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

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Healthcare workers' perspectives on the availability and use of mobile health technologies for disease diagnosis and treatment support in the Ashanti Region of Ghana
(Public Library of Science, 2024-04-16) Osei, Ernest; Apiribu, Felix; Kissi, Jonathan; Asante, Lydia Sarpomaa; Ampon-Wireko, Sabina; Mashamba‑Thompson, Tivani Phosa
INTRODUCTION : Considering the usefulness of mobile health (mHealth) technologies in healthcare delivery in low- and middle-income countries, including Ghana; there is a need to explore healthcare professionals’ perspectives on the availability and use of mHealth for disease screening and treatment of patients’ conditions. The study’s main aim is to explore healthcare professionals’ perspectives regarding the availability and use of mHealth applications for disease screening and management at point-of-care in Ghana’s Ashanti Region. MATERIALS AND METHODS : We conducted in-depth interviews with healthcare professionals who use mHealth applications daily between July and September 2020. A purposive sampling strategy was employed to select healthcare professionals who have been using mobile health application tools to support healthcare delivery. The researchers conducted 14 in-depth interviews with healthcare professionals on the availability and use of mHealth applications to support disease diagnosis and treatment of patients’ conditions. Data were transcribed, coded, arranged, and analyzed to determine categories and themes. RESULTS : The study results demonstrated that healthcare workers had positive perceptions towards mHealth applications. Healthcare professionals identified significant challenges concerning mHealth applications: the high cost of data; lack of education or limited awareness; poor mobile networks; unstable internet connectivity; erratic power supply; and unavailability of logistics. Healthcare professionals identified the following prerequisite strategies to strengthen the use and scale-up of mHealth applications: stable internet connectivity; creating awareness; supplying logistics; reducing the cost of data; and developing local mobile apps. CONCLUSIONS : The study results revealed the availability of mHealth applications at the individual level for disease screening and treatment support of patients’ conditions. The study also showed several significant challenges facing mHealth applications which need to be addressed to guarantee the successful implementation and scaling-up of mHealth activities at all levels of healthcare delivery. Hence, future research should incorporate healthcare professionals’ perspectives to completely understand mHealth implementation and scaling-up challenges and measures to inform policy regulations.
From diagnosis to therapy : the critical role of lncRNAs in hepatoblastoma
(Elsevier, 2024-08) Alzahrani, A. Khuzaim; Khan, Abida; Singla, Neelam; Hai, Abdul; Alzahrani, Abdullah R.; Kamal, Mehnaz; Asdaq, Syed Mohammed Basheeruddin; Alsalman, Abdulkhaliq Jassem; Hawaj, Maitham Abdullah Al; Odaini, Lulu Homeed Al; Dzinamarira, Tafadzwa; Imran, Mohd
According to findings, long non-coding RNAs (lncRNAs) serves an integral part in growth and development of a variety of human malignancies, including Hepatoblastoma (HB). HB is a rare kind of carcinoma of the liver that mostly affects kids and babies under the age of three. Its manifestations include digestive swelling, abdominal discomfort, and losing weight. This thorough investigation digs into the many roles that lncRNAs serve in HB, giving views into their varied activities as well as possible therapeutic consequences. The function of lncRNAs in HB cell proliferation, apoptosis, migratory and penetrating capacities, epithelial-mesenchymal transition, and therapy tolerance is discussed. Various lncRNA regulatory roles are investigated in depth, yielding information on their effect on essential cell processes such as angiogenesis, apoptosis, immunity, and growth. Circulating lncRNAs are currently acknowledged as potential indications for the initial stages of identification of cancer, with the ability to diagnose as well as forecast. In addition to their diagnostic utility, lncRNAs provide curative opportunities as locations and actors, contributing to the expanding landscape of cancer research. Several HB-linked lncRNAs have been demonstrated to exhibit abnormal expression and are involved in tumor-like characteristics via DNA, RNA, or protein binding or encoding short peptides. As a result, a better knowledge of lncRNA instability might bring fresh perspectives into HB etiology as well as innovative strategies for HB early diagnosis and therapy. We describe the abnormalities of lncRNA expression in HB and their tumor-suppressive or carcinogenic activities during HB carcinogenesis in this study. Furthermore, we explore lncRNAs' diagnostic and therapeutic possibilities in HB.
