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

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Strengthening local capacity for mathematical modelling in low- and middle-income countries : the process and lessons learnt in implementing the first cohort of Nigeria malaria modelling fellowships
(BioMed Central, 2025-04) Kaduru, Chijioke; Ibe, Uche; Aladeshawe, Shina; Eche-George, Adaeze; Eshikhena, Ganiyat; Aadum, Dumale; Okon, Bassey; Iorkase, Emmanuel D.; Leghemo, Kesiye; Ogunbode, Oladipo; Okoronkwo, Chukwu; Okoro, Onyebuchi; Igumbor, Ehimario Uche; Oyeyemi, Abisoye; Uhomoibhi, Perpetua; Babatunde, Seye
BACKGROUND : Mathematical modelling plays a crucial role in understanding malaria epidemiology and evaluating anti-malarial interventions. In sub-Saharan Africa, National Malaria Control Programs are increasingly collaborating with modellers to optimize impact within constrained fiscal environments and evaluate the effectiveness of ongoing malaria control efforts. Despite Nigeria’s National Malaria Elimination Program soliciting modelling expertise, there remains a significant capacity gap in low- and middle-income countries (LMICs), including Nigeria. To address this, the Nigerian Malaria Modelling Fellowship (MMF) adopts a one-health approach within the Nigerian Field Epidemiology and Laboratory Training Program. METHODS : The MMF aims to enhance mathematical modelling capacity among Nigerian public health professionals by increasing the number of doctoral and postdoctoral graduates proficient in using modelling for planning, program evaluation, and outcome assessment. This paper highlights the initiative’s innovative aspects and shares initial implementation insights. RESULTS : Implemented using a human-centred design, MMF is a collaborative effort involving multiple public health stakeholders. The curriculum spans four courses—Malaria, Mathematical Modelling, Evidence Translation, and Project Management—each with targeted modules. The first cohort recruitment attracted 2173 applications, rigorously screened through a five-step process, selecting 33 Fellows from all geopolitical zones of Nigeria. The cohort applies a one-health lens and includes 48% female representation. Key findings highlight the importance of government leadership, gender mainstreaming, stakeholder co-creation, leveraging existing investments, adopting best practices, and expanding engagement to meet national needs. CONCLUSION : MMF demonstrates a collaborative effort to build modelling capacity among epidemiologists and healthcare professionals in LMICs, particularly for malaria. The rigorous recruitment process underscores a strong interest in mathematical modelling. The human-centred approach has fostered government leadership, multi-stakeholder engagement, and national ownership. This paper recommends increased commitments to local capacity strengthening in LMICs and advocates for evaluating the project, including assessing Fellows’ competencies post-training to ensure effective capacity development.
Between-and within-socioeconomic groups temporal inequality in the uptake of malaria prevention strategies among pregnant women and under-five children in Ghana (2003-2022)
(BioMed Central, 2025-08) Okova, Denis; Lukwa, Akim Tafadzwa; Edusei, Marian; Bodzo, Paidamoyo; Atta-Obeng, Christian; Chiwire, Plaxcedes; Hongoro, Charles
BACKGROUND : Malaria remains a leading cause of morbidity and mortality among pregnant women and children under five in sub-Saharan Africa. Despite over two decades of efforts including insecticide-treated net (ITN) distribution and intermittent preventive treatment in pregnancy (IPTp), universal and equitable coverage has not been achieved. In Ghana, coverage disparities persist, particularly along socioeconomic and geographic lines. This study investigates temporal trends and decomposes both within-group and between-group socioeconomic inequalities in ITN use and IPTp coverage among children and pregnant women in Ghana. METHODS : This study analysed nationally representative data from the Ghana Demographic and Health Surveys (2003, 2008, 2014, and 2022), focusing on ITN use among pregnant women and children under five, and IPTp uptake. Inequality was assessed using the Erreygers normalized concentration index (ENCI) and the Theil index (GE 2). Theil indices were then decomposed to quantify within- and between-group contributions by socioeconomic status (SES) and residence (urban versus. rural). RESULTS : ITN use among under-five children increased modestly from 58.1% (2003) to 62.9% (2022); among pregnant women, usage fluctuated but returned to 60% in 2022. IPTp coverage rose markedly from 0.85% (2003) to 60% (2022). ENCI values showed that ITN use was consistently pro-poor, becoming more concentrated among the poor over time (e.g., ENCI for pregnant women: − 0.04 in 2003 to − 0.32 in 2022). In contrast, IPTp coverage shifted to a pro-rich distribution from 2008 onwards. Theil decomposition revealed that most observed inequalities were driven by within-group disparities (e.g., within SES or residence categories), though between-group inequality increased over time particularly for IPTp. For example, in 2022, 85% of ITN inequality among pregnant women was within SES groups, while 18% was attributable to between-group differences. CONCLUSION : Despite overall improvements in malaria prevention uptake, substantial socioeconomic inequalities persist especially within social and geographic subgroups. Equity-focused strategies must complement national-level efforts by addressing barriers specific to underserved populations, including informal urban settlements and remote rural communities. Policymakers must prioritize targeted, locally responsive interventions to reduce both within- and between-group disparities and achieve Ghana’s malaria elimination and health equity goals.
