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

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The role of mathematical modelling in predicting and controlling infectious disease outbreaks in underserved settings : a systematic review and meta-analysis
Khumbudzo, Mavhunga; Duah, Evans; Grobler, Estelle; Maluleke, Kahlula (Wiley, 2025-09)
BACKGROUND AND AIM : Mathematical modelling plays an important role in public health by enabling the prediction of disease outbreaks, assessment of transmission dynamics and evaluation of intervention strategies. Although widely applied in high-resource settings, its use in underserved contexts remains underexplored. This review aimed to examine and synthesize current evidence on the application of mathematical modelling for predicting and controlling infectious diseases in underserved settings. METHODS : A comprehensive and reproducible search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and population, intervention, comparison and outcome (PICO) frameworks across databases, including PubMed, Scopus, Medline, ScienceDirect and EBSCOhost. Keywords and Medical Subject Headings (MeSH) terms related to mathematical modelling and infectious disease control were applied. Two reviewers independently screened titles, abstracts and full texts, with a third resolving discrepancies. Thematic analysis and meta-analysis were used for synthesis. RESULTS : Out of 838 studies screened, 27 (3.2%) met inclusion criteria. Deterministic models were most used, followed by stochastic and agent-based models. Diseases modelled included COVID-19, malaria, tuberculosis (TB), Ebola, Zika, chikungunya, dengue, diphtheria, respiratory infections, visceral leishmaniasis (VL) and Mpox. Modelling predicted the impact of interventions on transmission, with pooled effect size (Ro) of 1.32 (θ = 1.3, p < 0.0001). However, challenges, such as data underreporting, gaps and inconsistencies, were common, potentially affecting model accuracy and real-world applicability. CONCLUSION : Mathematical modelling has demonstrated value in supporting infectious disease control in underserved settings. However, the predominance of deterministic models limits adaptability across diverse contexts. Poor data quality further constrains reliability. Future work should focus on expanding modelling approaches, strengthening data infrastructure and addressing a broader range of diseases. These findings can guide public health policy by supporting data-driven decision-making, improving resource allocation and integrating modelling into outbreak preparedness and response strategies in underserved settings.
Spatial distribution of COVID-19 diagnostic services in Mopani district, Limpopo Province, South Africa
Maluleke, Kuhlula; Musekiwa, Alfred; Mckelly, David; Baloyi; Mashamba‑Thompson, Tivani Phosa (Wiley, 2025-10)
INTRODUCTION : Access to healthcare facilities in rural areas remains a major challenge, particularly during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the spatial distribution and accessibility of COVID-19 point-of-care (POC) diagnostic services in Mopani District, Limpopo province, South Africa, using a geographic information system (GIS)-based approach. The aim was to identify areas where healthcare access requires improvement. METHODS : A descriptive cross-sectional study design was used, analysing secondary data through dasymetric mapping to disaggregate and re-aggregate population data into analytical units. Accessibility was measured by distances from residences to the nearest primary healthcare (PHC) clinics (<5 km) and from clinics to the nearest district hospitals (<30 km). Demographic and socio-economic data from Statistics South Africa were included for context. RESULTS : Mopani District had an estimated population of 1,202,916, with 942,801 (78.4%) residing within 5 kmof a PHC clinic. The district had 105 clinics, each serving about 11,456 people, and 72 (68.6%) of these clinics were within 30 km of a district hospital. The district contained both densely and sparsely populated areas, with high unemployment and low-income levels, particularly in rural regions. Limited public transport further constrained access. Ba-Phalaborwa, Maruleng, Greater Tzaneen and Greater Letaba have relatively good access, whereas Greater Giyani faces significant challenges. DISCUSSION : Although a majority of the population lived within 5 km of a clinic, notable gaps in accessibility remain. Improving transport infrastructure, using telemedicine and mobile health units, and implementing socio-economic support strategies, such as subsidized transport, can enhance access. Addressing geographic and structural inequalities in healthcare distribution is critical to promoting equity and improving health outcomes in rural districts like Mopani.