Modeling timing of sexual debut among women in Zimbabwe using a geoadditive discrete-time survival approach
(BioMed Central, 2025-03) Bere, Alphonce; Maposa, Innocent; Matsena-Zingoni, Zvifadzo; Twabi, Halima S.; Batidzirai, Jesca M.; Singini, Geoffrey C.; Mchunu, Nobuhle; Nasejje, Justine B.; Moyo-Chilufya, Maureen; Ojifinni, Oludoyinmola; Nevhungoni, Portia; Musekiwa, Alfred
BACKGROUND : Early sexual debut has undesirable health consequences such as an increased risk of contracting sexually transmitted infections (STIs) including HIV, mental health problems, pregnancy-related complications and death including abortion-related deaths. Despite a global decline in adolescent birth rates, Zimbabwe continues to face a high prevalence of underage pregnancies, highlighting significant early sexual debut among Zimbabwean adolescents. This study examined the spatial variation and the demographic and socio-economic determinants of the timing of early sexual debut among Zimbabwean women. METHODS : Data for 9,882 Zimbabwean women of reproductive age were drawn from the 2015 Zimbabwe Demographic and Health Survey (ZDHS). We defined early sexual debut as having first sexual intercourse before the 18 years of age. A fully Bayesian geoadditive discrete-time survival model was used. Adjustments for unequal sampling probabilities were done using the provided survey weights. RESULTS : Our findings show that women with primary education (aOR = 0.62,95% Crl:0.47–0.81), secondary education (aOR = 0.25,95% Crl:0.19–0.33) and higher education (aOR = 0.06,95% Crl:0.04–0.09) had lower odds of early sexual debut than those with no education. In comparison to those with middle household wealth index, women with higher household wealth index (aOR = 0.83, 95% CrI: 0.71–0.98) had lower odds of early sexual initiation. On the other hand, women with lower household wealth index had higher likelihood of early sexual debut (aOR = 1.13, 95% CrI: 1.03–1.26) than those with middle household wealth index. The type of place of residence and birth year cohort did not have a significant association with the odds of early sexual debut. The hotspots of early sexual debut were in Matabeleland North and Matabeleland South provinces. CONCLUSION : To mitigate early sexual debut in Zimbabwe, targeted interventions are essential in Matabeleland North and Matabeleland South provinces as well as in the identified high-risk groups.
Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa
(Public Library of Science, 2024-07-18) Dlangalala, Thobeka Nomzamo; Musekiwa, Alfred; Mashamba‑Thompson, Tivani Phosa
Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson’s pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.
Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption : a population attributable fraction analysis
(Elsevier, 2024-11) Rumgay, Harriet; Nethan, Suzanne; Shah, Richa; Vignat, Jerome; Ayo-Yusuf, Olalekan Abdulwahab; Chaturvedi, Pankaj; Guerra, Eliete N.S.; Gupta, Prakash C.; Gupta, Ruchika; Liu, Shiwei; Magnusson, Cecilia; Parascandola, Mark; Paulino, Yvette C.; Rezaei, Negar; Siddiqi, Kamran; Warnakulasuriya, Saman; Lauby-Secretan, Beatrice; Soerjomataram, Isabelle
BACKGROUND : Consuming products that contain smokeless tobacco or areca nut increases the risk of oral cancer. We aimed to estimate the burden of oral cancer attributable to smokeless tobacco or areca nut consumption globally and by type of smokeless tobacco or areca nut product in four major consuming countries. METHODS : We calculated population attributable fractions (PAFs) using prevalence of current use of smokeless tobacco or areca nut products from national surveys and corresponding risks of oral cancer from the literature. We applied PAFs to national estimates of oral cancer incidence in 2022 from the Global Cancer Observatory's Cancer Today database to obtain cases attributable to smokeless tobacco or areca nut consumption. We modelled 95% uncertainty intervals (UIs) using Monte Carlo simulations. FINDINGS : Globally, an estimated 120 200 (95% UI 115 300–124 300) cases of oral cancer diagnosed in 2022 were attributable to smokeless tobacco or areca nut consumption, accounting for 30·8% (95% UI 29·6–31·9) of all oral cancer cases (120 200 of 389 800). An estimated 77% of attributable cases were among male patients (92 600 cases, 95% UI 88 000–96 500) and 23% were among female patients (27 600 cases, 26 000–29 000). Regions with the highest PAFs were Melanesia, Micronesia, and Polynesia (78·6%, 95% UI 74·4–80·5), southcentral Asia (57·5%, 54·8–59·5), and southeastern Asia (19·8%, 19·0–20·6). Lower-middle-income countries represented 90·2% of the world total attributable cases (108 400 cases, 95% UI 103 400–112 200). INTERPRETATION : Our findings suggest that one in three cases of oral cancer globally are attributable to smokeless tobacco or areca nut consumption, and could be prevented through smokeless tobacco and areca nut control. Global cancer control efforts must incorporate further measures to reduce smokeless tobacco and areca nut consumption in populations with the largest attributable burden.
