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

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Exploring the application of dietary approaches to stop hypertension (DASH) in the management of patients with chronic kidney disease : a systematic review and meta-analysis
(Elsevier, 2025-10) Aderoju, Yaa Boahemaa Gyasi; Hayford, Frank Ekow Atta; Achempim-Ansong, Gloria; Duah, Evans; Baloyi, Tinyiko Violet; Morerwa, Smangaliso; Agordoh, Percival; Dzansi, Gladys
BACKGROUND & AIM : Chronic Kidney Disease (CKD) remains a significant global non-communicable disease (NCD) that affects more than 10 % of the world's population. Attention is gradually shifting to tertiary prevention of CKD to avoid End-Stage Renal Disease (ESRD) progression. This study reviewed evidence of the use of a Dietary Approach to Stop Hypertension (DASH) and its effect on disease progression among patients living with CKD. METHODS : A comprehensive search was conducted using the Scopus, PubMed, Web of Science, ProQuest, and EBSCO Host databases for studies published from 1997 to 2025. The PICO framework guided the search, focusing on patients with CKD, DASH as the intervention, other dietary and non-dietary approaches as comparisons, and CKD progression measured by changes in estimated Glomerular Filtration Rate (eGFR) and/or Urine Albumin-to-Creatinine Ratio (UACR) as outcomes. Effect sizes with 95 % confidence intervals and pooled effects were calculated using random effects REML models and Z-tests. Percentage changes in renal function post-intervention, based on eGFR, were also computed. Cochran's Q test and the I-squared (I2) statistic assessed study heterogeneity. This review protocol is registered with PROSPERO (CRD42024588682). RESULTS : Of the 174 studies screened, four met the eligibility criteria and were included in the review. All were prospective cohort studies with an average follow-up of 5.5 years and a combined patient sample size of 7033. Across studies, low DASH adherence was defined as scores in the lower half of the possible range used, and high adherence as scores in the upper half (e.g., 0-40 vs. 41-80; 0-4 vs. 5-9; 8-24 vs. 25-40). Low DASH adherence was associated with a mean eGFR improvement of 0.54 ml/min/1.73 m2 (1.2 %) (Z = 0.57, p = 0.57), while high adherence showed a greater improvement of 3.34 ml/min/1.73 m2 (6.8 %) (Z = 1.77, p = 0.08). Only one study assessed UACR, reporting a lower median UACR with high DASH adherence (33.6 mg/g) compared to low adherence (55.6 mg/g). CONCLUSIONS : The DASH diet has the potential to slow CKD progression; however, consistent adherence is crucial to maximize its clinical benefits and improve renal outcomes. Although improvements in eGFR with DASH diet adherence are clinically meaningful, they lack statistical significance. These findings support global efforts towards achieving Sustainable Development Goal 3 for NCDs.
Feasibility of implementing a non-invasive self-sampling method for saliva specimens that can be used for the diagnosis of respiratory infections among paediatric patients in the Tshwane District, South Africa : a study protocol
(BMJ Publishing Group, 2025-10) Nxele, Siphesihle Robin; Dlangalala, Thobeka Nomzamo; Gxekwa, Nobuhle Vanessa; Ramatsokotla, Sebueng; Musekiwa, Alfred; Kgatle, Mankgopo Magdalene; Hatchett, Daniel B.; Shin, Albert; Tu, Wan-chen; Robertson, Ingrid H.; Su, Xiaojing; Berthier, Erwin; Thongpang, Sanitta; Theberge, Ashleigh B.; Mashamba-Thompson, Tivani Phosa; sr.nxele@up.ac.za
INTRODUCTION : Effective community-based disease management is essential for public health. In low- and middle-income countries, sustainable strategies for timely diagnosis and treatment are a research priority. This study aims to assess the feasibility of a non-invasive saliva self-sampling method, paired with digitally linked molecular point-of-care diagnostics, for detecting respiratory infections among paediatric patients in the Tshwane District, South Africa. METHODS AND ANALYSIS : A field study will be conducted at Steve Biko Academic Hospital to compare saliva collection using the CandyCollect lollipop device and standard mouth swabs. The spiral groove of the lollipop device captures pathogens, which are stored in DNA/RNA preservation media and later analysed using quantitative PCR and commercially available rapid antigen tests. The multiplex respiratory pathogen panel, based on TaqMan real-time PCR technology, targets key paediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and influenza A/B. Nucleic acids will be extracted using standard viral extraction kits and analysed following manufacturer protocols. Internal controls will be included in each qPCR run, and samples with CT values below defined thresholds will be considered positive. Rapid antigen tests will detect common pathogens such as influenza A/B, RSV and SARS-CoV-2 for comparative analysis. User experience and acceptability will be assessed via child-friendly and caregiver surveys following sample collection. The study will be implemented in two phases: diagnostic performance evaluation and user feedback assessment. The protocol is aligned with the Standard Protocol Items: Recommendations for Interventional Trials 2013 checklist. ETHICS AND DISSEMINATION : Ethical approval has been granted by the University of Pretoria (509/2023) and the Gauteng Department of Health (GP_202406_032). The study is registered in the Pan African Clinical Trial Registry (PACTR202411743094783). Findings will be disseminated through peer-reviewed journals, conferences and stakeholder briefings. The study complies with South Africa’s Protection of Personal Information Act. Data collection is scheduled from November 2024 to February 2025, with project completion expected within 1 year. TRIAL REGISTRATION NUMBER : Pan African Clinical Trial Registry (PACTR202411743094783).
Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention programme into routine health services in Zimbabwe : a qualitative study
(BMJ Publishing Group, 2025-08-11) Chung , Amanda Marr; Murungu, Joseph; Case, Peter; Chitapi, Precious; Chikodzore, Rudo; Gosling, Jonathan; Xaba, Sinokuthemba; Ncube, Getrude; Mugurungi, Owen; Kunaka, Patience; Prata, Ndola; Gosling, Roly Daniel; Bertozzi, Stefano M.; Auerswald, Colette
INTRODUCTION : The transition of voluntary medical male circumcision (VMMC), an HIV prevention service, in Zimbabwe from a donor-funded to a government-owned programme involves the collective efforts and alignment of national and subnational government leaders, managers, healthcare providers, village health workers, community members, donors and implementing partners. We sought to understand stakeholders' perspectives on barriers, facilitators and recommendations as a vertical HIV prevention programme transitioned to an integrated, government-led model. METHODS : We conducted 54 semistructured stakeholder interviews at the national and subnational levels. Interviews were audio recorded, transcribed and thematically analysed. RESULTS : Participants highlighted a range of psychological and structural barriers and facilitators to integrating and sustaining the VMMC programme. Respondents mentioned financing and staffing barriers to integration, particularly a lack of domestic resources, the transition from a fee-for-service to a facility-based performance model and staff attrition. Notably, resistance to changing the VMMC programme's operations was a significant barrier that may be tied to individual psychological barriers such as loss of power and job security. Donors and partners continued to control the funding for VMMC. Ideally, the Ministry of Health and Child Care should have more autonomy over these decisions. At the subnational level, there is an opportunity for increased responsibility and a greater sense of ownership through the decentralisation of governance. CONCLUSIONS : To ensure successful integration and local ownership of VMMC as an HIV prevention programme, stakeholders must address both psychological and structural barriers while aligning their perspectives on the transition. Individual providers have valid concerns about their financial security and the burden of additional responsibilities without adequate compensation. It is crucial for donors and partners to reduce their involvement and oversight. Additionally, resolving the financial barriers that prevent the government from having complete control of the programme will require empowering local government stakeholders to fully take ownership.
Evaluating performance of the Bioline™ HCV point-of-care test in Ghana
(BioMed Central, 2025-10) Duah, Evans; Mathebula, Evans Mantiri; Maluleke, Kuhlula; Azumah, Daniel Edem; Ephraim, Richard Kobina Dadzie; Mashamba-Thompson, Tivani; evans.duah@tuks.co.za
BACKGROUND : Hepatitis C Virus (HCV) causes liver diseases including chronic hepatitis, cirrhosis, and hepatocellular carcinoma. In low- and middle-income countries (LMICs), particularly sub-Saharan Africa (SSA), HCV diagnostic resources are limited. Moreover, most evaluations of point-of-care (POC) invitro diagnostics (IVDs) are conducted outside the region using non-African populations, which may not reflect their performance in local settings where they are mostly used. This study assessed the diagnostic performance of the Bioline™ HCV POC test in Ghanaian HCV target populations. METHODS : A cross-sectional field evaluation was conducted among HCV priority populations including incarcerated individuals, patients requiring HCV testing, and voluntary blood donors undergoing pre-donation screening. Venous blood samples were tested using the Bioline™ HCV POC test, and the results were compared with the Enzyme-Linked Immunosorbent Assay (ELISA) reference standard. The sensitivity, specificity, test efficiency, Youden index, predictive values, likelihood ratios, and receiver operating characteristic (ROC) indicators were calculated. RESULTS : The Bioline™ HCV POC test demonstrated a sensitivity of 96.7% (95% CI: 82.8–99.9%), specificity of 99.8% (95% CI: 98.9–100%), and positive and negative predictive values of 96.7% (95% CI: 82.8–99.9%) and 99.8% (95% CI: 98.9–100%), respectively. The test efficiency was 99.6% (98.6–99.9%), Youden index 0.97 (0.82–0.99) with a ROC area of 0.98 and highly favorable likelihood ratios (LR + 483.5, LR − 0.03). CONCLUSION : This study highlights the high diagnostic performance of the Bioline™ HCV POC test in Ghanaian populations. The test’s reliability underscores its potential as a valuable tool for HCV screening and early detection in resource-limited settings, contributing to efforts to reduce the global HCV burden. TRIAL REGISTRATION : This study is part of a diagnostic trial registered in the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za) on 24th October 2024 with trial registration number: PACTR202410837698664.