Defining public health transformation : a scoping review
Phooko, Violet; Maluleke, Kuhlula; Ramatsokotla, Sebueng; Serite, Thato; Kgarosi, Kabelo; Sokudela, Funeka Brenda; Mashamba‑Thompson, Tivani Phosa (Wiley, 2025-06)
Public health transformation aims to instigate enduring changes in healthcare services, staff roles and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. Public health transformation is the process of reorganizing and creating a shared vision to ensure the right mindsets, capacity, resources and workforce to deliver equitable Foundational Public Health Services and ultimately promote health, well-being and equity. Such transformation requires a fundamental change in public health systems’ structure, functioning and interactions, supported by continuous quality improvement, innovation, partnerships, community-driven efforts and systems change. This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCO Host, Academic Search Complete, Africa-Wide Information, Dentistry & Oral Sciences Source, Health Source–Consumer and Academic Edition, PUBMED and Scopus. Abstracts and full-text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer-reviewed published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction. Emergent themes included (1) Transformation in Public Healthcare; (2) Evaluation of Health Transformation Programs; (3) Financial Implications; (4) Public Health Access; and (5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision-making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people-centred approach in both practice and research to effectively address these gaps.
Strategies and responses to the effects of climate change on health systems in Sub-Saharan Africa : a scoping review protocol
Chimatiro, Chancy Skenard; Mianda, Solange; Hajison, Precious L.; Lembani, Martina (Public Library of Science, 2025-08-06)
BACKGROUND : Climate change is recognized as the greatest global health threat of the 21st century. Projections suggest that the Sub-Saharan African region will face more consequences of climate change than any other region globally. The health systems within the region have been affected by the negative effects of climate change. Mapping strategies and responses used in the region to address the effects of climate change on health systems in Sub-Saharan Africa could be a starting point for understanding evidence-based decision-making to inform best practices. METHODS : This scoping review will follow the methodological framework by Arksey & O'Malley. A wide range of databases will be searched to identify articles published on the strategies and responses to the effects of climate change on the health systems in Sub-Saharan Africa. Only peer-reviewed articles (original quantitative and qualitative studies, mixed methods, systematic reviews, editorials, and commentaries) published in English Language between 2010 and 2024 will be reviewed. All Book chapters and the grey literature (dissertations, conference proceedings, abstracts, reports) and publications primarily focusing on climate change strategies and responses without effects on health systems will be excluded. Covidence software will be used during study selection, data extraction, and summary. Deductive thematic analysis will be performed using predetermined themes from the objectives. DISSEMINATION : The results of this scoping review will be disseminated at local and international research conferences. Furthermore, the findings will be published in open-access journals targeting different audiences. The findings will also be shared with the Ministry of Health in Malawi for possible policy considerations.
Adolescent girls and young women as a critical population for HIV epidemic control in sub-Saharan Africa : are we doing enough?
Murewanhema, Grant; Moyo, Enos; Moyo, Perseverance; Dzinamarira, Tafadzwa (Frontiers Media, 2025-11-13)
Without proper control measures, sub-Saharan African (SSA) adolescent girls and young women (AGYW) aged 15–24 are at high risk of HIV infection. Despite significant progress in the control of the HIV epidemic, most new infections in SSA in 2023 occurred in AGYW. High sexual and reproductive activity in AGYW contributes significantly to the HIV epidemic, making them a priority population for focused prevention efforts that uphold their sexual and reproductive health and rights.
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.