Assessing Anopheles species collection techniques in a low malaria transmission area: implications for vector surveillance and control
(BioMed Central, 2025-07) Mashatola, Thabo; Tshikae, Power; Govere, John; Mazarire, Theresa T.; Brooke, Basil; Munhenga, Givemore
BACKGROUND : Effective entomological surveillance is crucial for malaria control, especially in low transmission settings. This study aimed to compare the performance of three mosquito collection methods (clay pots, carbon dioxide (CO2)-baited tents, and human landing catches (HLC)) for malaria vector surveillance in the low transmission area of Nkomazi, South Africa. METHODS : From March 2019 to March 2020, adult mosquitoes were collected monthly from three different sites over five consecutive nights and mornings. Each collection method was used at each site to capture both outdoor resting and host-seeking mosquitoes. The collected mosquitoes were morphologically identified to the Anopheles genus and species, followed by confirmation using molecular PCR assays. The species composition, relative abundance, and diversity were evaluated, and statistical tests, including Kruskal–Wallis and ANOVA, were used to assess differences in abundance and diversity across collection sites and methods. A Generalized Linear Mixed Model was applied to assess the impact of various factors on species abundance. RESULTS : A total of 1337 Anopheles mosquitoes were collected, with 98.5% being females. CO2-baited tents yielded the highest number of mosquitoes (57.6%), followed by HLC (39.1%) and clay pots (3.3%). Species composition included 52.4% of the Anopheles gambiae complex and 13.6% of the Anopheles funestus group. While species richness varied significantly between collection methods, with CO2-baited tents showing the highest richness, no significant differences were observed in abundance across sites or methods. The clay pot method was associated with significantly lower species abundance compared to HLC and CO2-baited tents. Species abundance fluctuated across months, with February and November showing a higher record. Males were less prevalent than females. Additionally, species abundance was lower in Block C and Vlakbult compared to Block A. CONCLUSIONS : This study highlights the importance of choosing appropriate mosquito collection methods based on specific entomological indicators and transmission dynamics. While CO2-baited tents provided the highest species richness, clay pots, despite yielding fewer mosquitoes, are effective for capturing outdoor resting malaria vectors. These findings suggest that a combination of collection methods is essential for inclusive malaria vector surveillance, facilitating tailored strategies for effective malaria control and resource optimization.
