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

Permanent URI for this collectionhttp://hdl.handle.net/2263/1723

For inquiries regarding this collection or items in the collection, please contact : Estelle Grobler
Tel.: +27 12 354 1433

Browse

Now showing 1 - 20 of 1256

The role of pioneering transcription factors, chromatin accessibility and epigenetic reprogramming in oncogenic viruses
(Frontiers Media, 2025-06-16) Kgatle, Mankgopo; Mbambara, Saidon; Khoza, Leon; Fadebi, Olalekan; Mashamba-Thompson, Tivani Phosa; Sathekge, Mike Machaba
Oncogenic viruses typically manipulate host cellular mechanisms to drive tumorigenesis. They exploit pioneering transcription factors to modify gene expression, enabling uncontrolled proliferation. These viruses alter chromatin accessibility and induce chromatin remodelling, disrupting DNA repair and promoting viral genome integration. Additionally, epigenetic reprogramming through mechanisms like DNA methylation and histone modifications silences tumor suppressor genes and activates oncogenes. Understanding these mechanisms is critical for identifying more improved therapeutic targets, improving diagnostics, and predicting disease progression. Advances in this field can guide the development of innovative treatments and early detection tools. This comprehensive review synthesizes existing knowledge on the contributions of oncogenic viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), and human T-cell leukaemia virus type 1 (HTLV-1), Epstein–Barr virus (EBV), human herpesvirus 8 (HHV-8), and Merkel cell polyomavirus (MCV) to cancer development, highlighting their therapeutic relevance and driving forward research in viral oncogenesis.
In silico multi-epitope-based vaccine design for Mycobacterium avium complex species
(Frontiers Media, 2025-06-05) Kashiri, Leah; Choga, Wonderful T.; Musasa, Tinashe; Nziramasanga, Pasipanodya; Gutsire, Rutendo B.; Zijenah, Lynn S.; Mukarati, Norman L.; Gaseitsiwe, Simani; Moyo, Sikhulile; Chin'ombe, Nyasha
IINTRODUCTION : The Mycobacterium avium complex (MAC)—comprising M. colombiense, M. avium, and M. intracellulare—is an emerging group of opportunistic pathogens responsible for significant morbidity and mortality, particularly in immunocompromised individuals. Despite this growing burden, no vaccines currently provide cross-species protection. In silico vaccine design offers a rapid, cost-effective strategy to identify immunogenic epitopes and assemble multi-epitope constructs with optimized safety and efficacy. Accordingly, we aimed to develop a candidate multi-epitope vaccine (MEV) targeting conserved antigens across multiple MAC species. METHODS : From a genomic survey of nontuberculous mycobacteria (NTM) in Zimbabwe, we assembled complete genomes for M. colombiense (MCOL), M. avium (MAV), and M. intracellulare (MINT). Using both local and global reference datasets, we screened the conserved immunodominant proteins 85A, 85B, and 85C for high-affinity T-helper lymphocyte (THL) epitopes. Promising epitopes were further evaluated for antigenicity, immunogenicity, physicochemical stability, and population coverage. RESULTS : Epitope mapping across the nine target proteins yielded 82 THL epitopes predicted to bind 13 MHC class II (DRB*) alleles, ensuring broad coverage within Zimbabwean and pan-African populations. Clustering analyses consolidated 26 unique epitopes into 11 consensus peptides, 65.4% of which derived from the 85B proteins. In silico immune simulations predicted robust humoral and cellular responses, including elevated IgG titers, T-helper and T-cytotoxic cell proliferation and increased secretion of IFN-γ and IL-2 following MEV administration. CONCLUSION : These findings indicate that our construct possesses strong immunogenic potential and cross-species applicability. We present here a rationally designed MEV candidate that merits further experimental validation as a broad-spectrum vaccine against multiple MAC species.
Examination of the association between temperature variability and cardiovascular and respiratory mortality in South Africa, 2006–2016
(Frontiers Media, 2025-06-03) Makunyane, Malebo Sephule; Rautenbach, Hannes; Wichmann, Janine; u10202146@tuks.co.za
BACKGROUND : Evidence is limited on the impact of temperature variability (TV) on health in low-and-middle-income countries (LMICs), such as South Africa. This study examined the association between TV and cardiovascular disease (CVD) and respiratory disease (RD) mortality in five South African cities. METHODS : Daily mortality and meteorological data in five South African cities (Bloemfontein, Cape Town, Durban, Johannesburg, and Gqeberha) were collected from Statistics South Africa and the South African Weather Service for the period 2006–2016. TV was calculated as the standard deviation of the daily minimum and maximum temperatures over the exposure period. City-specific risks were estimated using quasi-Poisson regression models combined with distributed lag nonlinear models, adjusting for potential confounders. A meta-analysis was then conducted to pool the overall estimates across cities. Additionally, stratified analyses by age group and sex were performed to assess effect modification. RESULTS : A total of 213,875 cardiovascular and 114,887 respiratory deaths were recorded in the five cities during the study period. The risks with increasing TV were higher for RD mortality as compared to CVD mortality. The pooled estimates showed the highest and significant increase in RD mortality of 1.21(95% CI: 1.04;1.38) per an increase in TV at 0–2 days from the 25th to the 50th percentile for all ages combined. The elderly appeared more vulnerable to RD mortality than <65 years age group, with significant mortality risks per increase in TV at 0–2 days (RR = 1.18, 95% CI: 1.04; 1.32),0–3 days (RR = 1.16, 95% CI: 1.04; 1.28) and at 0–7 days (RR = 1.12, 95% CI: 1.02; 1.22) from the 50th to the 75th percentile. A stratified analysis showed the elderly and women as more vulnerable. The pooled results across the five cities suggested no statistically significant TV effect on CVD mortality. CONCLUSION : This study found a short-term association between temperature variability and respiratory mortality, especially among elderly individuals and women, in five South African cities. No significant effect was observed for cardiovascular mortality. The findings support targeted public health strategies that account for temperature-related risks in vulnerable populations.
