western-centric status quo, fostering a research environment that prioritises communal well-being and harmony. CONTRIBUTION : We can contribute to humanising healthcare by integrating these Afrocentric values, working towards creating a society that is more inclusive and compassionate. The inclusion of African research canons may lead to inclusive and culturally relevant research ethics by shifting the emphasis from Western individualism to a more holistic and human-centred approach.
Whole-genome sequencing suggests recent transmission of rifampicin-resistant tuberculosis in Botswana
Mogashoa, Tuelo; Ngom, Justice T.; Choga, Wonderful T.; Loubser, Johannes; Choga, Ontlametse T.; Molefi, Tuduetso; Stephen, One; Makhondo, Topo; Makhema, Joseph; Musonda, Rosemary M.; Gaseitsiwe, Simani; Warren, Rob M.; Moyo, Sikhulile; Dippenaar, Anzaan; Streicher, Elizabeth M. (BioMed Central, 2026-05-19)
BACKGROUND : Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), continues to be a global health challenge. Transmission of drug-resistant TB (DR-TB) poses a significant threat to effective TB prevention and care strategies. This study’s aim was to investigate transmission patterns of DR-TB strains, identify factors associated with the spread and reconstruct their transmission dynamics over the study period in Botswana. METHODS : We analysed whole-genome sequencing data for 195 rifampicin-resistant Mtb isolates, which were isolated between 2016 and 2023. Potential recent transmission clusters were identified using thresholds of 0 and 5 single-nucleotide polymorphisms (SNPs). The temporal signal for the predominant sublineages was assessed in TemPest, and BEAST was used to infer the evolution of Mtb strains over time. All statistical analyses were performed using STATA version 18. RESULTS : Of the 195 RR-TB isolates, 116 (60%) belonged to lineage 4. By inferring close genomic relatedness between isolates (0 SNPs and ≤ 5 SNPs difference), there was evidence of transmission. Phylogenetic analyses and SNP differences showed evidence of potential transmission events within and across different health districts. At a 0-SNP cut-off to define genomic clusters, being female (OR: 1.68, 95% CI: 1.04–2.7, p = 0.04) and being infected with a lineage 4 strain (OR: 2.80, 95% CI: 1.19–6.80, p = 0.02) were associated with clustering. Treatment history (OR: 1.41, 95% CI: 0.74–2.69, p = 0.30), smear result (OR: 1.11, 95% CI: 0.64–1.95, p = 0.71) and HIV status (OR: 0.58, 95% CI: 0.71–1.87, p = 0.58) were not associated with clustering. CONCLUSIONS : Our study offers insights into the transmission of rifampicin-resistant Mtb in Botswana. The findings indicate that targeted interventions in health districts showing evidence of transmission could help stop the spread of drug-resistant Mtb strains.