Anopheles arabiensis larval habitats characterization and Anopheles species diversity in water bodies from Jozini, KwaZulu-Natal Province
(BioMed Central, 2025-02) Marubini, Elliot; Musekiwa, Alfred; Maposa, Innocent; Mazarire, Theresa; Sekgele, Windy; Mabaso, Nondumiso; Dlamini, Dumsani; Mdose, Hetani; Kuonza, Lazarus R.; Munhenga, Givemore
BACKGROUND : The South African government is now implementing winter larviciding as a supplementary vector control tool. To achieve effective larviciding programme there is a need to understand the distribution of the breeding sites of vectors and their corresponding ecology. This study aimed to determine larval breeding sites of anophelines and characterize the physicochemical properties of water that promote the proliferation of Anopheles arabiensis immature stages. METHODS : A desktop survey of water bodies was carried out followed by a physical search of potential Anopheles breeding sites. Anopheline larvae were sampled from breeding sites in January and April 2021. At each breeding site, physicochemical characteristics of the water, including pH, electrical conductivity, total dissolved solids, salinity and turbidity, were measured. The collected Anopheles larvae were reared to adults and identified to genus and species level using morphological and molecular techniques. Factors associated with the presence of An. arabiensis larvae in the breeding sites were determined. RESULTS : Out of the 72 water bodies identified using desktop survey only 53% (n = 38/72) were identified through physical search. Of these 84% (n = 32/38) were positive for Anopheles larvae. A total of 598 Anopheles larvae were collected, of which 59.4% (n = 355/598) emerged into adults. Morphological identification of these adults, showed that the Anopheles gambiae complex accounted for 70% (n = 250/355) of the collections. From the 250 An. gambiae complex collected, 94% (235/250) were identified to species level by PCR and 6% (n = 15/250) failed to amplify. Of the 235 An. gambiae complex that were identified to species level, 62.5% (n = 147/235) were from January collections and 37.4% (n = 88/235) were from April collections. Molecular identification of the An. gambiae complex to species level showed predominance of An. arabiensis in April, 91% (n = 80/88). All physicochemical parameters differed significantly between the breeding site classes (p < 0.05 in all instances), except for electrical conductivity (p = 0.07). The aquatic habitats surveyed showed that the impermanency of the water bodies, neutral to alkaline pH, moderate salinity and low total dissolved solids were associated with the occurrence of An. arabiensis larvae. CONCLUSION : This study showed that An. arabiensis primarily breed in small temporary water bodies characterized by neutral pH.
Scaling for African inclusion in high-throughput whole cancer genome bioinformatic workflows
(MDPI, 2025-08) Jiang, Jue; Samaha, Georgina; Willet, Cali E.; Chew, Tracy; Hayes, Vanessa M.; Jaratlerdsiri, Weerachai
Sub-Saharan Africa is experiencing the highest mortality rates for several cancer types. While cancer research globally has entered the genomic era and advanced the deployment of precision oncology, Africa has largely been excluded and has received few benefits from tumour profiling. Through a thorough literature review, we identified only five whole cancer genome databases that include patients from Sub-Saharan Africa, covering four cancer types (breast, esophageal, prostate, and Burkitt lymphoma). Irrespective of cancer type, these studies report higher tumour genome instability, including African-specific cancer drivers and mutational signatures, suggesting unique contributory mechanisms at play. Reviewing bioinformatic tools applied to African databases, we carefully select a workflow suitable for large-scale African resources, which incorporates cohort-level data and a scalable design for time and computational efficiency. Using African genomic data, we demonstrate the scalability achieved by high-level parallelism through physical data or genomic interval chunking strategies. Furthermore, we provide a rationale for improving current workflows for African data, including the adoption of more genomic techniques and the prioritisation of African-derived datasets for diverse applications. Together, these enhancements and genomic scaling strategies serve as practical computational guidance, lowering technical barriers for future large-scale African-inclusive research and ultimately helping to reduce the disparity gap in cancer mortality rates across Sub-Saharan Africa. SIMPLE SUMMARY Africa faces the highest mortality rates across eight cancer types. However, cancer studies are biased toward European populations, leading to major concerns that cancer treatments may be ineffective for African patients. Providing a systematic review of African-inclusive whole cancer genome studies, African-derived tumours reveal distinct clinically relevant drivers, molecular taxonomies, and overall increased genomic instability, highlighting challenges associated with non-African-derived computational workflows. We provide a rationale for parallelism strategies to accelerate the processing steps of those distinctly intensive data, allowing for required scalability. Advocating for further resources that capture the rich African ancestral diversity, a concerted global effort will be required to improve and ultimately standardise bioinformatic workflows, thereby enhancing health outcomes for African cancer patients.
A randomized controlled trial combining house screening and insecticide-treated nets reduces malaria transmission in northwestern Ethiopia
(Nature Research, 2025-05) Belay, Aklilu; Asale, Abebe; Sole, Catherine L.; Yusuf, Abdullahi Ahmed; Torto, Baldwyn; Abro, Zewdu; Kassie, Menale; Mutero, Clifford Maina; Tchouassi, David P.