Lessons learnt in the response to COVID-19 in Mozambique : enabling readiness for the next pandemic
(Frontiers Media, 2025-07-31) Posse, Mariana E.; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Nwosu, Chijioke Osinachi; Ataguba, John Ele-Ojo
INTRODUCTION : The coronavirus disease 2019 (COVID-19) has led to a dramatic loss of human lives worldwide and caused economic and social disruptions. The risk of another pandemic occurring is ever-present requiring countries to document factors that influenced the response to COVID-19 to guide the response to future pandemics. This study documents lessons learnt from Mozambique's COVID-19 response, considering the perspectives of various stakeholders and examining different components of the response. METHODS : We used a qualitative phenomenology research design and collected data using in-depth interviews. We used purposive sampling by selecting institutions with relevant experience and knowledge to inform the study objectives. We also used snowballing techniques by asking respondents for other potential informants. We interviewed 19 individuals indicated by the representatives of the institutions selected for the study. The institutions were mostly based in Maputo city, the country's capital. Participants were asked about their role in the organization; responsibility in vaccine distribution and delivery in Mozambique; their opinion on what worked well in the country's response to COVID-19, and what could be improved as preparation to future pandemics. Data was coded using a computer-assisted qualitative data analysis software Maxqda 2020 and analyzed using a deductive thematic approach. A validation meeting was held, in which research participants were asked to check the accuracy of the results and interpretations. RESULTS : Key drivers of the COVID-19 response were strong leadership; a clear plan and strategies; a functional coordination mechanism; the use of evidence to make decisions; a careful consideration of priority groups; investments in the supply chain and surveillance systems; the utilization of pre-existing vaccination structures; and partnership between the government and several stakeholders. There is room for improvement including the development of a clear budget, a communication plan, creation of an emergency fund, accountability in the use of funds, decentralization of surveillance infrastructure and representation of vulnerable, marginalized, and hard-to-reach populations in the design and implementation of pandemic response. CONCLUSION : The lessons learned from the COVID-19 response in Mozambique, which could be considered when preparing for an effective and equitable response to future pandemics, are in essence the following: there should be government leadership, a response plan, adequate resources, use of data to inform decisions, constant vigilance, a prompt response, involvement of all stakeholders and documentation of actions for continuous learning. These lessons could improve pandemic preparedness nationally and globally.
Equitable access to COVID-19 vaccines in Botswana : a scoping review
(Frontiers Media, 2025-07-29) Tlhakanelo, John T.; Ataguba, John Ele-Ojo; Pagiwa, Vincent; Ramabu, Nankie; Kadimo, Khutsafalo; Molosiwa, Dintle; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Masuka, Nyasha; Nwosu, Chijioke Osinachi; Akazili, James; Ifeanyi, Chikezie
INTRODUCTION : Despite global market complexities, Botswana acquired about 2.6 million COVID-19 vaccine doses between March 2021 and March 2022, 76% of which were purchased while 24% were donations. Thus, the study was envisaged to aggregate evidence on the case of Botswana's COVID-19 vaccine access patterns, hesitancy, and uptake. MATERIALS AND METHODS : We conducted a scoping reviewof Botswana-based articles using a predetermined search strategy to search databases including Medline, CINAHL, Web of Science, PubMed, Scopus, and Google Scholar. The review included all the English-language written peer-reviewed and grey literature reporting on vaccination in Botswana, to broaden coverage in recognition of limited publications on COVID-19 vaccinartion in Botswana. Non-English articles were excluded due to limited translation resources. Due to the heterogeneity of studies, a narrative synthesis approach was used to collect, synthesize, and map the literature. RESULTS : As of 31 December 2021, 80.6% of the Botswana national target of 1,390,856 people over 18 years had received at least one dose of a COVID-19 vaccine, while 71.9% were fully vaccinated. Various vaccine distribution channels were utilized, including public facilities and outreaches, to improve access and uptake of vaccines. COVID-19 vaccine acceptance was considered generally high (73.4% amongst adults), and found positively associated with the male gender, those with comorbidities, those with non-restrictive religious beliefs, and those aged 55–64 years who thought the vaccine was safe for use. COVID-19 vaccine delivery relied on existing Expanded Program on Immunization (EPI) structures and therefore experienced to existing EPI challenges including, lack of transport, shortage of human resources, and vaccine stock-outs. CONCLUSIONS : Under-performance of immunization programs at the district level, characterized by declining immunization coverage and inadequate outreach services, exacerbates disparities in vaccine access. Efforts to strengthen healthcare infrastructure and expand outreach services are essential for reaching populations with limited access to healthcare facilities, particularly in rural and hard-to-reach areas. Collaboration with other government entities and the private sector improved vaccine access.