Determinants of educational institution enrolment among orphaned and vulnerable children in Namibia : a multi-year analysis 2018–2024
Dzinamarira, Tafadzwa; Moyo, Enos; Mangwana, Hadrian; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Robert, Kopano (Wiley, 2025-10)
BACKGROUND : Education significantly reduces poverty, enhances labour productivity, improves health outcomes and facilitates full participation in economic and community development. Orphans and vulnerable children (OVC) encounter numerous obstacles in obtaining education. This study evaluated the OVC's educational institution enrolment rate and associated factors. METHODS : This retrospective cross-sectional study used 2018-2024 programmatic data from OVC participating in PHN's Namibia DREAMS OVC program. The study included OVC aged 0 to 19 years. Data were analysed utilising IBM Statistical Package for Social Sciences (SPSS) version 29. Chi-square tests and bivariate and multivariate logistic regression analyses were conducted. RESULTS : Among the 16 845 participants included in this analysis, 10 607 (63.0%) participants were enrolled in an educational institution, 95% confidence interval (CI) (62.3%-63.7%). Among the 7393 participants aged 0-6 years, 1735 (23.5%) were enrolled in an educational institution. Participants from Onandjokwe, Tsandi and Katima had a higher likelihood of being enrolled in an educational institution than those in Windhoek, with adjusted odds ratio (AOR) = 1.42, 95% CI (1.07-1.87), AOR = 1.69, 95% CI (1.09-2.61) and AOR = 1.51, 95% CI (1.15-1.98), respectively. Participants aged 7-9 and 10-14 years were more likely to be enrolled in an educational institution than those aged 15-19 years, AOR = 3.02, 95% CI (2.34-3.90) and AOR = 3.29, 95% CI (2.64-4.09), respectively. Participants with male caregivers, HIV-negative caregivers and caregivers who had completed vocational training or tertiary education were more likely to be enrolled in an educational institution, AOR = 1.25, 95% CI (1.07-1.47), crude odds ratio (COR) = 2.67, 95% CI (2.35-3.04) and COR = 2.34, 95% CI (1.09-5.01), respectively. Participants from households with no to moderate hunger, caregivers who had a source of income and those who were not sexually abused were more likely to be enrolled in an educational institution. CONCLUSION : It is essential to implement strategies that provide OVC tuition assistance and additional financial resources to meet their basic needs during their education. Providing food support to vulnerable households and meals in schools may enhance educational institution enrolment. Interventions are needed to increase the number of early childhood development (ECD) schools in the country.
Chemical analyses and geographical origins of residential attic dust in central South Africa
Van der Westhuizen, Deidré; Welman‑Purchase, Megan; Wichmann, Janine; Von Eschwege, Karel G. (Springer, 2025-04-10)
Particulate matter (PM) is a widely used air pollution proxy indicator. Substantial supporting evidence links exposure to PM with adverse health effects. This study compares long-term accumulated particulate matter's chemical and morphological properties and possible sources from various locations in Bloemfontein, Kimberley, and the Vanderbijlpark residential areas. As the first study of this kind in South Africa, dust samples were collected from the attics of houses built over fifty years ago. Potential area PM sources located far away were identified by analyzing every tenth year from 1972 to 2022, representing five decades of backward Long-Range Transport (LRT) clusters, for air masses that passed the sampling sites. Several PM sources were determined by combining LRT geographic origin studies and chemical analyses of collected samples. Elemental compositions of samples were determined by the use of scanning electron microscopy, and electron dispersive spectroscopy. Mineral content was determined by X-ray fluorescence, X-ray diffraction, and electron probe microscopy techniques, revealing airborne sources that moved significantly due to climate change, over the 5-decade period. Potential area PM sources located far away included various South African provinces, neighboring states to the north, and the Atlantic and Indian Oceans west and east of South Africa. Elemental composition included: Al, Ag, C, Ca, Cl, Cu, Fe, K, Mg, Mn, Na, O, S, Si, Ti, and Zn. Mineral composition included SiO2, TiO2, Al2O3, Fe2O3, MnO, MgO, CaO, Na2O, K2O, P2O5, SO3, Cr2O3 and NiO. The most prominent minerals found were quarts and plagioclase. While considering relevant mining activities, combining methods allowed a successful study of change in source distribution associated with climate change.