House screening (HS) of doors, eaves, and windows using wire-mesh has demonstrated potential in the integrated vector management of malaria. However, limited epidemiological data are available to guide its implementation across different ecological settings. In a 16-month randomized controlled trial (follow-up period) conducted across three agroecological areas (dry mountain, plateau highland, and semi-arid) in Jabi Tehnan district, northwestern Ethiopia, treatment houses were equipped with HS combined with insecticide-treated nets (ITNs), while control houses received ITNs only. The intervention led to a significant 2.3-fold reduction in indoor malaria vector density, the primary entomologic outcome, largely influenced by An. gambiae s.l. mosquitoes. Fewer blood-fed mosquitoes were found in screened houses, indicating reduced human bites, which translated to six-fold decline in malaria prevalence (0.7%), the primary epidemiologic outcome, compared to control houses (4.3%). In contrast, Plasmodium sporozoite infection rates showed no differences between screened and control houses or agroecological zones, with An. arabiensis and An. funestus s.l. identified as the primary vectors. A modest protective effectiveness (22.6%) was observed, based on the estimated entomological inoculation rate of 0.24 and 0.31 infectious bites/person/night in screened and control houses, respectively, with no variation by agroecology. Despite the synergistic impact of HS with existing ITNs in reducing vector densities, human bite rates, and household malaria prevalence, sustained transmission persisted, partly due to the presence of highly competent vectors such as An. funestus s.l. which had an overall sporozoite rate of 68%. Future research should explore the interactions between vector behavioral adaptations, ecological and social factors contributing to residual transmission, even with seemingly effective control measures.
Evolving landscape of sickle cell anemia management in Africa : a critical review
(MDPI, 2024-11-29) Musuka , HazelW.; Iradukunda , Patrick Gad; Mano , Oscar; Saramba , Eric; Gashema , Pierre; Moyo, Enos; Dzinamarira, Tafadzwa
Sickle cell disease (SCD) is a prevalent inherited blood disorder, particularly affecting populations in Africa. This review examined the disease’s burden, its diverse clinical presentations, and the challenges associated with its management in African settings. Africa bears a significant burden of SCD, with prevalence varying across countries and age groups. Newborn screening programs have highlighted the high prevalence of SCD at birth, emphasizing the need for early diagnosis and intervention. The clinical manifestations of SCD in Africa are multifaceted, encompassing acute complications like vaso-occlusive crises, acute chest syndrome, and stroke, as well as chronic complications such as organ damage and leg ulcers. Biological factors, including fetal hemoglobin levels, and demographic factors, like age and sex, influence disease severity and outcomes. The management of SCD in Africa faces numerous challenges. Limited access to resources, including diagnostic tools, medications, and trained healthcare professionals, hinders optimal care. The high cost of advanced therapies further restricts patient access. Cultural stigma and a lack of awareness create additional barriers to effective management. To address these challenges, early diagnosis through newborn screening programs and point-of-care testing is crucial. Comprehensive care models, including hydroxyurea therapy, pain management, and patient education, are essential for improving outcomes. Collaboration with international networks and leveraging local resources can enhance the sustainability of SCD programs. In conclusion, SCD significantly impacts African populations. Overcoming the challenges associated with its management requires addressing resource limitations, affordability issues, and cultural barriers. Early diagnosis, comprehensive care models, and ongoing research focused on affordability and accessibility are crucial for improving the lives of individuals living with SCD in Africa.
Enhancing global health security in Sub-Saharan Africa : the case for integrated One Health surveillance against zoonotic diseases and environmental threats
(Elsevier, 2025-12) Gashema, Pierre; Sesonga, Placide; Iradukunda, Patrick Gad; Muvunyi, Richard; Mugisha, Jean Claude; Ndayisenga, Jerome; Musafiri, Tumusime; Habimana, Richard; Bigirimana, Radjabu; Kabanda, Alice; Gashegu, Misbah; Gahamanyi, Noel; Izudi, Jonathan; Siddig, Emmanuel Edwar; Ngabonziza, Jean Claude Semuto; Ahmed, Ayman; Dzinamarira, Tafadzwa; Mutesa, Leon; Muvuny, Claude Mambo
Integrated One Health surveillance is pivotal to Africa's future health security, particularly in preventing and managing zoonotic and environmental health threats. The One Health strategy recognizes the interconnectedness of human, animal, and environmental health, allowing a holistic framework for tracking and responding to emerging and re-emerging pathogens. The One Health approach facilitates cross-sectoral data sharing and enhances surveillance, enabling the early detection and response to potential outbreaks. This proactive approach shifts the paradigm from reactive crisis management to preventive containment strategies. However, challenges such as funding gaps, limited infrastructure, limited diagnostic capacity, and weak multi-sectoral and cross-border collaborations remain. This perspective paper aims to 1) explore the effectiveness of integrated One Health surveillance in early detection and response to zoonotic diseases and environmental threats in Sub-Saharan Africa (SSA), and 2) identify key challenges and proposed solutions to strengthen regional health security. A multisectoral laboratory working group (MLWG) emerged as a pillar to enable active surveillance targeting humans, animals, and the environment. This paper highlighted essential strategies for enhancing One Health surveillance in SSA in light of the recent Marburg virus disease in Rwanda. It emphasizes environmental sampling through animal excreta and wastewater surveillance for early zoonotic detection, advocates for point-of-care polymerase chain reaction (PCR) testing platforms, and multiplex models to improve decentralized diagnostics. With 48 % of African nations incorporating One Health in national agendas, a unified continental framework is needed to support broader adoption and advance regional health security.
