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Optimization of dried blood spot for hepatitis B virus surface antibody quantification
Motshosi, Patience; Phinius, Bonolo B.; Jongman, Mosimanegape; Baruti, Kabo; Bhebhe, Lynnette; Mulenga, Graceful; Choga, Wonderful T.; Moyo, Sikhulile; Gaseitsiwe, Simani; Anderson, Motswedi (Public Library of Science, 2025-05)
Dried blood spot (DBS) cards can be used as an alternative sample collection method to plasma, however, there is no optimized elution protocol for DBS cards specifically for hepatitis B surface antibody (anti-HBs) testing. The study aimed to develop a DBS elution protocol for anti-HBs quantification. Our study sought to determine the ideal phosphate-buffered saline (PBS) volume to use by comparing three PBS volumes (300 µL, 450 µL, and 500 µL), and the optimal time to agitate DBS discs on a plate shaker (1, 2, 3, and 4 hours) to yield DBS anti-HBs concentrations that are comparable to corresponding plasma anti-HBs concentrations. The optimal DBS storage temperature (25°C, -20°C, and -80°C) was investigated to determine the ideal long-term storage temperature of the cards. Residual samples were used for optimization (2019-2021). A total of 50 DBS-plasma pairs were used throughout the study, with plasma anti-HBs concentrations being used as the golden standard to compare. A two-way analysis of variance (ANOVA) was also performed to determine the impact of PBS elution volumes, elution time, and storage temperature on the anti-HBs concentration of DBS samples. No statistically significant difference between the DBS-plasma anti-HBs pairs was observed when using 450 or 500 µL of PBS and when samples were agitated for 3 hours (p = 0.59, p = 0.50) respectively. The optimal storage temperature for DBS cards was 25°C because the results showed no statistically significant difference between DBS-plasma anti-HBs titers (p = 0.59). The two-way ANOVA analysis showed that elution volumes and time had no statistically significant impact on the DBS anti-HBs concentrations, p = 0.95 and p = 0.38 respectively. Storage temperature had a statistically significant impact on the DBS anti-HBs concentrations, p = 0.002. The optimized DBS elution protocol for anti-HBs quantification will help monitor vaccine efficacy in infants due to the low sample volumes required compared to plasma and also can be used for anti-HBs testing in resource-limited areas around the country.
Joint predictors of antenatal care contacts and timing of antenatal care initiation among women of reproductive age in Ethiopia
Asmare, Abebew Aklog; Tegegne, Awoke Seyoum; Belay, Denekew Bitew (Public Library of Science, 2025-11-07)
BACKGROUND : Maternal and neonatal mortality remain major public health challenges, particularly in low-income countries like Ethiopia. Antenatal care (ANC) plays a vital role in improving maternal and neonatal outcomes. This study aimed to jointly assess the predictors of ANC contacts (defined as a woman receiving four or more contacts during pregnancy) and timing of ANC initiation (defined as a woman starting ANC early (during the first trimester)) using a bivariate binary logistic regression model. METHODS : Data were drawn from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS), conducted by the measures of the DHS Program. A total of 5,492 weighted women aged 15-49 years with recent births were included. A bivariate binary logistic regression model was employed to simultaneously examine the two ANC outcomes, taking into account their potential interdependence. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS : The prevalence of completing four or more ANC visits and timely ANC initiation was 59.7% and 19.8%, respectively. Among 5,492 ever-married women, timely ANC initiation and completing four or more ANC visits were significantly associated. Maternal age, region, maternal education, wealth index, and number of children ever born were identified as joint predictors affecting both outcomes. For example, compared to women from poor households, those from middle-income households had higher odds of receiving four or more ANC contacts (AOR = 1.391; 95% CI: 1.121-1.726) and initiating ANC early (AOR = 2.047; 95% CI: 1.669-2.511). CONCLUSION : The findings highlight significant socioeconomic and geographic disparities in ANC utilization in Ethiopia. Integrating both outcomes into a joint modeling framework provides a more comprehensive understanding of maternal health service use. Targeted interventions are needed to promote early and adequate ANC, particularly among poor and rural populations.