Trends in body mass index for people with and without HIV : pooled analysis of nationally-representative health surveys from 10 countries and 173,800 adults in Africa
(Public Library of Science, 2024-09-17) Carrillo-Larco, Rodrigo M.; Bulstra, Caroline A.; Manne-Goehler, Jennifer; Siedner, Mark J.; Johnson, Leslie C.M.; Marconi, Vincent C.; Chung, Michael H.; Venter, Willem Daniel Francois; Kocher, Erica; Lalla-Edward, Samanta; Chandiwana, Nomathemba C.; Kariuki, Jacob K.; Ali, Mohammed K.
It remains unclear if and how body mass index (BMI) levels have changed over time in HIV endemic regions. We described trends in mean BMI and prevalence of overweight between 2003–2019 in 10 countries in Africa including people living with (PLWH) and without (PLWoH) HIV. We pooled Demographic and Health Surveys (DHS) from countries where ≥2 surveys >4 years apart were available with height/weight measurements and HIV tests. HIV status was ascertained with a finger-prick dried blood spot (DBS) specimen tested in a laboratory. The DBS is taken as part of the regular DHS procedures. We summarized age and socioeconomic status standardized sex-specific mean BMI (kg/m2) and prevalence of overweight (BMI ≥25 kg/m2) by HIV status. We fitted country-level meta-regressions to ascertain if changes in ART coverage were correlated with changes in BMI. Before 2011, women LWH (22.9 [95% CI: 22.2–23.6]) and LWoH (22.6 [95% CI: 22.3–22.8]) had similar mean BMI. Over time, mean BMI increased more in women LWH (+0.8 [95% CI: 0.7–0.8] BMI units) than LWoH (+0.2 [95% CI: 0.2–0.3]). Before 2013, the mean BMI was similar between men LWH (21.1 (95% CI: 20.3–21.9)) and LWoH (20.8 (95% CI: 20.6–21.1)). Over time, mean BMI increased more in men LWoH (+0.3 [95% CI: 0.3–0.3]) than LWH (+0.1 [95% CI: 0.1–0.1]). The same profile was observed for prevalence of overweight. ART coverage was not strongly associated with BMI changes. Mean BMI and prevalence of overweight were similar in PLWH and PLWoH, yet in some cases the estimates for PWLH were on track to catch up with those for PLWoH. BMI monitoring programs are warranted in PLWH to address the rising BMI trends.