COVID-19 vaccine hesitancy in Ethiopia : a scoping review for equitable vaccine access
(Frontiers Media, 2025-09-03) Beshah, Senait Aleamyehu; Adem, Jibril Bashir; Degefa, Mosisa Bekele; Ayalew, Melkamu; Lakew, Yohannes; Garoma, Sileshi; Adote, Elizabeth Naa Adukwei; Achala, Daniel Malik; Muriithi, Grace Njeri; Mbachu, Chinyere Ojiugo; Akazili, James; Ifeanyi, Chikezie; Zegeye, Elias Asfaw; Nwosu, Chijioke O.; Ataguba, John Ele-Ojo
INTRODUCTION : COVID-19 vaccines are crucial for preventing severe illness from the virus. Despite their effectiveness; vaccine hesitancy, unequal access, and economic disparities hinder vaccination programs across Africa, posing significant challenges in Ethiopia. METHOD : This scoping review followed the methodological guidelines outlined in the Joanna Briggs Institute Reviewer's and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation to ensure transparency. To analyze the data, we developed tailored search strategies for key databases [HINARI, PubMed, Cochrane, African Journals Online (AJOL), and Science Direct] and gray literature sources. These strategies combined controlled vocabulary and relevant keywords. A descriptive thematic analysis was then employed to identify and categorize the various findings within the included studies. The results are presented in a narrative format, summarizing the key themes and providing a clear and comprehensive overview of the current evidence base. RESULTS AND RECOMMENDATIONS : A review of 34 Ethiopian studies revealed significant COVID-19 vaccine hesitancy, with rates exceeding 50% in over 40% of the studies. The lowest hesitancy was found in adults from Addis Ababa (19.1%), while the highest rates were seen among healthcare workers in Oromia (69.7%) and pregnant women in Southwest Ethiopia (68.8%). Factors contributing to vaccine hesitancy in Ethiopia include being female, having only primary education, residing in rural areas, younger age, limited knowledge about the vaccine, reduced trust in authorities, and misperceptions about the risk of the virus. To address this challenge effectively, policymakers should prioritize interventions that build public trust, enhance awareness of the vaccine's benefits, and counter misinformation.
Assessing the determinants of uptake and hesitancy in accessing COVID 19 vaccines in Nigeria : a scoping review
(Frontiers Media, 2025-09-04) Ifeanyi, Chikezie; Okechukwu, Emmanuel; Tosin, Olushola; Hyacinth, Ichoku; Ataguba, John Ele-Ojo; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Nwosu, Chijioke Osinachi; Tlhakanelo, John Thato; Akazili, James; Masuka, Nyasha
The coronavirus disease (COVID-19) is one of the largest public health threats in recent times, with significant health, economic, and social consequences globally. The WHO reported that over 651 million cases and 6.6 million deaths were attributed to COVID-19 globally. The Nigeria Centre for Disease Control (NCDC) in 2022 revealed that 266,057 cases with 3,155 deaths were reported. All the thirty-six states and the Federal Capital Territory (FCT) of Nigeria were affected, but Lagos and the FCT reported the highest number of cases. However, it is possible that these numbers do not accurately reflect the severity of COVID-19 disease in Nigeria because the country had only tested 5,160,280 people as at 2022, despite a population of around 200 million. Nigeria did not meet its 2021 vaccination target, prompting the need to identify the contextual factors affecting vaccine access and uptake as well as vaccine hesitancy in Nigeria and document the approaches that can be deployed to reduce opposition to vaccination as well as improve advocacy for vaccine equity. This scoping review, conducted using Arksey and O'Malley's framework, aimed to explore the factors influencing COVID-19 vaccine hesitancy and uptake in Nigeria. A comprehensive literature search was conducted across electronic databases, including Google Scholar and PubMed, with studies from Nigeria published in English. The review included 25 studies on vaccine hesitancy, uptake, and willingness to accept COVID-19 vaccination, identifying barriers at the national, community, and individual levels. The results indicated that 90% of the studies showed low vaccine acceptance and uptake, with barriers related to vaccine availability, misinformation, cultural and religious influences, socioeconomic factors, and lack of trust in the health system. Socio-demographic factors such as gender, age, education, and income were identified as key influences. The findings highlight the need for targeted, evidence-based strategies to address vaccine hesitancy, improve vaccine distribution, and engage diverse population groups to enhance vaccination uptake across Nigeria.