What works to prevent violence against women from 2000 to 2024 : a pragmatic review of evaluations of interventions to prevent violence against women
Jewkes, Rachel; Ramsoomar, Leane; Mahlangu, Pinky; Chirwa, Esnat; Gibbs, Andrew (Elsevier, 2026-12)
Violence against women is preventable and understanding how to prevent it effectively is vital for guiding investment in prevention programming. We conducted a pragmatic review of the global literature of interventions conducted to prevent physical or sexual intimate partner violence or non-partner rape published from 2000 to 2024. We identified 155 papers, reporting on 185 interventions (studies). 51.4% of the studies were conducted in Sub-Saharan Africa, 14.1% in Central and South-East Asia, 23.2% in North America and few from other regions. Overall, 49.7% of studies were in the top tertile of our quality score and 38.4% showed the intervention to significantly reduce at least one measure of VAW. Participant groups varied, but notably only 39.5% included men and boys, the main VAW perpetrator group. Particular at-risk groups including female sex workers, and women living in informal settlements and in conflict or humanitarian settings were infrequently included in research. Interventions design and evaluation methods varied, with notable differences by global region. Multivariable logistic regression modelling, showed interventions were significantly more likely to reduce VAW if they included a skills building component addressing poor conflict management and relationship skills (aOR 3.19 95%CI 1.49, 6.82, p = 0.003) and were better designed (aOR 1.40 (95%CI 1.05, 1.86) p = 0.022. A sensitivity analysis pointed to possible impact for poverty reduction elements. They were significantly less likely to work if they had participants from conflict and humanitarian settings. There is marked global unevenness in research on the prevention of VAW, and mismatch between VAW prevalence and risk factors and participant groups enrolled and intervention design. Also in the distribution of high-quality studies. Whilst the number of evaluations is rapidly rising, the VAW prevention research field remains disproportionately small compared to the scale of the problem and its social, economic and health impact. There is considerable scope for enhancement of the quality of both interventions and research. HIGHLIGHTS • We reviewed all published evaluations of interventions with a VAW prevention outcome and a study design with a comparison group. • There are huge global disparities in research. Half of the research is from Sub-Saharan Africa and a quarter from North America. • Only 40% of interventions sought to impact the behaviour of men and boys as study participants, despite VAW being perpetrated bythem. • Addressing poor communication and relationship skills and having a stronger research design was important. Some evidence suggested that including poverty reduction was also valuable. • Much more research is needed to deepen understanding of what works to prevent VAW. Having interventions built on best practice, evaluated with high quality research is essential.
Perceptions and experiences of men on antiretroviral treatment lost to follow-up in Govan Mbeki, Mpumalanga
Jiane, Sbongile C.; Moropeng, Mahlatse Lucky; Tshuma, Ndumiso (AOSIS, 2026-06-03)
BACKGROUND : Retention on antiretroviral treatment (ART) is essential for achieving viral suppression and preventing HIV transmission. However, men living with HIV in sub-Saharan Africa are disproportionately lost to follow-up (LTFU), posing significant public health challenges. OBJECTIVES : To explore the perceptions, experiences and barriers to ART adherence among men LTFU on ART treatment at three primary healthcare (PHC) facilities in the Govan Mbeki sub-district, Mpumalanga. METHOD : Qualitative, descriptive, and explorative contextual research methodologies were used to collect data among 21 LTFU men from three PHC facilities in the Govan Mbeki sub-district. Participants were selected using heterogenous purposive sampling, and the sample size was determined by data saturation. Semi-structured, in-depth interviews were conducted from May 2024 to July 2024. The data were thematically analysed using NVivo 14. RESULTS : The study identified key factors affecting ART adherence among men, including stigma, work-related barriers, long clinic waiting times, and medication side effects. Economic pressures, poor service delivery, and negative attitudes from healthcare staff further contributed to ART default. Suggested improvements include extended service hours, male-friendly environments, and better communication with healthcare providers. CONCLUSION : This study underscores the complex interplay of barriers driving ART disengagement among men and highlights the need for multi-pronged strategies to improve retention. Addressing these barriers is critical for achieving equitable HIV care outcomes and advancing progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets.
The burden and risk factors of NCDs in Zimbabwe : evidence from the Zimbabwe population based HIV impact assessment 2020 survey
Mapingure, Munyaradzi Paul; Dzinamarira, Tafadzwa; Chingombe, Innocent; Moyo, Enos; Mpofu, Amon; Mugurungi, Owen; Herrera, Helena; Madziva, Roda; Musuka, Godfrey N. (BioMed Central, 2026-06-30)
BACKGROUND : The burden of non-communicable diseases (NCDs) has emerged as a critical public health challenge in Zimbabwe, exacerbated by a complex interplay of socioeconomic factors, demographic shifts, and urbanization. This study leverages data from the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2020 survey to provide further insights and understanding of the prevalence and risk factors associated with NCDs in the country. METHODS : Utilizing a two-stage, stratified cluster sample design, we analyzed data from 19,535 participants. We conducted univariate and multivariate logistic regression analyses to evaluate the relationship between self-reported NCDs and demographic factors, including age, gender, urban versus rural residency, HIV status, and socioeconomic status. RESULTS : Findings revealed that approximately 14.3% of the population reported being diagnosed with at least one NCD, with hypertension and diabetes presenting prevalences of 10.8% and 2.2%, respectively. Age was a significant predictor of NCD burden, and we also noted disparities, particularly among women and individuals in higher wealth quintiles. CONCLUSION : Approximately one in seven Zimbabwean adults had been diagnosed with at least one non-communicable disease before 2020, with hypertension and diabetes the most common conditions. Older age increases NCD risk, and women and people in higher wealth quintiles carry a higher burden. These patterns suggest the need to keep prioritizing NCD prevention, screening, and management.