Cervical cancer awareness among women recently diagnosed with cervical cancer in South Africa and Zimbabwe
Govender, Sudarshan; Phillips, Tamsin K.; Walter, Fiona M.; Day, Sarah; Guzha, Bothwell; Scott, Suzanne E.; Chirenje, Zvavahera M.; Ataguba, John Ele-Ojo; Mbatani, Nomonde; Fakie, Nazia; Moodley, Jennifer (ecancer , United Kingdom, 2025-10)
Incidence and mortality rates of cervical cancer remain high in Southern Africa (SA). We explored awareness of cervical cancer symptoms and risk factors, as well as risk lay beliefs among women recently diagnosed with cervical cancer from SA and Zimbabwe. Patients were asked to complete a locally validated questionnaire with unprompted, open-ended questions to assess awareness of cervical cancer symptoms and risk factors. Among 501 women (SA 285, Zimbabwe 216), 46% (229) were able to recall one or more symptoms (SA 24%, Zimbabwe 76%) and 19% (93) were able to recall one or more risk factors of cervical cancer (SA 27%, Zimbabwe 73%). In SA, factors associated with increased symptom awareness included higher education level (completion of secondary education compared to not completing secondary education; adjusted odds ratios (aOR) 2.74, 95% confidence interval (CI) 1.17–6.43) as well as living in urban and peri-urban areas compared to living in rural areas (Urban: aOR 2.98, 95% CI 1.35–6.80; Peri-urban: aOR 3.28, 95% CI 1.13–9.35). Having a self-reported history of a chronic condition was associated with lower risk factor awareness compared to not having a self-reported chronic condition (aOR 0.07, 95% CI 0.00–0.42). In Zimbabwe, those who self-reported living with HIV were more likely to know one or more risk factors compared to those without HIV (aOR 2.69, 95% CI 1.31–5.67). Overall, 90 (18%) women mentioned at least one lay belief about risk factors for cervical cancer, with the most reported being inserting herbs, creams or objects into the vagina (9%, n = 43). The low levels of cervical cancer awareness in two Southern African countries highlight the urgent need to improve cervical cancer awareness, as low levels of awareness can impact timely cancer diagnosis and limit the uptake of cervical cancer prevention programs.
Spatial analysis of under-five mortality in Africa using geographically weighted poisson regression
Olusola, Johnson Adedeji; Oyinloye, Adedeji Adigun; Akeju, Kemi F.; Ogunsakin, Ropo Ebenezer; Moyo, Sibusiso (Springer, 2025-07)
Child mortality remains a significant public health challenge in developing countries despite the global decline in under-five deaths. The disparities in child mortality rates can be attributed to socioeconomic and environmental inequalities across nations. While several studies have examined geographic variations in under-five mortality in Africa using economic and health indicators, few have applied spatial analysis to characterize these patterns. This study employs Geographically Weighted Poisson Regression (GWPR) to uncover spatially varying in effects of global indicators on under-five mortality across Africa, offering a detailed understanding not captured by conventional global models. Data on under-five mortality rates and economic and health indicators were obtained from the World Bank’s World Development Indicators (WDI) for 2022 across 54 African countries. A Poisson regression model and GWPR were applied to examine the associations between under-five mortality and various socioeconomic and environmental factors. The results indicate substantial spatial heterogeneity in child mortality across countries. The GWPR model (AICc = 221.25, Pseudo R2 = 86.5%) outperformed the conventional Poisson regression model (AICc = 360.733, Pseudo R2 = 58.4%), highlighting the benefits of incorporating spatial variability. Key findings revealed that under-five mortality was positively associated with open defecation and negatively associated with literacy, health expenditure, access to electricity, and basic sanitation. Additionally, the relationship between under-five mortality, gross national expenditure, and access to basic drinking water varied across regions. These findings emphasize the need for localized, evidence-based interventions to address child mortality more effectively in Africa.
