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

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Insights into malaria vectors-plant interaction in a dryland ecosystem
(Nature Research, 2024-09-04) Kinya , Fiona; Milugo, Trizah K.; Mutero , Clifford M.; Wondji, Charles S.; Torto, Baldwyn; Tchouassi, David P.
Improved understanding of mosquito–plant feeding interactions can reveal insights into the ecological dynamics of pathogen transmission. In wild malaria vectors Anopheles gambiae s.l. and An. funestus group surveyed in selected dryland ecosystems of Kenya, we found a low level of plant feeding (2.8%) using biochemical cold anthrone test but uncovered 14-fold (41%) higher rate via DNA barcoding targeting the chloroplast rbcL gene. Plasmodium falciparum positivity was associated with either reduced or increased total sugar levels and varied by mosquito species. Gut analysis revealed the mosquitoes to frequently feed on acacia plants (~ 89%) (mainly Vachellia tortilis) in the family Fabaceae. Chemical analysis revealed 1-octen-3-ol (29.9%) as the dominant mosquito attractant, and the sugars glucose, sucrose, fructose, talose and inositol enriched in the vegetative parts, of acacia plants. Nutritional analysis of An. longipalpis C with high plant feeding rates detected fewer sugars (glucose, talose, fructose) compared to acacia plants. These results demonstrate (i) the sensitivity of DNA barcoding to detect plant feeding in malaria vectors, (ii) Plasmodium infection status affects energetic reserves of wild anopheline vectors and (iii) nutrient content and olfactory cues likely represent potent correlates of acacia preferred as a host plant by diverse malaria vectors. The results have relevance in the development of odor-bait control strategies including attractive targeted sugar-baits.
Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda
(Nature Research, 2024-07-10) Niyoyita , Jean Claude; Ndayisenga , Jerome; Omolo , Jared; Niyompano , Hosee; Bimenyimana, Pierre Celestin; Dzinamarira, Tafadzwa; Nsekuye , Olivier; Chavez , Isabella; Hakizayezu, Francois
More than one million neonatal deaths occur every year worldwide, of which 99% take place in low-income countries. In Rwanda, nearly 71% of neonatal deaths are preventable and among these, 10% are due to neonatal sepsis. Nevertheless, limited information exists on neonatal sepsis and its associated factors in Rwanda. The objectives of the study were to find prevalence and factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Ngoma District, Rwanda. We used a retrospective cross-sectional study design reviewing a subset of neonatal, maternal and laboratory records from Kibungo Hospital in 2017. Data were reviewed and collected from March to May, 2018. Logistic regression and odds ratios were calculated to identify the factors associated with neonatal sepsis at 95% CI, p < 0.05. Of the 972 total neonates’ medical records from 2017, we randomly selected 422 of which 12.8% (n = 54) had neonatal sepsis. When blood cultures were positive, 62% grew Klebsiella pneumoniae. Among neonates with sepsis, 38 (70%) recovered while 16 (30%) died. Neonatal sepsis was strongly associated with neonatal age less than or equal to three days (aOR: 2.769, 95% CI 1.312–5.843; p = 0.008); and gestational age less than 37 weeks (aOR: 4.149; CI 1.1878–9.167; p ≤ 0.001). Increased use of blood cultures including sensitivity testing, routine surface cultures of the neonatology and maternity wards facilities, and systematic ward cleaning are all important approaches to prevent and treat neonatal infections in additional to regular neonatal sepsis evaluations.
Accuracy of self‑collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections in females : an updated systematic review and meta‑analysis
(Nature Research, 2024-05-07) Jaya, Ziningi Nobuhle; Mapanga, Witness; Dlangalala, Thobeka Nomzamo; Thembane, Nokukhanya; Kgarosi, Kabelo; Dzinamarira, Tafadzwa; Mashamba‑Thompson, Tivani Phosa; u21848522@tuks.ac.za
The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), human papillomavirus (HPV), Mycoplasma genitalium (MG), Neisseria gonorrhoea (NG), Treponema pallidum and Trichomonas vaginalis (TV) in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.