Associating serum testosterone levels with African ancestral prostate cancer health disparities
(Nature Research, 2025-04) Lebelo, Maphuti Tebogo; Mmekwa, Naledi; Louw, Melanie; Jaratlerdsiri, Weerachai; Mutambirwa, Shingai B.A.; Loda, Massimo; Hayes, Vanessa M.; Bornman, Maria S. (Riana); riana.bornman@up.ac.za
Serum testosterone levels decrease in the aging male, while the risk for prostate cancer (PCa) increases concomitantly. Higher levels in younger men have been linked with racially driven PCa disparities, with African men disproportionately impacted. In turn, higher levels of serum lipids have been associated with aggressive disease, while racial disparity between serum testosterone, cholesterol and cancer mortality has been suggested. Having previously reported a 2.1-fold increased age-adjusted risk for aggressive PCa in Black South African over Black American men, we determined the serum testosterone and associated lipid levels in 250 Black South African men either with or without clinicopathologically diagnosed disease. Observing no associations with serum lipid levels, Black South Africans presented with testosterone levels between 1.24 (< 60 years) and 1.3-fold (≥ 60 years) greater than Black Americans. Notably, a rapid drop in total-, bioavailable- and free testosterone levels in men 65 years or older was significantly associated with PCa risk (P = 0.0057, 0.009 and 0.005, respectively), while irrespective of age, further associated with advanced disease (P = 0.004, 0.0012 and 0.0036, respectively). These preliminary data provide insights into the potential role of androgens in driving PCa health disparities, with important consequence for tailoring treatment for Black men.
Assessing user experience with the Bioline™ HCV point-of-care test in primary healthcare settings : a mixed-methods study
(BioMed Central, 2025-04) Duah, Evans; Mathebula, Evans Mantiri; Maluleke, Kuhlula; Baloyi, Tinyiko Violet; Ephraim, Richard Kobina Dadzie; Mashamba‑Thompson, Tivani Phosa; evans.duah@tuks.co.za
BACKGROUND : Hepatitis C Virus (HCV) is a major public health challenge, particularly in resource-limited settings with inadequate diagnostic services. The Bioline™ HCV Point-of-Care (POC) test provides a promising solution for improving diagnosis in Primary Healthcare (PHC) clinics without laboratory infrastructure. This study evaluated the test’s usability, acceptability, and deliverability in Ghana using user-oriented REASSURED criteria. METHODS : A convergent parallel mixed-methods design was adopted. Quantitative data was collected through direct observation of Healthcare Workers (HCWs) using audit checklists and analyzed with Stata 16. The analysis included descriptive statistics, inter-rater concordance assessment, and the application of the System Usability Scale (SUS). Qualitative data, analyzed using Atlas.ti 24.2.0, explored user experiences, confidence, storage infrastructure, and suggestions for test design improvement through in-depth interviews. RESULTS : The quantitative audit included 81 non-laboratory HCWs, with 22 participating in in-depth interviews. The test scored 88.7 on the SUS (95% CI: 86.40-90.88), with 88% of HCWs rating it as easy or very easy to use. Most HCWs (81.5%) successfully completed all testing steps independently, achieving 100% inter-rater concordance, but 83% made errors in at least one step, primarily during pre-testing. Qualitative findings revealed widespread acceptance, confidence, and adaptability despite challenges with storage infrastructure. DISCUSSION : The Bioline™ HCV POC test demonstrated high usability and acceptance among HCWs in resource-limited settings. Enhancements such as improved packaging, simplified information sheets, refined droppers, and additional components like gloves could further optimize usability. These findings support the Sustainable Development Goal (SDG) 3 by enhancing access to timely HCV diagnosis, contributing to Universal Health Coverage, and strengthening health systems in underserved areas. 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.
The long wait for long-acting HIV prevention and treatment formulations
(Elsevier, 2024-10) Venter, Willem Daniel Francois; Gandhi, Monica; Sokhela, Simiso; Sikwese, Kenly; Bygrave, Helen; Da Gama, Louis; Mphothulo, Ndiviwe; Jamieson, Lise; Siedner, Mark J.; Pozniak, Anton L.; Rojo, Pablo; Baptiste, Solange L.; Wambui, Jacque; Meyer-Rath, Gesine; Honermann, Brian; Warren, Mitchell; Bekker, Linda-Gail; Sinxadi, Phumla; Collins, Simon; Burry, Jessica; Moller, Karlien; Clayden, Polly; Owen, Andrew; Hill, Andrew
Large randomised studies of new long-acting medications for the prevention and treatment of HIV have shown high effectiveness and acceptability. Although modelling studies indicate these agents could be fundamental in HIV elimination, coordination of their entry into health-care markets is crucial, especially in low-income and middle-income countries with high HIV prevalence, where coordination is low despite UNAIDS flagging that global HIV targets will not be met. Research and implementation projects are tightly controlled by originator pharmaceutical companies, with only a small percentage of eligible people living with or affected by HIV benefiting from these projects. WHO, financial donors, manufacturers, and governments need to consider urgent coordinated action from stakeholders worldwide, akin to the successful introduction of dolutegravir into treatment programmes across low-income and middle-income countries. Without this immediate coordination, large-scale access to long-acting agents for HIV will be delayed, potentially extending into the 2030s. This delay is unacceptable considering the established global HIV targets.