Prevalence, associated factors and geospatial patterns of HIV drug resistance in South Africa among the virally unsuppressed adults : updated results from the 2017 national HIV household survey
Seleka, Mpho; Ledibane, Neo; Mokhele, Tholang; Zuma, Khangelani; Moyo, Sizulu; Jooste, Sean; Musekiwa, Alfred (BMC, 2026-03-26)
BACKGROUND : South Africa bears the highest HIV burden globally, with substantial antiretroviral therapy (ART) scale-up. HIV drug resistance (HIVDR) threatens progress toward UNAIDS 95–95-95 targets. We assessed national HIVDR prevalence and associated factors among virally unsuppressed adults in 2017, before dolutegravir (DTG)-rollout. METHODS : Secondary analysis of the 2017 national HIV household survey, included 1 253 virally unsuppressed (defined as≥1 000 copies/mL) adults (≥15 years) with HIVDR results. Survey-weighted analysis generated nationally representative estimates. Weighted multivariable logistic regression identified factors associated with HIVDR by treatment status. Province-stratified analyses examined sub-national disparities. RESULTS : Nationally, the study found high viral non-suppression estimated at 37.8% (95%CI: 35.2 to 40.2), and overall HIVDR prevalence of 26.3% (95%CI: 22.5 to 30.5; n=369), driven predominantly by efavirenz-associated NNRTI resistance (14.0%). Prevalence was highest in Eastern Cape (36.6%) and rural farms (35.0%); provincial variation was not statistically significant. Stratified analysis revealed HIVDR concentration among divorced individuals (75.0%, 95%CI: 41.7–92.6) and those with high stigma (19.9%, 95% CI: 13.3–28.7) in Eastern Cape, whereas North West showed consistently low prevalence. HIVDR was higher among ARV-positive (43.3%) vs. ARV-negative individuals (21.1%, adjusted odds ratio [aOR] 4.44, 95% CI: 2.78–7.10, p<0.001). In EFV-negative subgroup, the strongest risk factor was TB history (aOR=4.94, 95% CI:1.46–16.67, p=0.010), followed by secondary education (aOR=2.24, 95% CI:1.15–4.35,p=0.017) and stigma (aOR=1.86, 95% CI:1.09–3.19, p=0.023). Older age was associated with reduced odds of HIVDR (25–34 years: aOR=0.46, 95% CI:0.23–0.93);≥45 years: aOR=0.44, 95% CI:0.19–0.99). For EFV-positive individuals, being never married increased HIVDR odds (aOR=3.23, 95% CI:1.05–9.95, p=0.042), while employment substantially reduced odds (aOR=0.32, 95% CI:0.10–0.97, p=0.044). Elevated HIVDR among youth (15–24 years) likely reflects perinatal infection, prolonged paediatric ART, and treatment interruptions during transition to adult care. CONCLUSION : The 2017 pre-DTG baseline reveals high HIVDR (26.3%) shaped by clinical (ART, TB) and socio-structural (unemployment, stigma, marital status) factors. Distinct provincial and age-specific risk profiles, including youth with paediatric treatment histories, underscore the need for geographically tailored interventions, expanded resistance testing and youth-focused adherence and transition programmes.