Safety and efficacy of tocilizumab in COVID-19 : a systematic evaluation of adverse effects and therapeutic outcomes
(Elsevier, 2025-10) AlOmeir, Othman; Alhowail, Ahmad H.; Rabbani, Syed Imam; Asdaq, Syed Mohammed Basheeruddin; Gilkaramenthi, Rafiulla; Khan, Abida; Imran, Mohd; Dzinamarira, Tafadzwa
BACKGROUND : While COVID-19 has transitioned from a pandemic to an endemic state, the management of its persistent complications continues to present substantial clinical challenges. Tocilizumab, an interleukin-6 receptor antagonist endorsed by the World Health Organization (WHO) for severe COVID-19 management, remains a critical therapeutic intervention. This systematic evaluation provides a comprehensive assessment of tocilizumab's safety and efficacy profile to inform clinical decision-making. METHODS : The study involved exhaustive search across multiple databases (PubMed, SCOPUS, WoS, BIOSIS) utilizing MeSH terms and Boolean operators to identify relevant studies. Methodological worthiness was rigorously evaluated utilizing the Risk of Bias 2 (RoB 2) tool. The statistical analysis of the findings incorporated one-way ANOVA, Mann-Whitney U tests, and Pearson's correlation coefficient (r) with 95 % confidence intervals to quantify adverse effects and therapeutic outcomes. RESULTS : The analysis of nine studies encompassing diverse demographic populations (ages ≥2 years, both sexes) established a clear safety profile for tocilizumab. The treatment demonstrated a statistically important association (P < 0.05) with mild adverse effects (nausea, diarrhea, headache, fatigue; r = 0.62, 95 % CI = 0.59–0.71) and moderate adverse effects (tremors, urinary difficulties, mood changes; r = 0.54, 95 % CI = 0.47–0.60). More concerning were the severe adverse effects, including hepatobiliary dysfunction and hypersensitivity reactions (r = 0.36, 95 % CI = 0.32–0.41), with rare but critical instances of acute liver failure (r = 0.18, 95 % CI = 0.15–0.22). Notably, despite this safety profile, tocilizumab exhibited significant therapeutic efficacy (P < 0.01) in ameliorating COVID-19 symptoms, particularly in cases complicated by cytokine storm syndrome. CONCLUSION : This study confirms tocilizumab's position as a valuable therapeutic agent for COVID-19 complications while highlighting the necessity for judicious patient selection and vigilant monitoring due to its potential for significant adverse effects. The findings underscore the importance of pre-treatment screening, adherence to contraindications, and ongoing pharmacovigilance to optimize risk-benefit ratios.
Seven years in limbo and counting : pushing for a comprehensive regulation of tobacco and nicotine products amidst industry pushback in South Africa
(BMJ Publishing Group, 2025) Egbe, Catherine O.; Mthembu, Zanele R.S.; Ayo-Yusuf, Olalekan Abdulwahab
No abstract available.
Ten-year outcomes of antiretroviral therapy : a retrospective cohort study in Tshwane district, South Africa
(BioMed Central, 2025-10) Mhlongo, Kateko; Louw, Murray; Ngcobo, Sanele; sanele.ngcobo@up.ac.za
BACKGROUND : South Africa continues to face one of the world’s highest HIV burdens, with 7.7 million people living with HIV (PLWHIV) in 2023. Despite progress toward UNAIDS 95–95–95 targets, challenges in long-term retention and treatment outcomes persist. This study aimed to evaluate 10-year antiretroviral therapy (ART) outcomes among PLWHIV initiated on treatment in 2013 within Tshwane District, South Africa. METHODS : Retrospective cohort using Tier.Net data from 1,337 adults across 10 randomly selected facilities (clinics and community health centres [CHCs]). Outcomes were retention, loss to follow‑up (LTFU), mortality, viral suppression, and CD4 recovery. We used Kaplan–Meier methods and multivariable models (Cox for LTFU and mortality, logistic for viral suppression, linear for CD4 change). Mortality analyses were limited to participants with complete ascertainment (n = 640). RESULTS : At 10 years, 47.7% were retained, 30.4% LTFU, 20.1% transferred out, and 3.3% died. Attrition was steepest early and most pronounced among 18–24-year-olds. Advanced WHO stage strongly predicted death (Stage III/IV vs. I/II: aHR 3.06, 95% CI 1.26–7.44), and younger age was protective (≤ 34 vs. > 34 years: aHR 0.28, 95% CI 0.09–0.86). Care at CHCs was associated with lower mortality (aHR 0.33, 95% CI 0.13–0.83) and greater CD4 gains (clinic care: −74.35 cells/µL vs. CHCs; p < 0.001). Female sex was associated with larger CD4 recovery (+ 90.06 cells/µL vs. males; p < 0.001). Only baseline CD4 > 200 cells/µL independently predicted viral suppression (aOR for being suppressed ≈ 1.89, derived from aOR 0.53 for non-suppression; p < 0.001). No baseline covariates were significant predictors of time to LTFU (clinic type borderline: HR 0.80, p = 0.086). CONCLUSION : A decade after initiation, fewer than half remained in care. Mortality clustered among older adults and those presenting with advanced disease, while CHC-based care conferred survival and immunologic advantages. Programme priorities should include earlier diagnosis and ART start, youth-friendly retention strategies, and scaling CHC-style differentiated service delivery to improve long-term outcomes.
The HIV care and treatment cascade of adolescents and young adults living with HIV in sub-Saharan Africa
(BioMed Central, 2025-09-29) Silinda, Patricia; Musekiwa, Alfred; Yah, Clarence S.