Coexisting predictors for undernutrition indices among under-five children in West Africa : application of a multilevel multivariate ordinal logistic regression model
(BioMed Central, 2025-06) Asmare, Abebew Aklog; Tegegne, Awoke Seyoum; Belay, Denekew Bitew; Agmas, Yitateku Adugna
BACKGROUND : Due to its immediate and long-term implications for population health and socioeconomic advancement, children’s nutritional status is especially crucial. It is the main reason for morbidity and mortality in children under five. Therefore, this study aimed to investigate predictors for under-nutrition indices among under-five children in West Africa. METHODS : The study was conducted in 14 countries in West Africa. A weighted total sample of 35,162 under-five children was included. Considering the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate partial proportional ordinal logistic regression model was conducted to analyze the relationship between stunting, wasting and underweight. RESULTS : Among the participants in the study, approximately 27.7% were stunted, with 17.9% moderately stunted and 10.8% severely stunted. Additionally, about 18.6% (13.3% moderately and 5.3% severely) were underweight, and 9% (6.7% moderately and 2.3% severely) were wasted. More than half of the children (51.1%) were male, and 36.6% lived in urban areas. Compared to singleton children, a child with multiple birth types was 2.701, 3.740, and 1.777 times more likely to be stunted, underweight, and wasted, respectively. CONCLUSION : The findings in the current study revealed a direct correlation among underweight status, wasting, and stunting. Furthermore, even when ignoring the effects of other independent variables, underweight was found to serve as a composite measure of stunting and wasting when examining the link between these three indicators. The results identified several common predictors significantly associated with all three undernourishment indices. Therefore, governments and non-governmental organizations should prioritize public health interventions aimed at improving parental education and increasing antenatal care visits to enhance the nutritional status of under-five children. More attention should be given to improving healthcare delivery at health facilities and homes, promoting children’s health education, and ensuring access to clean drinking water sources.
Utilising clinical associates to address mental health service provision challenges in South Africa : the views of healthcare managers and providers
(BioMed Central, 2025-08) Moodley, Saiendhra Vasudevan; Wolvaardt, Jacqueline Elizabeth (Liz); Grobler, Christoffel; saiendhra.moodley@up.ac.za
BACKGROUND : A constraint in South Africa’s mental health system is the human resources required to provide services. Given the shortage of specialist mental health professionals, the use of non-specialists such as clinical associates in mental health task-sharing is essential. The study aimed to explore the views of health managers, doctors, and nurses in four districts of South Africa on the scale of mental illness seen in their health services, their human resources challenges, and their attitudes towards mental health task-sharing involving clinical associates. METHODS : Focus group discussions were conducted in one district in each of the four provinces where clinical associates were known to be employed. Focus group participants were purposively sampled to ensure that each focus group consisted of a combination of managers and healthcare professionals from hospital and primary health care levels. Audio recordings were transcribed, and thematic analysis was conducted. RESULTS : A total of 29 individuals participated. Four themes emerged from the focus group discussions. The first theme to emerge was ‘mental illness is not going away’ with substance use, increasing numbers of younger patients, and high rates of relapse and readmission accounting for this. The second theme identified was ‘the health system cannot cope with mental illness’ as mental health had not been prioritised and this had resulted in a lack of mental health units and beds, deficiencies at primary health care level, and human resources for mental health challenges. The third theme was ‘clinical associates could be part of the remedy’ based on past experience in other disciplines but constraints such as their scope of practice would need to be addressed. The final theme identified was ‘specialised clinical associates could help mend the mental health system’ but this would require a review of employment policies and a clarification of their roles. CONCLUSIONS : Mental health is a significant and expanding concern. Clinical associates could help alleviate human resource constraints in mental health with enhanced undergraduate and advanced training. However, overcoming structural barriers such as scope of practice, regulatory issues, and creation of posts will be crucial to realise their potential contribution.