Transforming diabetes prevention and care in South Africa : proceedings and outcomes of the 2025 Diabetes Summit
Piotie, Patrick Ngassa; Makina-Zimalirana, Ndinda; Van Essche, Alexandra; Modipane, Penelope; Makgopa, Herbert M.; Hassen, Mariam; Mbewu-Hlobo, Asanda; Mwangi, Kibachio Joseph; Pienaar, Melanie (AOSIS, 2026-08-05)
No abstract available.
Mapping eight decades of vaccination social science : bibliometric analysis of global research trends
Iwu-Jaja , Chinwe; Nkereuwem, Oluwatosin; Iwu, Chidozie Declan; Mazingisa , Akhona V.; Jaca, Anelisa; Ndwandwe, Duduzile; Wiysonge, Charles S. (MDPI, 2025-11-04)
BACKGROUND : Despite growing recognition of vaccination social science as essential to immunization strategies, the field’s evolution, geographic distribution, and research patterns remain poorly characterized. This study provides the first comprehensive mapping of the social science literature on vaccination over eight decades. METHODS : We conducted a bibliometric analysis of peer-reviewed publications indexed in PubMed from their inception, using a systematic search strategy that combined vaccination and social science terms. Publications were analyzed using the Bibliometrix R package (version 5.0) to examine temporal trends, author productivity, institutional contributions, geographic distribution, and thematic evolution globally. RESULTS : We retrieved 8005 eligible publications. Analysis highlighted three chronological research phases: sporadic early work (1945–1980, n = 85), sustained growth (1981–2019, n = 2743), and unprecedented expansion since the COVID-19 era (2020–2024, n = 4563). Annual publications reached a peak in 2022 (n = 1686). Research spans 146 countries but remains concentrated in high-income countries, with the United States (n = 10,230), China (n = 3796), and Canada (n = 2288) leading production. The top 20 institutions were from the United States (n = 8), United Kingdom (n = 4), and Canada (n = 3), with a few institutions from African countries. International collaboration was moderate (19.44%). Thematic analysis revealed a clear evolution from biological science (1963–1999) to socio-behavioural science, with an emphasis on vaccine hesitancy, trust, communication, and health equity (2015–2024). CONCLUSIONS : Vaccination social science has grown steadily over the decades, with a sharp rise in research during the COVID-19 pandemic. Most studies were from high-income countries, underscoring the need for enhanced social science capacity in low- and middle-income countries. As the focus of immunization efforts shifts toward issues like vaccine hesitancy and trust, broader collaboration and inclusion will be key to improving vaccine uptake worldwide.
Challenges to equitable COVID-19 vaccine distribution in Ethiopia : lessons and recommendations for future pandemic preparedness
Beshah, Senait Aleamyehu; Berhanu, Anene Tesfa; Degefa, Mosisa Bekele; Adem, Jebirl Bashir; Girmay, Aderajew; Ararso, Desalegn; Ayalew, Melkamu; Lakew, Yohannes; Garoma, Sileshi; Zegeye, Elias Asfaw; Adote, Elizabeth Naa Adukwei; Achala, Daniel Malik; Muriithi, Grace Njeri; Ifeany, Chikezie; Mbachu, Chinyere Ojiugo; Akazili, James; Nwosu, Chijioke O.; Ataguba, John Ele-Ojo (Springer, 2026-09-08)
BACKGROUND : The COVID-19 pandemic has posed unprecedented global health challenges, disproportionately affecting low- and middle-income countries. Vaccination is a key public health strategy; however, inequities in vaccine distribution have limited access, particularly in Ethiopia, where logistical, infrastructural, and socio-cultural barriers have hindered the COVID-19 vaccination rollout. This study explores stakeholders’ perspectives on vaccine distribution, delivery mechanisms, and strategies to enhance equitable access. METHODS : A qualitative study was conducted using purposive sampling to interview 21 key informants, including government officials, NGO representatives, and civil society actors involved