Socioeconomic and demographic factors associated with anaemia among women of reproductive age in Zimbabwe : a supervised machine learning approach
Chemhaka, Garikayi; Mbunge, Elliot; Dzinamarira, Tafadzwa; Musuka, Godfrey; Batani, John; Muchemwa, Benhildah; Fashoto, Stephen; Mapingure, Munyaradzi; Makota, Rutendo Birri; Petrus, Ester (Springer, 2025-04)
Anaemia affects approximately one-third of women of reproductive age globally, with the highest burden observed in resource-limited countries. Therefore, this study aimed to determine the socioeconomic and demographic factors associated with anaemia and predict anaemia among women in Zimbabwe. Using nationally representative, cross-sectional data from the 2015 Zimbabwe Demographic and Health Survey (DHS), a dataset from a sample of 5412 women of reproductive age was analyzed. The Chi-square test and multivariate logistic regression were employed to identify independent predictors of anaemia, while Elastic Net was used for feature importance scoring. To address the class imbalance, the Synthetic Minority Oversampling Technique (SMOTE) was applied. The prevalence of anaemia among women in Zimbabwe was 24.1%. Multivariate logistic regression revealed significant associations between anaemia and several factors, including older age (35–49 years) (adjusted Odds Ratio [aOR] = 1.31), marital status (being married) (aOR = 0.72), higher education (aOR = 0.47), middle household wealth (aOR = 1.32), professional occupation (aOR = 1.60), current use of modern contraceptives (aOR = 0.59), and overweight/obesity (aOR = 0.56). The highest burden was observed in Matabeleland South province (aOR = 3.44). Among prediction models, the random forest classifier outperformed K-Nearest Neighbors (KNN) and decision trees, achieving an accuracy of 74%, recall of 78%, F1-score of 75%, precision of 72%, and an Area Under the Curve (AUC) of 81.5%. Targeted interventions focusing on key socioeconomic and demographic characteristics could help reduce anaemia in women of reproductive age. Predictive models can aid healthcare practitioners in identifying at-risk individuals and implementing timely interventions to mitigate the impact of anaemia.
Community-led interventions for HIV and AIDS prevention, treatment, and care in Southern Africa : a scoping review
Moyo, Enos; Moyo, Perseverance; Murewanhema, Grant; Mhlanga-Gunda, Rosemary; Dzinamarira, Tafadzwa (Springer, 2025-03)
BACKGROUND : Over the past few decades, significant progress has been made in containing the HIV epidemic worldwide. A few countries, primarily in Southern Africa, have met the UNAIDS 95-95-95 goals. However, this does not warrant complacency. The contribution of communities to these gains is immeasurable. Therefore, there is a need to sustain and expand the involvement of communities in the testing, prevention, and treatment of HIV. AIM : This study aims to assess the scope and outcomes of community-led HIV interventions conducted in Southern Africa. STUDY DESIGN : This study followed a scoping review design. DATA SOURCES : PubMed, ScienceDirect, SCOPUS, Google Scholar, and Africa Journals Online (AJOL) databases were searched for peer-reviewed articles published in English between 2013 and 2023. METHODOLOGY : The scoping review was guided by the Joanna Briggs Institute methodology for scoping reviews. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Primary studies using mixed-methods, quantitative, and qualitative approaches that detailed HIV and AIDS community-led interventions carried out in Southern Africa were considered for this review. Two reviewers separately extracted the data from the included studies using a data extraction tool in Microsoft Excel. We used NVivo to develop codes and categories for the scope and outcomes of community-led interventions. RESULTS : Thirteen articles were included in this scoping review. Eleven of the studies were quantitative studies, one was a mixed-methods study, and another one was a qualitative study. Peer-based programs, adherence clubs, community conversations, support groups, community-based HIV testing, and antiretroviral therapy (ART) linkage are some of the community-led interventions found in this scoping review. The outcomes of these interventions include increased awareness of HIV and AIDS, decreased risky behaviours and stigma related to HIV, increased disclosure of partners' HIV status, increased testing for HIV, linkage to care, adherence to ART, retention in care, and viral suppression. CONCLUSION : Based on the promise demonstrated in this review, further investment in and support for community-led HIV interventions in Southern Africa is justified. Scaling up these interventions, alongside robust evaluation efforts, holds significant potential to contribute to a more comprehensive and effective response to the HIV epidemic in the region.