'We do not like talking about our problems' : socialization and idealized masculinity as drivers of help-seeking avoidance among college men in South Africa
(BioMed Central, 2025-03) Sikweyiya, Yandisa; Mahlangu, Pinky; Jewkes, Rachel; Brooke-Sumner, Carrie; Gibbs, Andrew; Dartnall, Elizabeth; Pillay, Managa; Machisa, Mercilene
BACKGROUND : This article explores how identities and contexts influence help-seeking avoidance behaviour among college men. METHODS : This exploratory qualitative study purposively selected 88 male students (aged 18–30) from some universities and Technical and Vocational Training colleges (TVETs) in South Africa. Data were collected through focus group discussions (FGDs). Eight FGDs were conducted, one in each selected university (n = 2) and TVETs (n = 6) in 2018–2019. Data were analyzed using a thematic analysis approach. RESULTS : We found that college men’s early life experiences and socialisation strongly influenced their ability to express emotion and access services when in need of help. The data also revealed a masculinity that men aspired to and wanted to be seen as embracing or personifying while on campus. Most men ascribed to an ideal of masculinity that made it difficult for them to share their feelings (e.g., emotional pain, sadness; and bottle their emotions) and seek help from campus-based counselors or peers. The few men who reported using campus mental health support services appraised them as unsuitable and unhelpful for them, and indicated a preference for services that were more culturally relevant. Most men indicated a preference for male counselors, of which there were very few. CONCLUSIONS : These findings may be useful for the formulation of evidence-based context-specific and culturally sensitive approaches for increasing men’s access to mental health and psychological support services on South African college campuses.
Higher genotyping performance of the applied biosystems TaqPath Seq HIV-1 genotyping kit against ViroSeq HIV-1 genotyping Kit in HIV protease, reverse transcriptase, and integrase regions
(Dove Press, 2025-04) Choga, Ontlametse Thato; Okafor, Obiageli; Lemogang, Goitseone Martha; Choga, Wonderful Tatenda; Muzanywa, Gaonyadiwe; Garcia, Andrea E.; Moyo, Sikhulile; Gaseitsiwe, Simani
PURPOSE : We assessed the performance of Applied Biosystems TaqPath Seq HIV-1 Genotyping Kit (CE-IVD) (TaqPath Kit) against the ViroSeq HIV-1 Genotyping Assays in genotyping HIV protease (PR), reverse transcriptase (RT), and integrase (INI) regions. METHODS : The study included 43 HIV-1 plasma specimens: 20 from people living with HIV-1C and 23 well-characterized HIV-positive Virology Quality Assurance (VQA) samples with PR-, RT-, and INI mutations. VQA samples included HIV-1 subtypes A, B, C, D, F, G, CRFO2_AG and URF. HIV-1 RNA extracted from all specimens was tested with both genotyping assays. Known HIV drug resistance mutations (DRMs) were identified using the Stanford HIV drug resistance database. Sequencing success rates, nucleotide identity, and DRMs from the two commercial assays were compared. RESULTS : Of 43 samples, TaqPath Kit amplified 93.0% (40) for HIV PR/RT and 97.7% (42) for HIV INI regions, compared to ViroSeq Assays, which amplified 69.8% (30) and 72.1% (31) for PR/RT and INI, respectively. The TaqPath Kit successfully sequenced 90.0% (36/40) PR/RT and 97.6% (41/42) INI amplicons, while ViroSeq Assays sequenced 53.3% (16/30) PR/RT and 87.1% (27/31) INI amplicons. The mean nucleotide similarity was 98.8% (SD ± 1.30), 99.6% (SD ± 1.32) and 99.2% (SD ± 0.72) for paired RT, PR and INI sequences, respectively. The TaqPath Kit detected 97.2% (35/36) of DRMs identified by the ViroSeq Assays and an additional 83 mutations and polymorphisms in samples that failed genotyping with the ViroSeq Assays. Among these, 85.5% (71/83) were confirmed by the reference sequence, including 39 major DRMs. CONCLUSION : The TaqPath Kit demonstrated higher genotyping performance compared to the ViroSeq assays. The TaqPath Kit was able to detect DRMs in the PR, RT and INI regions of various HIV-1 subtypes, offering a critical tool to identify and monitor HIV drug resistance to new and existing antiretroviral drugs targeting these regions.