in COVID-19 vaccine distribution in Ethiopia. Data were collected through face-to-face and online interviews, transcribed verbatim, translated into English, and analyzed thematically using NVivo 12. Ethical approval was obtained, and confidentiality was maintained throughout the study. RESULTS : Participants highlighted multiple challenges affecting vaccine distribution, including global supply inequities, limited cold chain infrastructure, logistical constraints, inadequate health infrastructure, and vaccine hesitancy. Geographical barriers, conflict-affected areas, and socio-cultural factors, particularly gender norms, further exacerbated inequitable access, leaving rural populations and women disproportionately underserved. Effective multisectoral collaboration, political commitment, and public-private partnerships facilitated distribution, Key recommendations include strengthening cold chain systems, enhancing health infrastructure, implementing gender-sensitive strategies, to improve equitable vaccine delivery and preparedness for future pandemics. CONCLUSION : Ethiopia’s COVID-19 vaccination campaign faced complex logistical, infrastructural, and socio-cultural challenges that impeded equitable distribution. Addressing these barriers requires a comprehensive approach integrating strengthened logistics, gender-sensitive outreach, stakeholder coordination, and robust surveillance systems. Lessons from this study can inform national pandemic preparedness plans and support more resilient, equitable vaccination strategies in low-resource settings.
The recurring Ebola virus disease outbreaks in Africa : the problem is not outbreak response, but failure to sustain preparedness between epidemics
Iwu, Chidozie Declan; Iwu-Jaja, Chinwe; Patrick, Sean Mark; Wiysonge, Charles Shey (Elsevier, 2026-07)
No abstract available.
A study protocol for co-designing risk communication strategies for hepatitis C virus (HCV) testing among priority populations in Johannesburg district, Gauteng, South Africa
Chauke, Nyeleti P.; Mashamba-Thompson, Tivani Phosa; Maluleke, Kuhlula (Springer, 2026-09-05)
BACKGROUND : Hepatitis C virus (HCV) infection remains a major public health challenge globally and in South Africa, particularly among key populations such as people who inject drugs (PWID), men who have sex with men (MSM), and sex workers. Despite the availability of curative direct-acting antivirals and point-of-care testing, HCV testing uptake remains suboptimal due to stigma, limited access to services, and ineffective risk communication. Evidence-informed, contextually relevant risk communication strategies are crucial to improve HCV testing uptake among priority populations. AIM : This study aims to co-design risk communication strategies to promote HCV testing among key populations in the Johannesburg District, Gauteng Province, South Africa. METHODS : This study will employ a multi-phase, mixed-methods design guided by the Socio-Ecological Model and principles of Community-Based Participatory Research. Phase 1 will involve a scoping review to map evidence on barriers and facilitators to effective risk communication and HCV testing uptake. Phase 2 will use a cross-sectional design with a crowdsourcing approach to identify existing communication channels and tools. Phase 3 will apply participatory mapping with key stakeholders to co-design tailored HCV risk communication strategies. Phase 4 will use a discrete choice experiment to determine the most acceptable strategies. Data will be analysed thematically in ATLAS.ti and quantitatively in STATA. ETHICS AND DISSEMINATION : Ethical approval was obtained from the University of Pretoria's Faculty of Health Sciences Research Ethics Committee, and permission was granted by the Johannesburg Health District Research Committee. Findings will be disseminated through peer-reviewed publications, policy briefs, conference presentations, and community-friendly outputs.