BACKGROUND : The Joint United Nations Programme on HIV/AIDS called for the end of the HIV pandemic by 2030 by setting the 95-95-95 HIV cascade targets. This cascade is used to monitor the progress of different populations in different settings. The progress of adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) toward these targets remains unknown. We propose to conduct a systematic review and meta-analysis to assess the proportion of AYA retained at each step of the HIV care cascade in SSA. METHOD : Studies published between 2015 to date that reported on the HIV care cascade among AYA in SSA will be included. The following databases will be searched: PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM), African Journals Online (AJOL), SABINET African Journals, HINARI (for institutional access to global journals) and University institutional repositories and gray literature sources will be searched. Two reviewers will independently screen titles and abstracts, assess the full texts for eligibility, and extract data. Disagreements will be resolved by consensus and consultation with a third reviewer. The number and proportion of AYA retained in the HIV care cascade from HIV diagnosis, initiation of ART, and viral suppression will be used for the meta-analysis. Random-effect statistical models will be used to estimate the pooled proportion of AYA retained at each step of the cascade. The results will be graphically represented via forest plots. Variability across studies will be assessed via heterogeneity test statistics (I2). DISCUSSION : This systematic review aims to synthesize current evidence and identify gaps in the treatment cascade. The findings of this meta-analysis provide guidance for designing a framework to improve the care and treatment of AYA living with HIV. SYSTEMATIC REVIEW REGISTRATION : PROSPERO registration number CRD42024561024.
Mumps outbreak in Zimbabwe : the case for universal MMR vaccination in Africa
(Elsevier, 2024-12) Gwinji, Phanuel Tawanda; Murewanhema, Grant; Moyo, Enos; Dzinamarira, Tafadzwa; u19395419@up.ac.za
Cases of mumps have been recorded throughout the country of Zimbabwe. Though the total number of cases is currently unclear, Bulawayo alone is estimated to have recorded at least eight consecutive months of a mumps outbreak, with at least 240 cases of mumps reported between January and August 2023. In the recent past, mumps outbreaks have also been reported in other countries in the region, such as South Africa, Botswana, Lesotho, and Zambia. Mumps is a contagious viral infection that mostly affects children. It affects the salivary glands, causing painful swellings under the ears and parotid glands, resulting in a characteristic ‘hamster face’ appearance [5]. Other symptoms include headaches, joint pains, fatigue, loss of appetite, and fever, which often precede facial swelling. In boys, it can also result in swelling of testicles.
Postnatal care knowledge and perceptions among women in the Oshana region, Namibia
(AOSIS, 2025-09) Moyo, Enos; Moyo, Perseverance; Dzinamarira, Tafadzwa; Ross, Andrew
BACKGROUND : Postnatal care (PNC) knowledge and positive perceptions are crucial for women’s utilisation of PNC services. AIM : The study aimed to assess the level of PNC knowledge, perceptions of PNC, and determinants of both among women. SETTING : Public healthcare facilities in the Oshana region, Namibia. METHODS : The study followed a quantitative cross-sectional survey design. A self-administered questionnaire was administered to 814 participants selected via systematic random sampling. PNC knowledge and perceptions were used separately as dependent variables. Participants’ characteristics were used as independent variables. Chi-square tests and binomial and multinomial logistic regression were used to analyse associations between PNC knowledge or perceptions and participants’ characteristics. RESULTS : Among the participants, 55.6% (n = 434) demonstrated good PNC knowledge, while 27.3% (n = 213) had positive PNC perceptions. Participants who had no formal education, were unemployed, and did not utilise PNC services had a lower likelihood of having good PNC knowledge; adjusted odds ratio (AOR) = 0.33, 95% confidence interval (CI), 0.21–0.53, crude odds ratio (COR) = 0.68, 95% CI, 0.49–0.92; and AOR = 0.72, 95% CI, 0.52–0.98. Similarly, women who did not attend antenatal care had a lower likelihood of having positive PNC perceptions; COR = 0.56, 95% CI, 0.33–0.96. CONCLUSION : There is a need for multipronged interventions to improve PNC knowledge and perceptions among women in the Oshana region. CONTRIBUTION : This study identified context-specific factors that influence women’s PNC knowledge and perceptions.