Using machine learning models to plan HIV services : emerging opportunities in design, implementation and evaluation
(South African Medical Association, 2024-06) Dzinamarira, Tafadzwa; Mbunge, E.; Chingombe, I.; Cuadros, D.F.; Moyo, E.; Chitungo, I.; Murewanhema, G.; Muchemwa, B.; Rwibasira, G.; Mugurungi, O.; Herrera, H.; Musuka, G.; u19395419@up.ac.za
HIV/AIDS remains one of the world’s most significant public health and economic challenges, with approximately 36 million people currently living with the disease. Considerable progress has been made to reduce the impact of HIV/AIDS in the past years through successful multiple HIV/AIDS prevention and treatment interventions. However, barriers such as lack of engagement, limited availability of early HIV-infection detection tools, high rates of HIV/sexually transmitted infections (STIs), barriers to access antiretroviral therapy, lack of innovative resource optimisation and distribution strategies, and poor prevention services for vulnerable populations still exist and substantially affect the attainment of the UNAIDS 95-95-95 targets. A rapid review was conducted from 24 October 2022 to 5 November 2022. Literature searches were conducted in different prominent and reputable electronic database repositories including PubMed, Google Scholar, Science Direct, Scopus, Web of Science, IEEE Xplore, and Springer. The study used various search keywords to search for relevant publications. From a list of collected publications, researchers used inclusion and exclusion criteria to screen and select relevant papers for inclusion in this review. This study unpacks emerging opportunities that can be explored by applying machine learning techniques to further knowledge and understanding about HIV service design, prediction, implementation, and evaluation. Therefore, there is a need to explore innovative and more effective analytic strategies including machine learning approaches to understand and improve HIV service design, planning, implementation, and evaluation to strengthen HIV/AIDS prevention, treatment, and awareness strategies.
Trends and factors associated with adverse pregnancy outcomes in Zimbabwe, 2005-2015
(South African Medical Association, 2024-06) Chibura, T.; Twabi, H.S.; Maluleke, Kuhlula; Musekiwa, Alfred; kuhlula.maluleke@up.ac.za
BACKGROUND : Adverse pregnancy outcomes, including abortions, miscarriages and stillbirths, are common in developing countries such as Zimbabwe. OBJECTIVE : To determine the trends and factors associated with adverse pregnancy outcomes. METHODS : This article is a secondary data analysis of three repeated cross-sectional Zimbabwe Demographic and Health Surveys to assess adverse pregnancy outcomes among women of reproductive age (15 - 49 years old) who fell pregnant during the study period. Bivariate and multivariable logistic regression models were applied to the 2015 dataset to determine factors associated with adverse pregnancy outcomes. RESULTS : There was an overall increase in reported adverse pregnancy outcomes (stillbirths, miscarriages and abortions) from 2005 to 2015. The percentage of women who experienced adverse pregnancy outcomes among those who fell pregnant in the 5 years preceding each survey rose from 13.4% in 2005 to 13.8% in 2010, followed by a sharp increase to 16.3% in 2015. The multivariable model, belonging to the 35 - 49-year age group, was associated with almost a twofold increased odds of experiencing an adverse pregnancy outcome (adjusted odds ratio (aOR) 2.11, 95% confidence interval (CI) 1.35 - 3.31, p=0.001). Women currently married/in a union (aOR 4.69, 95% CI 2.64 - 8.34, p<0.001) or formerly married/in a union (aOR 3.56, 95% CI 1.89 - 6.69, p=0.001) had higher odds of experiencing an adverse pregnancy outcome. Not belonging to any religion or being a traditionalist or Muslim decreased the odds of experiencing an adverse pregnancy outcome (aOR 0.58, 95% CI 0.42 - 0.80, p=0.001). Women from Harare (aOR 1.56, 95% CI 1.05 - 2.32, p=0.027), Mashonaland West (aOR 1.59, 95% CI 1.08 - 2.36, p=0.027) and