Exploring determinants of under-five stunting and wasting in Ethiopia
Warssamo, Birhanu Betela; Belay, Denekew Bitew; Chen, Ding-Geng (Din) (Springer, 2026-08)
BACKGROUND : Malnutrition remains a major public health problem in Ethiopia, with stunting and wasting causing long-term physical and cognitive harm. Evidence on key determinants is still limited. Unlike previous EDHS studies that ignored data hierarchy, this study uses a generalized linear mixed model to account for clustering and unobserved heterogeneity. Identifying key socioeconomic, maternal, and environmental factors is essential for effective interventions. METHODS : This study used nationally representative cross-sectional data from the 2016 EDHS, including children aged 0–59 months. Analyses accounted for clustering and stratification. Data were analyzed using STATA 14 with descriptive statistics and cross-tabulations. A generalized linear mixed-effects model with cluster level random intercepts identified factors associated with stunting and wasting. Results were reported as adjusted odds ratios with 95% confidence intervals, and model fit was evaluated using AIC and BIC. RESULTS : The prevalence of stunting was 34.2% (95% CI: 33.65–36.25), while the prevalence of wasting was 12.6% [95% CI: 12.10–13.7]. Female children had lower odds of being stunted compared with male children (AOR = 0.86; 95% CI: 0.79, 0.94). Similarly, children from middle-wealth and rich households had lower odds of stunting (AOR = 0.85; 95% CI: 0.73, 0.99) and (AOR = 0.76; 95% CI: 0.65, 0.89) respectively relative to children from poor households. For wasting, female children also showed reduced vulnerability, compared to males (AOR = 0.78; 95% CI: 0.68, 0.89). In addition, children aged 25–59 months had lower odds of wasting than those aged 0–24 months (AOR = 0.41; 95% CI: 0.35, 0.48). CONCLUSION : Childhood stunting and wasting in Ethiopia are strongly influenced by maternal education, household socioeconomic status, birth-related factors, and child biological characteristics.
In vitro effects of environmentally relevant concentrations of nonylphenol and selected pyrethroid metabolites on a mouse sertoli cell line (TM4)
Matjomane, Nthabiseng Kgabele; Repsold, Lisa; Patrick, Sean Mark; Van Zijl, Catherina; Visagie, Michelle Helen; Aneck-Hahn, Natalie Hildegard (Taylor & Francis Group, 2025-11)
Advances in the chemical industry and increased environmental pollution have contributed to declining reproductive health. Many pollutants act as endocrine-disrupting chemicals (EDCs), with (anti-)estrogenic and (anti-)androgenic properties that disrupt hormonal balance and contribute to male reproductive dysfunction. Mouse Sertoli cells, which closely resemble human Sertoli cells, are targets for various environmental contaminants, making the cell line an ideal model for male reproductive toxicological studies. Sertoli cells (TM4) were exposed to environmentally relevant concentrations of EDCs, including cypermethrin, deltamethrin, rac-trans permethrinic acid, 3-phenoxybenzoic acid and para-nonylphenol (p-NP), for 24 h in vitro. Cytotoxicity was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, oxidative stress via an intracellular total reactive oxygen species (ROS) activity assay kit, and morphological changes via hematoxylin & eosin staining. The MTT assay revealed a moderate decrease (approximately 20% cell death) in cell viability. ROS levels were significantly higher in EDC-treated cells than in controls, with small effect sizes confirmed through Cohen’s d analysis. Morphological changes, including membrane elongation, cytoplasmic vesicles, and reduced cell density, were most pronounced in p-NP-exposed cells. These findings suggest that exposure to pyrethroids and nonylphenol may induce toxicity in mouse Sertoli cells.