Patterns of tobacco use and related factors among adolescents in South Africa : insight from the Global Youth Tobacco Survey
(European Publishing, 2025-07) Londani, Mukhethwa; Sewani-Rusike, Constance; Ayo-Yusuf, Olalekan Abdulwahab; Oladimeji, Olanrewaju
INTRODUCTION : Adolescent multiple tobacco use is a major public health issue, both in South Africa and globally. This study sought to use latent class analysis to identify patterns of tobacco products use (combustible cigarettes, chewing tobacco, snuff) and combustible non-cigarette tobacco products smoking (such as cigars, little cigars, pipes) and related factors among adolescents in South Africa. METHODS : Data from the Global Youth Tobacco Survey (2011) were used. A nationally representative cross-sectional school-based survey was conducted among secondary school students using a stratified two-stage cluster sampling. The sample comprised 10822 students in grades 8 to 11 in South Africa (approximately aged 13–18 years). Latent class analysis was used to identify patterns of tobacco use and examined how sociodemographic and tobacco-related characteristics are associated with such patterns. Subsequently, the multinomial logistic regression analysis was used to assess the relationship between covariates and tobacco-related variables with the probability of belonging to a specific latent class. Results : The latent class analysis identified three classes: Class 1 (8.8%) was characterized by high probabilities of multiple tobacco product use; Class 2 (3.4%) had high probabilities of combustible non-cigarette tobacco products smoking; and Class 3 (83.9%) showed a minimal likelihood of current use across all four products. Compared to non-users, adolescents exposed to peer smoking had significantly higher odds of multiple product use (AOR=4.07; 95% CI: 2.93– 5.66) and combustible tobacco use (AOR=6.29; 95% CI: 4.15–9.53). Parental smoking was also associated with increased odds of both multiple (AOR=2.33; 95% CI: 1.81–3.00) and combustible (AOR=1.91; 95% CI: 1.31–2.79) tobacco use. Females had lower odds than males of using multiple (AOR=0.65; 95% CI: 0.49–0.87) and combustible products (AOR=0.51; 95% CI: 0.36–0.71). Older adolescents (aged ≥18 years) were more likely to be multiple users (AOR=4.18; 95% CI: 1.59–10.98). Support for smoke-free policies was associated with reduced odds of tobacco use, while knowledge of smoking harms was associated with combustible tobacco use (AOR=1.60; 95% CI: 1.07–2.39). CONCLUSIONS : Multiple tobacco use and combustible non-cigarette tobacco products smoking is common among South African adolescents. Understanding different patterns of multiple tobacco use and combustible non-cigarette tobacco products smoking can help to inform prevention and cessation programs for adolescents. Given the risk adolescents face, tobacco cessation interventions tailored to their tobacco product of choice are urgently needed.
Profiling HIV risk and determined, resilient, empowered AIDS-free, mentored, and safe (DREAMS) program reach among adolescent girls and young women (AGYW) in Namibia : secondary analysis of population and program data
(MDPI, 2025-08-27) Moyo, Enos; Melese, Endalkachew; Mangwana, Hadrian; Takawira, Simon; Indongo, Rosalia; Harases , Bernadette; Moyo, Perseverance; Nyoni, Ntombizodwa Makurira; Robert, Kopano; Dzinamarira, Tafadzwa; u19385419@up.ac.za
BACKGROUND : Namibia is experiencing a generalized HIV epidemic, with 7.5% of the population living with HIV. Adolescent girls and young women (AGYW) aged 15–24 account for 28.6% of new infections annually. Various factors increase AGYW’s vulnerability to HIV. To address this, Project HOPE Namibia (PHN)-led consortium implemented the PEPFAR/USAID-funded DREAMS project in Khomas, Oshikoto, and Zambezi regions from 2018 to 2023. This study estimated the AGYW population most in need of HIV prevention and assessed geographic and age-specific gaps to improve program effectiveness and efficiency. METHODS : This secondary data analysis utilized the Namibia Population-Based HIV Impact Assessment (NamPHIA) 2017, the Namibia census, and service data from the DREAMS project, which includes entry points for recruitment, screening, and enrolment. We used Python to conduct unadjusted and adjusted Poisson regression and UpSet plots for data visualization. RESULTS : Analysis of NamPHIA data revealed low HIV prevalence in 10–14-year-olds, with only Oshikoto showing a detectable rate of 2.76%, mostly attributed to perinatal HIV transmission. Of the 12 DREAMS eligibility criteria, three could be mapped to 10–14-year-olds, while all except sexually transmitted infections could be mapped for 15–19 and 20–24-year-olds. Nationally, 17.3% of 10–14-year-old AGYW, 48.0% of 15–19-year-olds, and 50% of 20–24-year-olds met at least one DREAMS eligibility criterion. Among 15–19-year-olds, a history of pregnancy, no/irregular condom use, and out-of-school status were positively associated with HIV status. For 20–24-year-olds, transactional sex was positively associated with HIV status. Overall, 62% of screened individuals were eligible, and 62% of eligible individuals enrolled. PHN screened 134% of the estimated 37,965 10–14-year-olds, 95% of the estimated 35,585 15–19-year-olds, and 57% of the 24,011 20–24-year-olds residing in the five districts where DREAMS was implemented. CONCLUSIONS : We recommend the refinement of the DREAMS eligibility criteria, particularly for AGYW 10–14, to better identify and engage those at risk of HIV acquisition through sexual transmission. For 15–19-year-olds, PHN efforts should interrogate geographic variability in entry points for recruitment and screening practices. PHN should enhance the recruitment and engagement of AGYW 20–24, with a particular focus on those engaged in transactional sex.