Impact of US funding cuts and stop work orders on TB services and research in South Africa
(International Union Against Tuberculosis and Lung Disease, 2025-04-09) Ndjeka, N.; Kubjane, M.; Abdullah, Fareed; Mohr-Holland, E.; Subrayen, P.; Loveday, M.; Dube, M.; Boffa, Jody
No abstract available.
Assessing socioeconomic inequality in ageing in sub-Saharan Africa : an empirical assessment of South Africa
(Springer, 2025) Ataguba, John E.
The population younger than 5 years is now exceeded by those older than 65 globally, with women making up a larger share. Because ageing was traditionally about people older than 60 or 65, Africa, with a predominantly younger population under 50 years, was previously not a focus of ageing research. However, shifting the focus away from people older than 65, a concept without concrete meaning in many African settings, this paper considers ageing a continuous process. It assesses socioeconomic inequalities in ageing and gaps in gender-related socioeconomic disparities in ageing in Africa using South Africa as a case study. Data come from four rounds of nationally representative general household surveys spanning 2003–2018. Using the concentration index to assess socioeconomic inequalities in ageing, a significantly large proportion of younger populations comes from poorer households, while the reverse is the case for older adults. There is a gendered pattern in socioeconomic inequality in ageing. While there are no significant differences in socioeconomic inequalities in ageing between boys and girls aged 0–9 years, socioeconomic disparities become apparent and significantly “favour” males in much older groups, say 60 years and above. The paper highlights the importance of multisectoral action and a gendered approach in addressing the significant socioeconomic inequalities in ageing. While further research is needed to understand key drivers of inequalities, mainstreaming ageing into multisectoral policies, especially prioritising younger women, is necessary to build up resources to reduce socioeconomic disparities in ageing at older ages in South Africa.
Women's experience of preterm birth in an East African context : a qualitative study
(Makerere University, Medical School, 2024-03-01) Habtu, Thomas Asmelash; Pembe, Andrea Barnabas; Chiwanga, Faraja S.; Odland, Jon Oyvind; Darj, Elisabeth
BACKGROUND: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all childbirths worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. OBJECTIVE: The current study aimed to explore and understand women’s experiences and perceptions regarding giving birth prematurely at the National Hospital of Muhimbili in Dar es Salaam, Tanzania. METHOD: A qualitative method, using Interpretive Phenomenological Analysis approach was chosen to understand and describe the women’s experiences. A semi-structured guide was used during the interviews. All interviews were audio-recorded and transcribed verbatim. FINDINGS: Eight in-depth interviews were conducted. The analysis revealed three superordinate themes: (a) Emotional turmoil: unmet expectations shattering maternal identity, emotional distress, and loss of hope; (b) Adapting to preterm birth and challenges: the unexpected situation, lack of proper care, strenuous breastfeeding routines, and socioeconomic challenges; (c) Significance of proper care and emotional support: good maternal care, mother-to-mother and family support. CONCLUSION: This study provided a deeper understanding of women’s experiences and perceptions of premature childbirth. The current study indicated the importance of caregivers’ awareness of the women’s emotional distress, their need to adapt to a sudden unexpected situation, and the necessity of emotional support.