Intimate partner violence among lesbian, bisexual, and queer women students on campuses in South Africa : a qualitative study exploring context, drivers, and impacts
(BioMed Central, 2025-04) Mahlangu, Pinky; Brooke-Sumner, Carrie; Sikweyiya, Yandisa; Dunkle, Kristin; Mabena, Ntlotleng; Jewkes, Rachel; Duma, Sinegugu; Khuzwayo, Nelisiwe; Dartnall, Elizabeth; Pillay, Managa; Machisa, Mercilene Tanyaradzwa
BACKGROUND : Intimate partner violence (IPV) is a global public health problem, associated with negative physical and mental health impacts. Research on IPV has mainly focused on heterosexual relationships with limited focus on same-sex relationships. This paper reports the findings of a qualitative study which explored experiences, context, drivers, and impact of IPV in same-sex relationships of students who identify as lesbian, bisexual, and queer (LBQ) women at three campuses in a university in South Africa. METHODS : We collected data through focus group discussions (FGDs) with 56 students who self-identified as LBQ women. Participants were Black African, between 18 and 30 years of age, enrolled in courses for at least 1 year, and volunteered to participate in group discussions. Data were analyzed inductively using a thematic analysis approach. We drew from the post-structural feminist theory to understand the relationship dynamics in same sex relationships of LBQ women. RESULTS : Three themes were developed through the analysis of data. The first theme is on the nature and forms of violence experienced by LBQ women—where women described bidirectional partner violence, including physical, sexual, and emotional IPV, and controlling behaviors in their relationships; and discrimination and disregard for bisexual women. Theme two highlighted the drivers and context of violence experience and enactment in intimate relationships which included multiple factors: past traumas, previous experience of violence, poor communication and poor conflict resolution skills, and heteronormativity and gender norms. IPV occurred when gender roles and expectations were not met, and when contesting for power and dominance in relationships. The last theme elaborates on the mental health impacts of IPV among LBQ women which included depression, anger, self-hate, and negatively impacted self-esteem. Furthermore, participants spoke of their mental health contributing to IPV perpetration and negatively affecting their academic outcomes. CONCLUSIONS : Our findings suggest the need for IPV interventions that address both victimization and perpetration, given the occurrence of bidirectional violence. Such interventions should focus on building healthy and non-violent relationships and on promoting mental health of LBQ women students in same-sex relationships. Interventions should be co-developed with LBQ women on campuses for greater relevance and impact.
Monkeypox virus occurrence in wastewater environment and its correlation with incidence cases of mpox : a systematic review and meta-analytic study
(MDPI, 2025-03) Omatola, Cornelius A.; Ogunsakin, Ropo Ebenezer; Olaniran, Ademola O.; Kumari, Sheena
The COVID-19 pandemic has increased the interest in the use of wastewater-based surveillance (WBS) strategy for infectious disease monitoring, especially when clinical cases are underreported. The excretion of monkey virus (MPXV) in the feces of both symptomatic and preclinical individuals has further driven the interest in WBS applicability to MPXV monitoring in wastewater to support its mitigation efforts. We performed a systematic review with meta-analysis, using six databases to assess MPXV detection in wastewater. We performed a random-effects model meta-analysis to calculate the pooled prevalence at a 95% confidence interval (95% CI). Also, we carried out a subgroup analysis according to the country regions and a sensitivity analysis excluding studies classified as having a high risk of bias. The overall MPXV positivity rate in wastewater was estimated at 22% (95% CI: 14−30%; I2 = 94.8%), with more detection rate in North America (26%, 95% CI: 8–43%) compared to Europe and Asia (22%, 95% CI: 12–31%). The MPXV detection rate was significantly higher in 2022 studies (22%, 95% CI: 13–31%) compared to 2023 (19%, 95% CI: 14–25%). The real-time PCR platform significantly detected more MPXV (24%, 95% CI: 14–34%) than the digital droplet PCR-based studies (17%, 95% CI: 4–31%), which was used less frequently. Viral concentration with centrifugation procedure indicated higher detection rates (21%, 95% CI: 10–33%) than other known sample concentration protocols. Generally, MPXV detection rates in wastewater samples strongly correlate with incidence cases of mpox (range of R = 0.78–0.94; p < 0.05). Findings from this study suggest that WBS of MPXV could be employed as an epidemiological early warning tool for disease monitoring and mpox outbreak prediction similar to the clinical case-based surveillance strategies.