Mashonaland Central (aOR 1.76, 95% CI 1.15 - 2.69, p=0.009) provinces had higher odds of experiencing adverse pregnancy outcomes than those from Bulawayo Province. Women who gave birth for the first time at ≥25 years of age (aOR 3.08, 95% CI 2.27 - 4.16, p<0.001) had higher odds of experiencing adverse pregnancy outcomes. Women who delivered 2 - 4 children (aOR 0.75, 95% CI 0.59 - 0.95, p=0.018) or ≥5 children (aOR 0.51, 95% CI 0.36 - 0.72, p<0.001) were less likely to experience adverse pregnancy outcomes. CONCLUSION : Trends showed an increase in the proportion of women experiencing adverse pregnancy outcomes in Zimbabwe from 2005 to 2015. Advanced maternal age, marriage, lack of religion and living in Harare, Mashonaland Central or Mashonaland West were associated with adverse pregnancy outcomes. There is a need to reduce these outcomes through integration of social issues into maternal health programmes, as well as ensuring accessibility and availability of comprehensive reproductive health services that target high-risk groups such as women aged 35 - 49 years.
Trends and distribution patterns of infant mortality and maternal HIV positivity in South Africa : a decade review (2007-2016)
(South African Medical Association, 2024-06) Makhele, M.; Ledibane, Neo R.T.; Ramatsoma, Hlologelo; Musekiwa, Alfred
BACKGROUND : The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs. OBJECTIVES : To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA. METHODS : This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey – ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman’s rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0. RESULTS : A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman’s rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001). CONCLUSIONS : The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.
The prevalence of malaria in the five districts of Limpopo Province, South Africa, 2015-2017
(South African Medical Association, 2024-05) Lamola, Mashudu Teresa; Musekiwa, Alfred; De Voux, A.; Reddy, Carl; Morifi, M.; Mutevedzi, P.C.
BACKGROUND : In South Africa (SA), malaria is endemic in three of nine provinces - KwaZulu-Natal, Mpumalanga and Limpopo. During 2010 - 2014, SA reported that ~47.6% of all malaria cases were imported. Contemporary estimates for the prevalence of malaria in the five districts of Limpopo Province are limited, with unknown proportions of imported malaria cases. We estimated the prevalence of malaria, and the proportion of imported malaria cases in the five districts of Limpopo, from January 2015 to December 2017. OBJECTIVE : To measure the prevalence of malaria in Limpopo Province, the proportion of malaria cases that are imported and to determine factors associated with malaria from January 2015 to December 2017. METHODS : We retrospectively reviewed data routinely collected through the Malaria Information System and Laboratory Information System of the National Health Laboratory Services, and assessed associations with age, sex and district, using a multivariable logistic regression model. RESULTS : From 2015 to 2017, a total of 43 199 malaria cases were reported, of which 3.5% (n=1 532) were imported. The prevalence of malaria in Limpopo Province was the highest in 2017, at 331.0 per 100 000 population. The highest malaria prevalence district was Vhembe, with 647.9 in 2015, 220.3 in 2016 and 659.4 in 2017 per 100 000 population. However, Waterberg had the highest proportion of imported malaria cases 28.5% (437/1 532). In adjusted analyses, ages 15 - 49 years (adjusted odds ratio (aOR) 1.58, 95% confidence interval (CI) 1.48 - 1.68, p<0.001) and <1 year (aOR 1.55, 95% CI 1.37 - 0.74, p<0.001) were at higher odds of having malaria compared with ages >65 years. CONCLUSION : These findings highlight the significant burden of imported malaria in Limpopo Province. There is a need for strengthened surveillance and control programmes in neighboring countries (such as Mozambique, Zimbabwe and Botswana) to reduce the importation and spread of malaria in this region.
Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe : evidence from the 2019 National Multiple Indicator Cluster Survey
(South African Medical Association, 2024-07) Musuka, G.; Murewanhema, G.; Herrera, H.; Mbunge, E.; Birri-Makota, R.; Dzinamarira, Tafadzwa; Cuadros, D.; Chingombe, I.; Moyo, E.; Mpofu, A.; Mapingure, M.
Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.
Prevalence and factors associated with adverse pregnancy outcomes in South Africa : evidence from the 2016 demographic and health survey
(South African Medical Association, 2024-06) Mpolokeng, L.; Musekiwa, Alfred; u13248422@tuks.co.za
BACKGROUND : Adverse pregnancy outcomes are an important indicator of the overall health of a population and the socioeconomic development of a country. OBJECTIVES : To determine the prevalence and factors associated with adverse pregnancy outcomes among women of reproductive age in South Africa, and to recommend strategies to reduce the burden of these outcomes. METHODS : We conducted a secondary data analysis on women of reproductive age using data from the nationally representative, population- based, cross-sectional 2016 South Africa Demographic and Health Survey (SADHS). We described the sociodemographic characteristics of the study participants and determined the prevalence and factors associated with adverse pregnancy outcomes using the multivariable logistic regression model. We adjusted all our analyses for complex survey sampling using survey weights. RESULTS : There were 8 514 women of reproductive age, of whom 41.2% had fallen pregnant during the 5-year period preceding the survey. The majority (70.9%) were of age 20 - 34 years, 78% had secondary education, 61.6% were unemployed, 65% were from urban areas, and more than 40% of these women were currently living with a man, while 51.5% reported that they had never been in a union. The prevalence of adverse pregnancy outcomes was 14.6% (95% CI 13.2 - 16.1%). The odds of experiencing adverse pregnancy outcomes were significantly higher for those aged 35 - 49 years (adjusted odds ratio (aOR) 7.41, 95% CI 3.46 - 15.85) or 20 - 34 years (aOR 2.07, 95% CI 1.02 - 4.18), compared with those aged 15 - 19 years. Women who were currently in a union/living with a man (aOR 1.85, 95% CI 1.41 - 2.43) or formerly in a union/living with a man (aOR 2.66, 95% CI 1.64 - 4.29), compared with those who had never been in a union, had higher odds of adverse pregnancy outcomes. Contrarily, adverse pregnancy outcomes were lower with each additional child delivered or ever born (aOR 0.66, 95% CI 0.58 - 0.75). CONCLUSIONS : We report a high prevalence of adverse pregnancy outcomes among women of reproductive age in South Africa. We recommend addressing factors such as maternal age and currently/formerly living with a man within interventions to reduce the burden of adverse pregnancy outcomes in South Africa.
Safety, pharmacokinetics, and neutralisation activity of PGDM1400LS, a V2 specific HIV-1 broadly neutralising antibody, infused intravenously or subcutaneously in people without HIV-1 in the USA (HVTN 140/HPTN 101 part A) : a first-in-human, phase 1 randomised trial
(Elsevier, 2025-06) Seaton, Kelly E.; Paez, Carmen A.; Yu, Chenchen; Karuna, Shelly T.; Gamble, Theresa; Miner, Maurine D.; Heptinstall, Jack; Zhang, Lu; Gao, Fei; Yacovone, Margaret; Spiegel, Hans; Dumond, Julie B.; Anderson, Maija; Piwowar-Manning, Estelle; Dye, Bonnie; Tindale, India; Proulx-Burns, Lori; Trahey, Meg; Takuva, Simbarashe G.; Takalani, Azwidihwi; Bailey, Veronique C.; Kalams, Spyros A.; Scott, Hyman; Mkhize, Nonhlanhla N.; Weiner, Joshua A.; Ackerman, Margaret E.; McElrath, M. Juliana; Pensiero, Michael; Barouch, Dan H.; Montefiori, David; Tomaras, Georgia D.; Corey, Lawrence; Cohen, Myron S.; Huang, Yunda; Mahomed, Sharana; Siegel, Marc; Kelley, Colleen F.