The integrated care costs of HIV and non-communicable diseases in South Africa
(International Union Against Tuberculosis and Lung Disease, 2024-12-01) Moyo-Chilufya, Maureen; Mgutshini, Tennyson; Musekiwa, Alfred; Hongoro, Charles; u21572152@tuks.co.za
SETTING: In sub-Saharan Africa, the syndemic of HIV and non-communicable diseases (NCDs) poses a significant challenge. To address this, leading global think tanks like the WHO advocate for integrated HIV/NCD care at primary healthcare levels. However, comparative empirical data on the costs of integrated care are limited. South Africa, with the largest HIV programme globally, was purposively selected for our comparative case study. OBJECTIVE: To determine the cost of integrated HIV/ NCD care from the providers’ perspective at two ‘ideal status’ public healthcare facilities in South Africa as case studies. DESIGN: A multi-pronged methodology was used to collect provider cost data via retrospective documentary sources or records and a question-and-answer session with facility managers who provided key information on costrelated data. Data analysis utilised an activity-based costing (ABC) method. RESULTS: Despite the difference in the size of the clinics, the cost per patient in terms of ABC is similar between the two primary healthcare facilities, USD261.60 and USD226.30, respectively. CONCLUSION: The ABC method can be utilised to cost integrated care, foster health economic data availability for future research, and inform health policymakers.
Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe
(Elsevier, 2024-09) Mtisi, Takudzwa J.; Kouamou, Vinie; Morse, Gene D.; Dzinamarira, Tafadzwa; Ndhlovu, Chiratidzo E.; u19395419@up.ac.za
BACKGROUND : Monitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression. METHODS : This was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods. RESULTS : Poor level of agreement was found between PC records and DBS tenofovir concentrations (k = -0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 - 16.5, p < 0.0001). CONCLUSIONS : Self-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression.
Genetic variants associated with dengue hemorrhagic fever. A systematic review and meta-analysis
(Elsevier, 2024-04) Kanan, Mohammed; Naffaa, Mohammed; Alanazi, Ahmed; Nasser, Faiz; Alsaiari, Ahad Amer; Almehmadi, Mazen; Assiry, Ali; Muzafar, Hisham; Katam, Hejab; Arar, Abdullah; Asdaq, Syed Mohammed Basheeruddin; Abida; Imran, Mohd.; Dzinamarira, Tafadzwa; u19395419@up.ac.za
Dengue hemorrhagic fever (DHF) is a severe condition resulting from the dengue virus, with four serotypes known as DEN-1, DEN-2, DEN-3, and DEN-4. Genetic variations play a crucial role in influencing susceptibility to DHF. Therefore, this investigation conducted a meta-analysis to uncover genetic changes that might have remained undetected in individual studies due to small sample sizes or methodological differences. Among 2212 initially identified studies, 23 were deemed suitable for analysis based on PRISMA guidelines. Toll-like receptors (TLR) and CD209 showed significant association with DHF (odds ratios: TLR=0.56, CD209 =0.55), indicating protective effects. However, tumor necrosis factor (TNF) and human leukocyte antigen (HLA) did not exhibit a statistically significant relationship with DHF. This study emphasizes the relevance of TLR and CD209 in DHF susceptibility and resistance across diverse geographical locations.