Factors linked to virological failure in people on a dolutegravir-based regimen in Mamelodi
(AOSIS, 2024-10-04) Mmatsoku, Moloko S.; Ngcobo, Sanele; sanele.ngcobo@up.ac.za
BACKGROUND : Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz. OBJECTIVES : This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA). METHOD : A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital’s Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed (> 50 copies/mL) VLs. RESULTS : Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p < 0.05). Newly initiated patients had significantly lower suppression rates (p < 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p < 0.05). CONCLUSION : The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD. CONTRIBUTION : Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.
Tobacco cessation research in low- and middle-income countries : a commentary on challenges, innovations, and opportunities
(Oxford University Press, 2025-08) Dogar, Omara; Amer Nordin, Amer Siddiq; Barnoya, Joaquin; Ayo-Yusuf, Olalekan Abdulwahab; Bullen, Chris
Tobacco use (predominantly smoking) is the leading cause of preventable disease, disability, and death worldwide. It increases the risk of cancer, heart disease, stroke, chronic lung disease, and tuberculosis, among others, costing healthcare systems billions in direct medical costs each year. Global tobacco use has declined from 22.7% in 2007 to 17% in 2021, but the total number of people who use tobacco remains high due to population growth, one leading to more than 8 million tobacco-related premature deaths yearly. Half of these deaths currently occur in high-income countries (HICs) due to the 50-year lag period between tobacco use initiation and death. More than 80% of the world’s 1.3 billion people who use tobacco now live in low- and middle-income countries (LMICs), where an exponential increase in tobacco-related deaths is anticipated to occur in the next 30–50 years. LMICs are not yet fully able to benefit from the global progress in tobacco control because they lag behind that in HICs, due to the disparity in access to comprehensive anti-tobacco programs, which will further exacerbate this extremely rapid increase in tobacco-related deaths in the future. Moreover, certain groups in LMICs (e.g., men, low income, and low education) report the highest tobacco use rates leading to a disproportionate burden of tobacco-related disease requiring targeted efforts.
Working at Cross-PURPOSEs to ending HIV
(Massachusetts Medical Society, 2025-04) Gray, Glenda E.; Venter, Willem Daniel Francois
No abstract available.
Navigating health financing cliffs : a new era in global health
(Elsevier, 2025-05) Rasanathan, Kumanan; Beltran, Maylene M.; Biritwum-Nyarko, Alberta A.; Blecher, Mark S.; Dybul, Mark; Inoue, Hajime; Ohiri, Kelechi; Patcharanarumol, Walaiporn; Pillay, Yogan; Reddy, K. Srinath; Ren, Minghui; Cyrus Shroff, Zubin; Simons, Bright; Sparkes, Susan; Chalkidou, Kalipso
No abstract available.
Lessons for long-acting lenacapavir : catalysing equitable PrEP access in low-income and middle-income countries
(Elsevier, 2025) Lynch, Sharonann; Cohen, Rachel M.; Kavanagh, Matthew; Sharma, Agrata; Raphael, Yvette; Pillay, Yogan; Bekker, Linda-Gail
Despite substantial advances in biomedical HIV prevention, including long-acting injectable pre-exposure prophylaxis (PrEP) options such as cabotegravir, barriers to widespread adoption and scale-up persist in low-income and middle-income countries. Long-acting injectable lenacapavir is a potentially transformative HIV prevention tool, providing an unprecedented opportunity to accelerate progress. However, the global HIV response is under threat like never before, with drastic funding cuts undermining the gains of the past 25 years. The challenges of introducing and scaling up long-acting lenacapavir and other PrEP innovations are numerous. Without deliberate policy, programmatic, and financing interventions, new prevention technologies risk following slow adoption patterns of previous innovations, weakening a needed transformation of the HIV response. Drawing on lessons from the scale-up of antiretroviral therapy, and experience with previous biomedical prevention tools, a new ten-point framework should be adopted to accelerate individual and epidemiological impact—even at this time of extraordinary uncertainty.