BACKGROUND : PGDM1400LS is a human monoclonal antibody targeting the HIV envelope V2 apex with a lysine-serine modification intended to enhance serum and tissue half-lives and is being considered for use in combination monoclonal antibody trials. We sought to test whether PGDM1400LS was safe and had favourable serum concentration, pharmacokinetics, and neutralising ability in healthy adults. METHODS : HVTN 140/HPTN 101 part A is an open-label, dose escalation, first-in-human phase 1 trial of PGDM1400LS given intravenously or subcutaneously to healthy adults aged 18–50 years without HIV-1. The study enrolled participants at four sites in the USA, across five groups, each receiving one dose of PGDM1400-LS intravenously (group 1: 5 mg/kg; group 2: 20 mg/kg; and group 4: 40 mg/kg) or subcutaneously (group 3: 20 mg/kg; and group 5: 40 mg/kg). Participants in group 1 were enrolled sequentially without random assignment. Participants in groups 2 and 3 were block randomised and enrolled simultaneously after group 1 safety review. Groups 4 and 5 followed the same process, contingent on groups 2 and 3 safety review. The primary endpoints were safety and tolerability of PGDM1400LS, serum concentration of PGDM1400LS, and serum neutralising activity after single administration of PGDM1400LS. Serum PGDM1400LS concentrations collected at seven timepoints (day 0, day 3, day 6, day 28, day 56, day 112, and day 168) were assessed via an anti-idiotype binding assay and characterised via non-compartmental pharmacokinetic analysis. Serum neutralisation activity (ID80) was assessed by a TZM-bl assay. The study is registered with ClinicalTrials.gov, NCT05184452. FINDINGS : Between Nov 15, 2021, and March 4, 2022, 15 participants were enrolled into the five study groups (three participants per group) with 6 months of follow-up. Ten of 15 participants were female, 14 of 15 participants were non-Hispanic, and 11 of 15 participants were White, with a median age of 27 years (range 24–47). PGDM1400LS was safe and well tolerated, with mild to moderate solicited symptoms. Serum concentrations showed dose proportionality by administration route, with peak concentrations observed immediately after intravenous infusion (range 95·7–727·4 μg/mL) or on day 6 after subcutaneous infusion (205·6–547·1 μg/mL). The median elimination half-life was 55 days (range 48–59), representing a 2-to-3-times increase versus parental PDGM1400. Estimated subcutaneous (vs intravenous) bioavailability was 50–60%. ID80 titres showed agreement with concentration-predicted ID80 titres, indicating maintenance of neutralisation activity in vivo. INTERPRETATION : PGDM1400LS is a promising candidate for combination monoclonal antibody efficacy trials going forward.
Immunization coverage, equity, and access for children with disabilities : a scoping review of challenges, strategies, and lessons learned to reduce the number of zero-dose children
(MDPI, 2025-03) Musuka, Godfrey; Cuadros, Diego F.; Miller, F. DeWolfe; Mukandavire, Zindoga; Dhliwayo, Tapiwa; Iradukunda, Patrick Gad; Mano, Oscar; Dzinamarira, Tafadzwa
BACKGROUND : Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. METHODS : This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. RESULTS : Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. CONCLUSIONS : Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.