Lessons learnt during establishment of COVID-19 active vaccine safety surveillance in nine African countries
(Elsevier, 2025-08) Cutland, Clare L.; Gutu, Kimberley; Yun, Jessica Ann; Izu, Alane; Mahtab, Sana; Peter, Jonny; Ansah, Nana Akosua; Obaro, Stephen; Tilahun, Binyam; Jambo, Kondwani; Sow, Samba; Kagucia, Eunice Wangeci; Chicumbe , Sergio; Dlamini, Tenelisiwe; Browne , Michael; Clothier, Hazel; Griffin , Jennifer; Jiang, Yannan; Lee, Arier; Ghebreab, Luam; Madhi , Shabir A.; Black, Steven B.; Active Vaccine Safety Surveillance Team; Ndlovu , Xumani; Thwala, Bukhiwe Nana; Mpungose, Aneliswa; Ansah, Patrick O.; Hama, Anthony; Igumbor, Ehimario Uche; Ebruke, Bernard; Toni , Alemayehu; Mumba, Daniel; Haidara, Fadima Cheick; Sang, Samuel; Sigilai, Antipa; Khosa , Celso; Sevene , Esperanca
BACKGROUND : Globally, several gaps in vaccine safety surveillance exist, particularly in low- and middle- income countries (LMICs). Establishing and maintaining vaccine surveillance platforms in resource-constrained settings poses significant challenges. These countries often rely on paper-based medical records and immunization cards, lack unique patient identifiers across the healthcare systems, have limited electronic data capture capabilities, and face a shortage of clinical reviewers for case assessments. This report highlights the establishment of two active vaccine safety surveillance studies across nine African countries: (i) Active COVID-19 vaccine safety surveillance (ACVaSS) in eight COVAX 92 Advanced Market Commitment (AMC-92) eligible African countries including Ethiopia, Ghana, Kenya, Mali, Malawi, Mozambique, Nigeria and Eswatini and (ii) the South African COVID-19 vaccine safety surveillance study (SA-CVSS). METHODS : Both ACVaSS and SA-CVSS were hospital-based sentinel active surveillance studies designed to monitor the safety of COVID-19 vaccines in the aforementioned COVAX AMC-92 countries and South Africa, a middle-income African country. Patients presenting to healthcare facilities with illnesses resembling pre-selected adverse events of special interest (AESIs), were enrolled, with informed consent, into the studies. The Brighton Collaboration Case Definitions were applied to classify AESIs. FINDINGS : Over 60,000 admitted patients were screened and over 12,700 eligible patients were enrolled in 18 months. Despite challenges in accessing and abstracting data from predominantly paper-based medical and vaccination records, the identification of specific AESIs and estimating association with vaccination status was feasible in LMIC healthcare facilities. CONCLUSIONS : The establishment of active vaccine safety surveillance sentinel sites is achievable in LMICs, though the lack of digital medical records hindered data accessibility and availability. Regulatory authorities, health departments and organizations supporting immunization programs must prioritize the development, maintenance and funding of active vaccine safety surveillance systems. Such surveillance is crucial to ensuring that new vaccines are properly monitored and assessed for safety following their introduction and use in these populations.
Reliability, validity and dimensionality of the 12-Item General Health Questionnaire among South African healthcare workers
(AOSIS, 2024-10) Kufe, Nyuyki Clement; Bernstein, Colleen; Wilson, Kerry Sidwell
Healthcare workers (HCWs) were among the high-risk groups for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and suffer a high burden of challenges with mental health including depression, anxiety, traumatic stress, avoidance and burnout. The 12-Item General Health Questionnaire (GHQ-12) has shown the best fit in both a one-factor structure and a multidimensional structure for the screening of common mental disorders and psychiatric well-being. The aim was to test for reliability and validity and ascertain the factor structure of the GHQ-12 in a South African HCW population. Data were collected from 832 public hospital and clinic staff during the coronavirus disease 2019 (COVID-19) pandemic in Gauteng, South Africa. The factor structure of the GHQ-12 in this professional population was examined by exploratory factor analysis (EFA) to identify factors, confirmatory factor analysis (CFA) for construct validity and structural equation modelling (SEM) to establish model fit. The GHQ-12 median score was higher (n = 25) in women than in men (n = 24), p = 0.044. The assumptions for inferential statistics were tested: the determinant for the correlation matrix was 0.034, Bartlett’s test of sphericity was p < 0.001, Chi-square 2262.171 and the Kaiser-Meyer-Olkin (KMO) of sampling adequacy was 0.877. The four factors identified were labelled as social dysfunction (37.8%), anxiety depression (35.4%), capable (24.9%) and self-efficacy (22.7%). The sample had a Cronbach’s alpha and McDonald’s Omega coefficient of 0.85. CONTRIBUTION : The study highlighted the gaps in the use of GHQ-12. The findings affirm the validity and reliability of the GHQ-12 in this group of professionals and the multidimensional structure for screening for psychological distress.
Contributions of a community health worker program in improving district health system performance in South Africa, using routine health service variables in a quasi-experimental study design
(BioMed Central, 2025-08) Thomas, Leena Susan; Jordaan, Joyce; Pillay, Yogan; Buch, Eric; leena.thomas@up.ac.za
BACKGROUND : Globally low- and middle-income countries are investing in community health worker (CHW) programs. These programs are viewed as fundamental to ensuring universal health coverage for all. Where CHW programs are doing what they should be doing and doing it adequately, they should make a difference in population health outcomes, reflecting health system changes. However, there are not many studies exploring the contributions and effectiveness of large-scale, comprehensive community health worker programs on health system performance. METHODS : This study takes place in the Ekurhuleni health district, in urban South Africa. A before (pre) and after (post) intervention study (quasi-experimental) using routine health service variables (secondary data) from district clinics over nine years was conducted. Performance of intervention clinics with community health worker teams that had more than 60% population coverage were compared to similar control clinics that had no teams or teams with less than 30% coverage. RESULTS : Both groups of clinics generally improved over time for routine health service variables for maternal, child health, infectious diseases, and cervical cancer programmes. Over nine years, intervention clinics showed more improved performance, statistically significant, in six health variables while controls improved in four. But importantly, intervention clinics improved proportionately better pre to post in seven of the nine (78%) variables studied compared to controls, demonstrating reduced diarrhoeal disease and pneumonia in children, better Vitamin A coverage, fewer severely malnourished children, better testing for HIV, and better screening for Tuberculosis and cervical cancer. Illustrating the comprehensive range of services provided by CHWs, the seven routine health service variables represented maternal, child health, infectious and non-communicable diseases. We also observed less uncontrolled hypertensive and diabetics in intervention clinics compared to control clinics. CONCLUSION : Large-scale, sustained and comprehensive community health worker programs adequately covering populations contributed to improved urban district health system performance in Ekurhuleni, demonstrating their effectiveness. This was explored through improvements in health system performance over time. These findings, using routine health service variables, have policy implications for financial and other resource allocations in health districts in low- and middle-income countries.