Fine-tuning a sentence transformer for DNA
(BioMed Central, 2025-10) Mokoatle, Mpho; Marivate, Vukosi; Mapiye, Darlington; Bornman, Maria S. (Riana); Hayes, Vanessa M.
BACKGROUND : Sentence-transformers is a library that provides easy methods for generating embeddings for sentences, paragraphs, and images. Sentiment analysis, retrieval, and clustering are among the applications made possible by the embedding of texts in a vector space where similar texts are located close to one another. This study fine-tunes a sentence transformer model designed for natural language on DNA text and subsequently evaluates it across eight benchmark tasks. The objective is to assess the efficacy of this transformer in comparison to domain-specific DNA transformers, like DNABERT and the Nucleotide transformer. RESULTS : The findings indicated that the refined proposed model generated DNA embeddings that exceeded DNABERT in multiple tasks. However, the proposed model was not superior to the nucleotide transformer in terms of raw classification accuracy. The nucleotide transformer excelled in most tasks; but, this superiority incurred significant computing expenses, rendering it impractical for resource-constrained environments such as low- and middle-income countries (LMICs). The nucleotide transformer also performed worse on retrieval tasks and embedding extraction time. Consequently, the proposed model presents a viable option that balances performance and accuracy.
Leveraging risk communication and community engagement and lessons from previous outbreaks to strengthen a public health response : a case study of Disease X in the Panzi region, DRC
(AOSIS, 2025-06-30) Gashema, Pierre; Iradukunda, Patrick G.; Sesonga, Placide; Bigirimana, Radjabu; Mugisha, Jean C.; Harelimana, Jean dD.; Fallah, Mosoka P.; Dzinamarira, Tafadzwa; Muvunyi, Claude M.
On 08 December 2024, the World Health Organization (WHO) reported an outbreak of Disease X in the Panzi Health Zone, Kwango province, Democratic Republic of the Congo (DRC). This unknown pathogen, with 406 cases and 31 deaths at the time of its declaration, predominantly affects children under 5 years. Disease X, hypothesised to be a zoonotic ribonucleic acid (RNA) virus, poses significant challenges because of limited healthcare infrastructure, gaps in risk communication and ineffective community engagement. This opinion article aims to explore these challenges and advocate for the urgent need for culturally tailored, inclusive communication strategies that foster trust and empower local communities in responding to outbreaks. Key approaches highlighted include mobilising local leaders, utilising mobile laboratories for decentralised diagnostics and improving sample collection techniques. Drawing on lessons from previous epidemics, such as COVID-19 and Ebola, this article emphasises the importance of robust surveillance systems, community engagement and effective risk communication, skilled health workforce and collaborative management frameworks. Strengthening early warning systems and ensuring equitable access to diagnostic and treatment resources are essential for mitigating future outbreaks of unknown diseases in resource-limited settings.
The epidemiology of human schistosomiasis in Gauteng Province, South Africa, 2017-2022
(AOSIS, 2025-08) Makhubele, Nchucheko; Ngoma, Nqobile; Matjokotja, Tebogo; Nyasulu, Peter S.; Neti, Mzimasi; Mokgetle, Refilwe
BACKGROUND : Schistosimiasis affects over 250 million people globally. It is considered a moderately endemic condition in South Africa, with 36 people per 100 000 infected annually between 2011 and 2018. Despite its ability to cause long-term complications, it remains under-studied in Gauteng Province, and its epidemiological patterns are poorly understood. AIM : To describe the prevalence and trends of human schistosomiasis from 2017 to 2022. SETTING : Gauteng Province, South Africa. METHODS : A descriptive cross-sectional study was conducted using all clinical and laboratory human schistosomiasis cases in Gauteng Province from 2017 to 2022. Descriptive statistics summarised cases. Annual trends, seasonal patterns, and geographic distribution were assessed. Yearly incidence rates and overall provincial prevalence were estimated per 100 000 population. RESULTS : There were 2526 human schistosomiasis cases recorded. The median age was 28 years (interquartile range [IQR]: 19–42), and men aged 10–19 years were most affected (15%). Cases declined by 37 per year over the study period, with seasonal peaks in February–March and August–September. The highest incidence occurred in 2019 (3.83 cases per 100 000). City of Tshwane Metropolitan and Mogale City had region-specific prevalence of > 25 cases per 100 000; overall provincial prevalence was 15 cases per 100 000. CONCLUSION : Enhanced surveillance, strengthened reporting, targeted awareness and preventative measures in vulnerable communities are recommended to reduce transmission. Ongoing research is crucial to inform evidence-based interventions in Gauteng Province and South Africa. CONTRIBUTION : The study identified key demographic patterns, geographic hotspots, and temporal trends of human schistosomiasis cases in Gauteng Province.
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.

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