Antimicrobial resistance and its impact on food safety determinants along the beef value chain in sub-Saharan Africa-a scoping review
(MDPI, 2025-03) Musuka, Godfrey; Machakwa, Jairus; Mano, Oscar; Iradukunda, Patrick Gad; Gashema, Pierre; Moyo, Enos; Nsengimana, Amon; Manhokwe, Shepherd; Dhliwayo, Tapiwa; Dzinamarira, Tafadzwa
Antimicrobial resistance (AMR) poses a significant threat to human, animal, and public health, particularly in Sub-Saharan Africa (SSA), where the beef sector is vital to food security and livelihoods. We conducted a scoping review to explore the determinants and impacts of AMR within the beef value chain in SSA, highlighting the challenges and progress in mitigating AMR risks in livestock production. This review identifies key factors contributing to AMR, including the overuse and misuse of antimicrobials, inadequate veterinary oversight, and weak regulatory frameworks. These practices are prevalent across various stages of the beef value chain, from farm to slaughterhouse, and are exacerbated by informal markets and insufficient infrastructure. Our findings also highlight the role of environmental factors, such as contamination of feed, water, and manure, in the spread of resistant pathogens. Additionally, gaps in AMR surveillance, education, and enforcement limit effective control measures in the region. While efforts to combat AMR have gained momentum in some countries, including the development of national action plans and surveillance systems, substantial challenges remain. These include poor adherence to antimicrobial guidelines, insufficient veterinary training, and the lack of integration between sectors. There is a need for targeted research to better understand antimicrobial misuse, socio-economic drivers, and the environmental pathways of AMR, as well as the need for stronger regulatory frameworks and cross-border cooperation. Addressing these challenges will be essential to safeguarding food safety, public health, and the sustainability of the beef industry in SSA.
Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province
(South African Medical Association, 2024-06) Mhlanga, S.; Turner, Astrid Chrisilda; Bibbulph, S.J.
BACKGROUND : In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. OBJECTIVES : To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. METHODS : A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. RESULTS : One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. CONCLUSION : OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.
Knowledge of pregnant women regarding prevention of mother-to-child transmission of HIV infection in Gert Sibande District, Mpumalanga Province, South Africa
(South African Medical Association, 2024-06) Manyawu, V.; Musekiwa, Alfred; Moyo-Chilufya, Maureen; Yah, Clarence S.; alfred.musekiwa@up.ac.za
BACKGROUND : Prevention of mother-to-child transmission (PMTCT) of HIV helps in closing the gaps for new HIV infections, thereby contributing to achieving the global targets of an AIDS-free generation. OBJECTIVE : To explore knowledge regarding PMTCT among pregnant women in Gert Sibande District, Mpumalanga Province, South Africa (SA). METHODS : The study was performed in two clinics in Chief Albert Luthuli Municipality, Gert Sibande District. It was a qualitative and descriptive exploratory study involving in-depth, one-on-one interviews with pregnant women regarding their PMTCT knowledge and perspectives. RESULTS : The study findings showed that pregnant women from the two clinics have a good knowledge of PMTCT. However, they were not aware that caesarean section can minimise mother-to-child transmission (MTCT) of HIV infection. CONCLUSION : PMTCT is important in establishing an HIV-free generation. The study revealed that women had a good understanding of MTCT; nevertheless, additional education is necessary, particularly regarding birthing procedures that minimise the risk of MTCT.
Insights into prostate cancer awareness and perceptions among men in Tshwane
(South African Medical Association, 2024-06) Nzombe, L.; Shirinde, Joyce; Patrick, Sean Mark; sean.patrick@up.ac.za
BACKGROUND : Globally, prostate cancer (PCa) accounts for 6.6% of deaths, while in South Africa (SA), PCa accounts for 13% of deaths in males, with over 4 000 SA men diagnosed with PCa annually. This may be attributed to the inadequate availability of screening, early detection and possibly other socioeconomic and lifestyle factors. OBJECTIVES : To determine the factors associated with knowledge and perceptions of PCa among men in the Tshwane district. METHODS : A descriptive cross-sectional survey was conducted between August 2022 and June 2023 in a study population of men, ≥18 years, residing in Tshwane district located in Gauteng, South Africa. RESULTS : In this study, 91.7% of the subjects responded that they had heard about PCa, while 11% thought they might be at risk for having PCa. While 93.7% of the respondents reported that they had never tested for PCa, 98.3% said that if they were offered the opportunity to test voluntarily, they would agree to test for PCa. There was a significant association between age and knowledge of PCa (p≤0.001). There was also a significant association between perception of PCa and smoking (p=0.034), age (p=0.035) and level of education (p=0.04). CONCLUSION : This study shows significant associations between age and level of education with knowledge, perception and awareness of PCa. Educational campaigns targeting diverse age and education groups are recommended, along with smoking cessation programmes, improved PCa screening access, tailored messaging, healthcare collaborations, and cultural sensitivity to enhance awareness and early detection.