Enteropathogenic viruses associated with acute gastroenteritis among African children under 5 years of age
(Elsevier, 2024-06) Omatola, Cornelius Arome; Ogunsakin, Ropo Ebenezer; Onoja, Anyebe Bernard; Okolo, Martin-Luther Oseni; Abraham-Oyiguh, Joseph; Mofolorunsho, Kehinde Charles; Akoh, Phoebe Queen; Adejo, Omebije Patience; Idakwo, Joshua; Okeme, Therisa Ojomideju; Muhammed, Danjuma; Adaji, David Moses; Samson, Sunday Ocholi; Aminu, Ruth Foluke; Akor, Monday Eneojo; Edegbo, Emmanuel; Adamu, Andrew Musa
Gastroenteritis viruses are the leading etiologic agents of diarrhea in children worldwide. We present data from thirty-three (33) eligible studies published between 2003 and 2023 from African countries bearing the brunt of the virus-associated diarrheal mortality. Random effects meta-analysis with proportion, subgroups, and meta-regression analyses were employed. Overall, rotavirus with estimated pooled prevalence of 31.0 % (95 % CI 24.0–39.0) predominated in all primary care visits and hospitalizations, followed by norovirus, adenovirus, sapovirus, astrovirus, and aichivirus with pooled prevalence estimated at 15.0 % (95 % CI 12.0–20.0), 10 % (95 % CI 6–15), 4.0 % (95 % CI 2.0–6.0), 4 % (95 % CI 3–6), and 2.3 % (95 % CI 1–3), respectively. Predominant rotavirus genotype was G1P[8] (39 %), followed by G3P[8] (11.7 %), G9P[8] (8.7 %), and G2P[4] (7.1 %); although, unusual genotypes were also observed, including G3P[6] (2.7 %), G8P[6] (1.7 %), G1P[6] (1.5 %), G10P[8] (0.9 %), G8P[4] (0.5 %), and G4P[8] (0.4 %). The genogroup II norovirus predominated over the genogroup I-associated infections (84.6 %, 613/725 vs 14.9 %, 108/725), with the GII.4 (79.3 %) being the most prevalent circulating genotype. In conclusion, this review showed that rotavirus remains the leading driver of viral diarrhea requiring health care visits and hospitalization among under-five years children in Africa. Thus, improved rotavirus vaccination in the region and surveillance to determine the residual burden of rotavirus and the evolving trend of other enteric viruses are needed for effective control and management of cases.
Mortality trends and causes of death in a South African hospital complex pre- and during COVID-19
(AOSIS, 2025-03) Tshabalala, Khanyisile; Fabris-Rotelli, Inger Nicolette; Basu, Debashis; Myburgh, Magriet; Abdullah, Fareed; khanyisile.tshabalala@ up.ac.za
BACKGROUND : Before coronavirus disease 2019 (COVID-19), global health was improving, with declining mortality trends. The pandemic disrupted this progress, increasing mortality in South Africa between April 2020 and March 2022. Pre-pandemic data establishes a baseline for assessing COVID-19’s impact on all-cause mortality. OBJECTIVES : This study examines changes in hospital-based mortality trends in a Gauteng hospital complex from April 2018 to March 2022, addressing the scarcity of such studies during the COVID-19 era. METHOD : A retrospective review of 7815 deaths from April 2018 to March 2022 was conducted. Chi-squared tests were used to analyse deaths by age group and gender, with correlations reported. RESULTS : Mortality rates rose from 3.2% in 2018–2019, peaked at 5.1% in 2020–2021, and declined to 4.2% in 2021–2022. Patients aged 15 years–64 years had the highest death rates, with an increase among those over 65. Male deaths exceeded female deaths, with the smallest difference observed in 2020–2021. Leading causes of death included diseases of the circulatory and respiratory systems, neoplasms, digestive system diseases, and infectious and parasitic diseases. CONCLUSION : The study highlights COVID-19’s impact on mortality, showing variations by year, age, gender, and disease. Contribution: Excess non-COVID-19 deaths likely stemmed from disrupted healthcare services. These findings underscore the need for ongoing monitoring of hospital mortality to identify pandemic-related service disruptions and guide interventions to strengthen healthcare services, improve access to care, and enhance referral systems during unexpected disasters.
Effective cervical cancer prevention in sub-Saharan Africa needs the inclusion of men as key stakeholders
(Frontiers Media, 2025-01) Dzobo, Mathias; Dzinamarira, Tafadzwa
Cervical cancer is a major public health problem in low-middle-income countries, especially in sub-Saharan Africa. Strategies for cervical cancer prevention are multi-sectorial, often involving many stakeholders. However, male engagement is still not fully embraced. Involving men in cervical cancer prevention can potentially increase access to prevention services and promote health equity among women. Men’s involvement can overcome barriers to women’s access to preventive services and increase community awareness of cervical cancer prevention.

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