PrEP awareness and willingness to use oral PrEP among males ≥ 18 years attending VMMC services in Gauteng, South Africa
(Springer, 2025) Shangase, Nosipho; Tobaiwa, Ocean; Cutler, Ewalde; Singh, Beverley; Brukwe, Zinhle; Pillay, Erushka; Dorrell, Philip; Moyo, Khumbulani; Zondi, Lindokuhle; Pillay, Yogan; Patrick, Sean Mark; Puren, Adrian; Kufa, Tendesayi
Integration of voluntary medical male circumcision (VMMC) with pre-exposure prophylaxis (PrEP) services may increase access to and/or uptake of combination HIV prevention strategies. We examined awareness of and willingness to use oral PrEP among adult males attending VMMC services in Gauteng province, South Africa. A cross-sectional study was conducted among HIV-negative males aged ≥ 18 years seeking healthcare at one of six high-volume public VMMC clinics from June-October 2021. Participants provided written informed consent, completed an interviewer-administered questionnaire (covering demographics, clinical history, sexual behavioural and risk perception, PrEP eligibility, PrEP awareness and PrEP willingness), and underwent a rapid dual HIV/syphilis test. Logistic regression models (adjusted for education, age and sexual debut) were used to determine factors associated with PrEP awareness and PrEP willingness. Among the participants, 40% were at substantial risk of HIV and thus eligible for PrEP, 45% were aware of PrEP and 80% were likely/highly likely to use oral PrEP. Awareness of PrEP was lower among males who reported being at substantial risk of HIV than males not at substantial risk (aOR = 0.59, 95% CI: 0.41–0.86). PrEP willingness was higher in males who reported: (1) not being married, separated or widowed compared to married males (aOR = 2.28, 95% CI: 1.14–4.54); (2) being aware of PrEP (aOR = 1.91, 95% CI: 1.19–3.08) than those who were not aware of PrEP; and (3) having high/very high self-perceived HIV risk compared to those with lower self-perceived HIV risk (aOR = 1.94, 95% CI: 1.01–3.73). Considering the significant proportion of males attending VMMC who are at risk of HIV, integrating PrEP and VMMC services can significantly impact HIV prevention efforts by increasing awareness and uptake. Programs should prioritize PrEP awareness campaigns and highlight the combined benefits of VMMC and PrEP.
Women’s experiences of alcohol-related severe intimate partner violence : findings from formative research in South Africa
(Kettil Bruun Society for Social and Epidemiological Research on Alcohol , Canada, 2025-03) Ramsoomar, Leane; Willan, Samantha; Paile, Charntel; Mtimkulu, Maureen; Ketelo, Asiphe; Zembe, Amanda; Pass, Desiree; Nothling, Jani; Machisa, Mercilene; Abrahams, Naeemah; Shai, Nwabisa; Jewkes, Rachel
INTRODUCTION : Gender-based violence (GBV) is a threat to the health and well-being of women globally, and a key barrier to the achievement of the Sustainable Development Goals 3.3 and 5.2. Harmful alcohol use is a recognised risk factor for the perpetration and experience of GBV, particularly, intimate partner violence, and for the severity of intimate partner violence. This paper seeks to explore the role of alcohol in women’s experience of severe intimate partner violence (SIPV) in South Africa. METHODS : We conducted a qualitative study, using six focus group discussions and 20 in-depth interviews with 62 demographically diverse adult women from three provinces in South Africa (Gauteng, KwaZulu-Natal, and the Western Cape) who sought help for SIPV. FINDINGS : Women reported alcohol-related SIPV, frequently describing that her partner intentionally started arguments after he had been drinking. Their abuse included controlling and coercive behavior that restricted their movement and ability to participate in daily activities, economic abuse, and instances of severe physical and sexual intimate partner violence and attempted femicide. They viewed men's alcohol use as a ‘right’ associated with masculinity, that often intersected with expressions of masculinity, including controlling behavior, dominance, and aggression, and performing a provider role, especially among friends in taverns and bars. CONCLUSIONS : Planning for effective prevention, providing services and policy efforts requires an understanding of the complexity of the interaction between men's alcohol abuse and their perpetration of SIPV particularly in a context like South Africa, where both harmful alcohol use and GBV are prevalent.

Browse

Recent Submissions