Cannabis for medicine and food : a benefit vs risk critical appraisal
(Elsevier, 2024-12) Nethengwe, M.; Maphosa, Y.; Ahiante, Blessing Osemengbe; Oyenihi, A.B.
The use of cannabis for health purposes continues to gain significant attention due to the presence of important phytochemicals, chiefly, cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (THC). The therapeutic potentials of CBD and THC in the management of cancer-associated chronic pain, anxiety, stress, nausea, vomiting, and weight loss are well-reported. These benefits are triggered by the intricate interactions of the cannabinoids with their receptors in the endocannabinoid system (ECS) leading to pharmacodynamic actions. Conversely, the possible physiological, psychiatric, cognition, addiction, and dependency risks, especially due to chronic intake of THC, are huge limitations in fully harnessing the clinical utility of cannabis. Here, an up-to-date critique of the potential merits and adverse effects of cannabis and cannabis-containing products is provided. A thorough knowledge of the interplay between CBD, THC, and the ECS gives deep insights that can be explored for consumer health without the attendant complications. Future directions in cannabis research must be guided by a nuanced understanding of its molecular mechanisms of action and potential risks, enabling the development of targeted and effective medical interventions. Besides, standardized regulations and comprehensive education that are backed by empirical evidence are crucial to fostering the safe and responsible use of cannabis for food or medicine.
Mental illness attitudes, service provision interest and further training preferences of clinical associates
(AOSIS, 2024-01-23) Moodley, Saiendhra Vasudevan; Wolvaardt, Jacqueline Elizabeth (Liz); Grobler, Christoffel; saiendhra.moodley@up.ac.za
BACKGROUND : Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training. METHODS : A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians’ Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score. RESULTS : The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health. CONCLUSION : The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health. CONTRIBUTION : Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates’ attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.
Dietary patterns in relation to asthma and wheeze among adolescents in a South African rural community
(MDPI, 2025-03) Rathogwa-Takalani, Funzani; Mudau, Thabelo Rodney; Patrick, Sean Mark; Shirinde, Joyce; Voyi, Kuku; sean.patrick@up.ac.za
BACKGROUND : The rise of asthma prevalence in recent decades has been attributed to changes in dietary patterns, especially in developing countries. Studies have also suggested that dietary patterns play an important role in both asthma development and management. This study aimed to investigate the association between consumption of various foods and environmental factors with asthma and wheeze among adolescents. METHODS : A self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to collect data on demographics, respiratory health, exposure to air pollution, and diet on n = 2855 adolescents residing in Vhembe District, South Africa. RESULTS: The prevalence of asthma and wheeze were 18.91% and 37.69%, respectively. Consuming various foods such as fast foods (OR = 1.41; 95% CI: 1.06-1.88), bread (OR = 0.60; 95% CI: 0.45-1.81), pasta (OR = 1.39; 95% CI: 1.06-1.84), seafood (OR = 1.79; 95% CI: 0.65-1.24), and nuts (OR = 0.85; 95% CI: 0.65-1.12) were significantly associated with asthma in the crude logistic regression analysis. Further analysis in the multiple regression model indicated a strong association of asthma with consumption of nuts (OR = 1.55; 95% CI: 1.11-2.17), seafood (OR = 1.60; 95% CI: 1.03-2.49), and cereal (OR = 0.67; 95% CI: 0.45-0.99). In relation to wheeze, consumption of meat (red) (OR = 0.77; 95% CI: 0.60-0.99) was a protective factor in the crude analysis. The multiple logistic regression model showed that, seafood (OR = 0.76; 95% CI: 0.59-0.96), fruit (OR = 0.55; 95% CI: 0.32-0.94), nuts (OR = 1.88; 95% CI: 1.50-2.66), and olive oil (OR = 1.48; 95% CI: 1.09-2.00) were significantly associated with wheeze. CONCLUSION : Diet plays a major role in respiratory health, especially in asthma and wheeze. Dietary changes may play a role in reducing the burden of asthma and other respiratory symptoms in adolescents.

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