HIV status and contraceptive use in Zimbabwe among sexually active adolescent girls and women : secondary analysis of Zimbabwe demographic health survey data
(South African Medical Association, 2024-06) Musuka, G.; Murewanhema, G.; Mukandavire, Z.; Chingombe, I.; Cuadros, D.; Mutenherwa, F.; Dzinamarira, Tafadzwa; Eghtessadi, R.; Malunguza, N.; Mapingure, M.; u19395419@up.ac.za
BACKGROUND : Understanding the pattern of contraceptive use among women living with HIV is critical for formulating relevant public health interventions to improve the uptake and use of reliable methods in this population. This helps to reduce the incidence of unintended pregnancies. OBJECTIVE : In this secondary data analysis, we aimed to describe contraceptive use by HIV-positive and HIV-negative sexually active adolescent girls and women, using data from the Zimbabwe Demographic and Health Survey (2015-16). METHOD : We used statistical analysis to determine the association between the use of various methods of contraception and HIV status using the Zimbabwe Demographic and Health Survey, 2015-16 data. RESULTS : Overall, the contraceptive use prevalence in this study was 60%. Sexually active adolescent girls and women on the Pill and injections were less likely to be HIV-positive compared with those not using any method of contraception (odds ratio (OR)=0.54, 95% confidence interval (CI) (0.45 - 0.64), p=0.001; and OR=0.75, 95% CI (0.59 - 0.96), p=0.020, respectively). Those using either a male or female condom were more likely to be HIV-positive, OR=3.36, 95% CI (2.63 - 4.28), p=0.001. CONCLUSIONS : This study revealed that there is still a considerable unmet need for contraception among the study population, highlighting the need to devise strategies to increase contraception uptake among women. Statistically significant differences were noted in the use of condoms, with those who are HIV-positive having a higher use of condoms compared with those who are HIV-negative. This may reflect that HIV-positive individuals have received appropriate counselling messages on the need to use barrier methods.
Frequent outbreaks of cholera in Zimbabwe : urgent need for strengthened public health interventions
(South African Medical Association, 2024-05) Dzinamarira, Tafadzwa; Murewanhema, G.; Mapingure, M.; Chingombe, I.; Musuka, G.
No abstract available.
Evaluation of choices and time spent on an open online elective course by undergraduate medical students during the COVID-19 pandemic
(South African Medical Association, 2024-06) Mfeka, Z.; Turner, Astrid Chrisilda; Wolvaardt, Jacqueline Elizabeth (Liz); Muganhiri, D.; liz.wolvaardt@up.ac.za
BACKGROUND : The COVID-19 pandemic highlighted the weakness of relying on in-person tuition in higher education. Massive open online courses (MOOCs) have been a successful addition to higher education. In this study, educators had to replace a planned elective in the medical curriculum with an online option during the pandemic. The roles of the competency framework of the Health Professions Council of South Africa (HPCSA) (Leader and Manager, Health Advocate, Professional, Communicator, Collaborator, Scholar, and Healthcare Practitioner) were used to guide its development. This elective emphasised the non-clinical roles of medical practitioners and was offered in 2020 and 2021. OBJECTIVES : To describe the choices of third-year medical students and time spent participating in a modified online elective in 2020 and 2021. METHODS : A descriptive cross-sectional study design was used, involving the participation of 629 medical students. Data were collected and analysed from three primary sources: registration data from LinkedIn Learning, data from the Foundation for Professional Development, and self-reported estimates by students of the average time spent on selected courses. Data included identification of the associated competency acquired. Data analysis was conducted using Python, version 3.10.11. RESULTS : The course choices of 629 students were analysed. In 2020 there were 300 participants and in 2021 there were 329. All the students had one compulsory inclusion in the elective (Management and Leadership Short Course for Undergraduate Healthcare Students). Students in both years reported spending the most average time on courses related to clinical knowledge (Healthcare Practitioner), followed by financial literacy and management (Professional), diversity management (Collaborator), and priority actions to identify and/or respond to (Health Advocate). The most popular courses related to the Leader and Manager role were around decision-making in human resources, problem-solving, and managing healthcare teams. Based on the top 10 LinkedIn Learning course selections of both cohorts, there appeared to be a preference for courses that were consistent with the role of medical professionals in practice. The most popular LinkedIn Learning course was The Six Morning Habits of High Performers. CONCLUSION : Students gravitated toward courses aligned with their role as professional doctors within the HPCSA competency framework. More studies are needed to understand how medical students develop the six non-clinical roles in the HPCSA framework and the effectiveness of MOOCs in a medical curriculum.