Implications of incorporating environmental sustainability into health technology assessment for digital health technologies
Di Bidino, Rossella; Majumdar, Abhirup Dutta; Pegg, Melissa; Mahon, Ronan; Papavero, Sara Consilia; Mueller, Debjani (Elsevier, 2026-04)
Health technology assessment (HTA) must increasingly incorporate environmental sustainability (ES) to ensure digital health technologies (DHTs) deliver true value for both population and planetary health. Existing HTA frameworks inadequately capture the upstream and downstream environmental implications of DHTs, overlooking critical factors such as energy consumption, data storage, water usage, and electronic waste. Using a few examples on telehealth platforms, electronic health records, and artificial intelligence–driven diagnostic tools, we illustrate how these technologies can reduce carbon emissions and other pollutants by limiting patient travel and optimizing resource use. We review current HTA frameworks, identify ongoing initiatives, and highlight gaps and challenges in integrating ES into value assessment. Traditional HTA models provide limited guidance for incorporating broad environmental factors, risking underestimation of DHTs’ environmental impacts and potentially undermining health systems’ net-zero commitments by 2050. To address these issues, in this commentary, we propose targeted investment in frameworks, streamlined environmental data collection, and stronger cross-sector collaboration. Systemic inclusion of ES can reduce inequalities, support ethical supply chains, and incentivize developers to design lower-impact technologies, positioning HTA as a driver of sustainable digital health innovation. By embedding environmental metrics, health systems can better balance clinical benefits, economic efficiency, and ecological responsibility, thereby advancing both human and planetary health. HIGHLIGHTS • The climate change crisis is imminent, with the healthcare sector contributing 4.6% of the global greenhouse gas emissions. • Digital health technologies represent a heterogeneous group of interventions with applications across care and research pathways, offering potential to reduce emissions while delivering co-benefits such as disease prevention, streamlined care, patient empowerment, and lower-carbon alternatives. • This commentary proposes integrating environmental evaluation into health technology assessment through environmental lifecycle assessments, robust data strategies, and estimating aversion parameters in cost-effectiveness analyses. Achieving this necessitates cross-functional collaboration across clinical, environmental, economic, and policy domains to accurately assess and mitigate digital health technology impacts.
The total PM₂.₅, chemical composition and geographical origin of air masses in a legacy mining town, Welkom, South Africa
Howlett-Downing, Chantelle Margaret; Boman, Johan; Molnar, Peter; Wichmann, Janine (Taylor and Francis, 2026)
This study investigated fine particulate matter (PM₂.₅) in Welkom, South Africa, a legacy mining town. PM₂.₅ was sampled over 12 months at two sites, an Industrial Site and a Residential Site located only 5.6 km apart, to assess total concentrations, PM₂.₅ chemical composition, soot, black carbon (BC), UV-absorbing particulate matter (UV-PM), and the geographical origin of air masses. At the Industrial Site, the annual mean PM₂.₅ concentration was 14.7 µg/m³ (0.17–66.3 µg/m³), while the Residential Site recorded a markedly lower mean of 6.47 µg/m³ (0.17–24.3 µg/m³). Mean soot levels were 1.07 × 10−5 m−1 (0.01–5.52 × 10−5 m−1) at the Industrial Site and 1.10 × 10−5 m−1 (0.014–5.50 × 10−5 m−1) at the Residential Site. BC concentrations averaged 1.9 µg/m³ (0.028–8.01 µg/m³) at the Industrial Site and 0.6 µg/m³ (0.2–2.8 µg/m³) at the Residential Site. UV-PM averaged 1.6 µg/m³ (0.006–5.22 µg/m³) at the Industrial Site and 0.8 µg/m³ (0.1–3.1 µg/m³) at the Residential Site. Clustered back-trajectory analysis further showed that northerly and easterly air masses carried the highest PM₂.₅, soot, BC, and UV-PM levels. Across all pollutants, higher concentrations at the Industrial Site highlight the influence of local combustion sources, resuspended dust, and industrial activities.
Strengthening infection prevention in long-term care facilities in low-income and middle-income countries
Iwu, Chidozie Declan; Iwu-Jaja, Chinwe; Patrick, Sean Mark; Okoh, Anthony Ifeanyi; Wiysonge, Charles Shey (Elsevier, 2026-09)
No abstract available.
Intimate partner violence, stigma, shame self-blame and survivor realities : a qualitative study from Fediša Modikologo in South Africa
Willan , Samantha; Machisa, Mercilene; Mahlangu, Pinky; Khoza , Zamakhoza; Zembe, Amanda; Mbowane, Venice; Paile, Charntel; Pass, Desiree; Jewkes, Rachel (Elsevier, 2025-12-07)
No abstract available.

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