How value perspectives influence decision-making in the South African private healthcare sector
Laubscher, Anchen; Rodseth, Reitze N.; Retief, Francois; Saville, Adrian David (Public Library of Science, 2025-02-04)
BACKGROUND : Every healthcare clinical event aims to create value at a certain cost. This value has been defined as the outcome achieved (the degree to which a care event achieved a clinical goal) divided by the cost incurred (determined by the combined price charged by the care provides) to generate the outcome. Subsequently, patient experience has been included as a third factor contributing to value of care, but its value and relationship relative to clinical outcome and event cost is not well understood. This cross-sectional comparative study explored the relative importance of 1) clinical outcome, 2) event cost, and 3) patient experience as they relate to the value of care in the South African private healthcare context. MATERIALS AND METHOD : Using a value perspectives survey, healthcare consumers (n = 662) and healthcare providers (n = 318) distributed 100 points between the three factors according to how they perceived their value. They were then asked to assess the value of the three factors across six clinical scenarios progressing in clinical severity. RESULTS : For all scenarios, all participants valued patient experience above event cost, but lower than clinical outcome. However, there were significant differences between consumers and providers in the relative value assigned to each of the three factors. These values changed as the severity of the surgical and medical scenarios changed. Patient experience was consistently assigned a higher value than event cost, thereby making a strong argument for its inclusion into the healthcare value equation. CONCLUSION : Both South African healthcare consumers and providers assigned significant value to patient experience across a range of clinical scenarios. These findings suggest that patient experience should be included as a factor in the Value Care Index (VCI) where VCI = (Outcome ÷ Cost) x Patient Experience.
Monitoring, surveillance, antimicrobial resistance and genetic diversity analysis of non-typhoidal Salmonella in South Africa from 1960–2023 from animal and animal products
Matle, Itumeleng; Pfukenyi, Davies Mubika; Maphori, Nozipho; Moatshe, Nkagiseng; Nkabinde, Thabo; Motaung, Annah; Schmidt, Tracy; Seakamela, Emmanuel; Mwanza, Mulunda; Ngoma, Lubanza; Sirdar, Mohamed Mahmoud; Mbatha, Khanyisile R.; Magwedere, Kudakwashe (Public Library of Science, 2025-08-01)
Salmonellosis remains one of the most frequently reported foodborne diseases globally, with the highest burden in low-resource areas. The millions of deaths caused by Nontyphoidal Salmonella (NTS) infections emphasize the urgent need for timely, detailed, and evidence-based interventions to effectively manage and monitor NTS burdens. This study retrospectively analyzed 1,028 NTS isolates from animals, the environment, and food products in South Africa, collected between 1960 and 2023. Among the 102 serotypes identified, S. Heidelberg, isolated only between 2000−2009 and 2020−2023, accounted for 94.3% of isolations during the latter period, suggesting a recent shift in Salmonella epidemiology in the region. The highest resistance rates were observed for cefoxitin (65.7%), cephalothin (62.8%), and tetracycline (59.8%), with a significant increase in resistance to several antibiotics, including ceftriaxone and aztreonam, from 2010−2023. Genetic analysis revealed that S. Gallinarium had the highest prevalence of antibiotic resistance genes, such as tetA (71.4%), qnrA (64.3%), cat1 (64.3%), blaPSE (57.1%), and both blaCMY-2 and qnrB at 50%. The blaPSE and blaSHV genes were strongly associated with ceftriaxone resistance in S. Dublin isolates, while blaPSE and qnrS were linked to chloramphenicol resistance in S. Enteritidis and S. Dublin isolates. Additionally, 87% of the virulence genes screened were present in over 50% of the serotypes, indicating increased adaptability and potential shifts in disease dynamics. The rise in antimicrobial resistance, driven by antimicrobial misuse, horizontal gene transfer, and biofilm formation, could alter serotype dynamics and changing disease epidemiology. This trend underscores the urgent need for effective antimicrobial stewardship and surveillance to combat the spread of antibiotic resistance in Salmonella populations.
Remote sensing applied in land use and land cover change (LUCC) in arid and semi-arid ecosystems : current status, challenges and prospects – a systematic review
Agassounon, Bill M.; Assede, Emeline Sessi Pelagie; Bastin, Jean-Francois; Biaou, S.S. Honore (Springer, 2025-10)
Arid and semi-arid ecosystems face a triple environmental threat at the intersection of climate change, biodiversity loss, and desertification. Land use and land cover change (LUCC) in the region is, therefore, a key indicator in monitoring overall ecosystem health. However, persistent challenges hinder LUCC assessment in dry biomes, notably due to the heterogeneity of arid vegetation and its response to high temperature and water availability variations throughout the year. To identify the most important knowledge gaps easily tackled in the near future, this systematic review synthesizes current scientific knowledge on LUCC monitoring in arid and semi-arid ecosystems from the Scopus and Dimensions databases. Study results showed that seasonality (41%) and spatial resolution (28%) were the two main factors limiting LUCC in arid and semi-arid ecosystems. These factors had a significant influence on map accuracy, particularly due to seasonal variations in vegetation and the conditions under which satellite images were taken. Classification accuracy decreased substantially when the studies attempted to describe vegetation classes in more detail. Reported classification accuracies in the literature (accuracy ≥ 80%) reflected overconfidence, as a large proportion of the publications (70%) were limited to general distinctions such as forest and non-forest, without tackling more complex categories. Thus, given the importance of global vegetation maps for ecosystem management, a valuable tool for forest management and environmental planning, wrong estimation can introduce biases, leading to inappropriate management decisions and thus compromising the sustainability of natural resources and the ecosystem services that depend on them.