Community perceptions of community health worker effectiveness : contributions to health behaviour change in an urban health district in South Africa
(South African Medical Association, 2024-02) Thomas, Leena Susan; Pillay, Y.; Buch, Eric; leena.thomas@up.ac.za
BACKGROUND : Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage. OBJECTIVE : These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes. METHODS : A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction. RESULTS : Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6%). CONCLUSION : As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions.
A decomposition analysis of sociodemographic factors and non-cigarette tobacco use as contributors to the change in smoking rates in South Africa between 2017/18 and 2021
(South African Medical Association, 2024-06) Kali, K.; Ayo-Yusuf, Olalekan Abdulwahab; lekan.ayo-yusuf@up.ac.za
BACKGROUND : Trends data up to 2018 suggest that tobacco smoking was increasing in South Africa (SA), but only limited information is available on the impact of the COVID-19 pandemic on the current pattern of use of tobacco and nicotine products (TNPs). OBJECTIVES : To assess trends in sociodemographic patterns in the use of TNPs and the extent to which sociodemographic factors and non-cigarette tobacco use may explain possible changes in rates of TNP use between 2017/18 and 2021. METHODS : Data from three waves (2017, 2018 and 2021) of the South African Social Attitudes Survey (total N=8 140) were analysed. The sociodemographic correlates of current daily and non-daily use of factory-manufactured cigarettes (FMCs), roll-your-own (RYO) cigarettes, waterpipe/hubbly, electronic cigarettes (ECigs), snuff (a smokeless tobacco) and any combination of FMCs, RYO cigarettes and waterpipe/hubbly (‘current smoking’) in 2017/18 (pre-pandemic) were compared with those for 2021 (during the pandemic). Chi-square analyses and generalised linear models were used to compare the prevalence of TNP use between the two periods. A Blinda-Oaxaca decomposition analysis was also used to explore the roles of various sociodemographic factors, including any differences in the use of TNPs, that may explain any observed differences in smoking rates between 2017/18 and 2021. RESULTS : Current smoking increased significantly from 22.4% (95% confidence interval (CI) 20.4 - 24.5) in 2017/18 to 27.6% (95% CI 24.3 - 31.1) in 2021 (p=0.009). Smoking of FMCs did not change significantly overall between these two periods (20.1% v. 22.1%; p=0.240), except for a significant increase among those who self-identified as black African and a decrease among those who self-identified as coloured and those currently employed. However, the use of waterpipe/hubbly, ECigs, RYO cigarettes and snuff increased significantly. Women, individuals aged <35 years and black Africans had the largest increase in waterpipe/hubbly and ECig use. A decomposition analysis showed that increased waterpipe/hubbly and RYO use explained 52% and 15%, respectively, of the increase in smoking rates, while lower employment during 2021 compared with 2017/18 explained 15% of the increase in smoking rates during 2021. CONCLUSION : The use of all TNPs continued to increase in SA, particularly among women and unemployed people. These findings have policy and practice implications for addressing socioeconomic disparities in tobacco-related diseases.

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