A qualitative study of Nigerian community members awareness of Mpox and their willingness and barriers to receiving the Mpox vaccine
Olufadewa, Isaac Iyinoluwa; Adesina, Miracle Ayomikun; Oladele, Ruth Ifeoluwa; Olufadewa, Toluwase Ayobola; Okpokoro, Evaezi; Daodu, Oluwafemi Babatunde; Ige, Fehintola; Adebajo, Sylvia; Igumbor, Ehimario Uche; Shaibu, Joseph Ojonugwa; Ibrahim, Musbaudeen Olaitan; Audu, Rosemary Ajuma (Springer, 2025-05)
BACKGROUND : Two vaccines, the JYNNEOS and ACAM 2000 have been approved for use for Mpox protection, however vaccine hesitancy and vaccine refusal poses a significant challenge in its uptake. This study explored participants’ awareness of Mpox, willingness, and barriers to receiving the approved Mpox vaccines when they become available in Nigeria. METHOD : This was a qualitative cross-sectional study. Participants were recruited using a purposive sampling technique. A total of 16 Focus Group Discussions (FGDs) and 64 in-depth interviews (IDIs) were conducted by trained research assistants among community members in four states in Nigeria (Bayelsa, Delta, Lagos, and Rivers states) between October 1 and November 30, 2023. The interviews were audio-recorded and transcribed before thematic analysis was conducted. RESULTS : One hundred and sixty-four persons, comprising 71 males and 93 females, participated in this study. The anticipated rollout of the Mpox vaccine in Nigeria elicited mixed reactions; while some participants expressed willingness to be vaccinated, others expressed their concerns about the vaccine side effects, vaccine safety, and their mistrust of new vaccines. There were also reports about physical access and financial cost being a barrier to receiving the Mpox vaccine. CONCLUSION : The study highlights the critical need for more community-based public health education campaigns to enhance awareness and correct misconceptions about Mpox. Effective communication strategies that address specific community issues and emphasize vaccine safety are important for increasing vaccination uptake and controlling the spread of Mpox in Nigeria.
Evaluating variant pathogenicity prediction tools to establish African inclusive guidelines for germline genetic testing
Zhou, Kangping; Gheybi, Kazzem; Soh, Pamela X.Y.; Hayes, Vanessa M. (Nature Research, 2025-05)
BACKGROUND : Genetic germline testing is restricted for African patients. Lack of ancestrally relevant genomic data perpetuated by African diversity has resulted in European-biased curated clinical variant databases and pathogenic prediction guidelines. While numerous variant pathogenicity prediction tools (VPPTs) exist, their performance has yet to be established within the context of African diversity. METHODS : To address this limitation, we assessed 54 VPPTs for predictive performance (sensitivity, specificity, false positive and negative rates) across 145,291 known pathogenic or benign variants derived from 50 Southern African and 50 European men matched for advanced prostate cancer. Prioritising VPPTs for optimal ancestral performance, we screened 5.3 million variants of unknown significance for predicted functional and oncogenic potential. RESULTS : We observe a 2.1- and 4.1-fold increase in the number of known and predicted rare pathogenic or benign variants, respectively, against a 1.6-fold decrease in the number of available interrogated variants in our European over African data. Although sensitivity was significantly lower for our African data overall (0.66 vs 0.71, p = 9.86E-06), MetaSVM, CADD, Eigen-raw, BayesDel-noAF, phyloP100way-vertebrate and MVP outperformed irrespective of ancestry. Conversely, Mutation Taster, DANN, LRT and GERP-RS were African-specific top performers, while Mutation Assessor, PROVEAN, LIST-S2 and REVEL are European-specific. Using these pathogenic prediction workflows, we narrow the ancestral gap for potentially deleterious and oncogenic variant prediction in favour of our African data by 1.15- and 1.1-fold, respectively. CONCLUSION : Although VPPT sensitivity favours European data, our findings provide guidelines for VPPT selection to maximise rare pathogenic variant prediction for African disease studies.
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
Aderoju, Yaa Boahemaa Gyasi; Hayford, Frank Ekow Atta; Achempim-Ansong, Gloria; Duah, Evans; Baloyi, Tinyiko Violet; Morerwa, Smangaliso; Agordoh, Percival; Dzansi, Gladys (Elsevier, 2025-10)
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
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 (BMJ Publishing Group, 2025-10)
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
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 (BMJ Publishing Group, 2025-08-11)
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
Duah, Evans; Mathebula, Evans Mantiri; Maluleke, Kuhlula; Azumah, Daniel Edem; Ephraim, Richard Kobina Dadzie; Mashamba-Thompson, Tivani (BioMed Central, 2025-10)
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
Mokoatle, Mpho; Marivate, Vukosi; Mapiye, Darlington; Bornman, Maria S. (Riana); Hayes, Vanessa M. (BioMed Central, 2025-10)
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.

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