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

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Building community capacity in diabetes care : perspectives of community health workers
Heyns, Tanya; Muvhungu, Mukhethwa A.; Mathete, Sehlale; Filmalter, Cecilia Jacoba; Piotie, Patrick Ngassa (AOSIS, 2025-09-16)
BACKGROUND : Diabetes is a global public health concern. Approximately, 79% of people living with diabetes reside in low- and middle-income countries. Community healthcare workers (CHWs) provide basic care to communities, including people living with diabetes in South Africa; however, their contribution still needs to be explored. AIM : To explore the perceptions of CHWs regarding their roles in diabetes care. SETTING : This study was conducted at primary healthcare clinics in the Tshwane District, located in the northern part of Gauteng province in South Africa, where CHWs form part of ward-based outreach teams. METHODS : Using a descriptive qualitative research design, four focus group interviews were conducted with 32 CHWs with 5 or more years of experience and involved in providing care to people living with diabetes. The Dynamic reading, Engaged code book development, Participatory coding, Inclusive reviewing and summarizing of categories, Collaborative analysis, Translating (DEPICT) approach for collaborative qualitative data analysis was used. RESULTS : The participants indicated that their roles focused on health education, specifically related to diet, lifestyle changes, medication, involving family and self-care, support and monitoring. CONCLUSION : CHWs play an important role in the screening, continuous monitoring and referral of people living with diabetes. It is important that training and support for CHWs are aligned and informed by evidence and the needs of the communities they serve. CONTRIBUTION : The results may assist in the development of appropriate competencies, to inform programs and in-service training topics and regulate the practices of CHWs.
Availability and access to long-term inpatient rehab centers in north Tshwane, Gauteng
Komane-Mnguni, Rorisang G.; Mkhize, Nonhlanhla M.; Mfolo, Tshepiso; Madiba, Thomas Khomotjo (AOSIS, 2025-11-21)
BACKGROUND : Substance abuse is increasing in South Africa with research indicating a lack of access to public drug rehabilitation centres in all provinces of the country. The insights of recovering substance abusers in terms of access to centres remain a gap in the north of Tshwane. AIM : The study explored the recovering substance abusers' views or perspectives on the accessibility of long-term inpatient substance abuse rehabilitation centres. SETTING: South African National Council on Alcoholism and Drug Dependence (SANCA) centers in Soshanguve and Hammanskraal. METHODS : The qualitative study involved recovering substance abusers undergoing treatment at two outpatient substance rehabilitation centres in the north of Tshwane. The participants were interviewed using a semi-structured questionnaire which explored their views and perceptions and experiences on the accessibility to rehabilitation centres. RESULTS : Saturation was reached at 13 male participants between 29 years and 35 years of age. The interviews were transcribed and translated, and five distinct themes were identified. The themes identified were: rehabilitation is mindset-related; long waiting times translated into continuous substance abuse; peer pressure; no jobs or skills to keep busy; and a lack of trust within the community. Four of the themes were attributed to enabling factors for their substance abuse. CONCLUSION : Long waiting times, few rehabilitation centres, stigma, the lack of jobs and skills were identified as barriers to access rehabilitation centres. CONTRIBUTION : The study contributes to the body of literature exploring access problems in rehabilitation centres from the perspective of recovering drug addicts. It provides insights into risk factors that exacerbate the scourge of substance abuse in the north of Tshwane.
The global burden of Cholesteatoma : a systematic review and meta-analysis
Melariri, Herbert; Balakrishna, Yusentha; Mukhtar, Abdiwahab; Joseph, Elizabeth; Labuschagne, Simone; Hapunda-Chibanga, Racheal; Finestone, Sara; Bosman, Allison; Ukaegbe, Onyinyechi; Werkineh, Haben Birhane; Merven, Marc; Seguya, Amina; Melariri, Blessing; Mokoh, Lillian; Els, Timothy; Tharratt, Daniel; Murtaza, Amir; Moosajee, Mohamed; Harris, Tashneem; Onotai, Lucky; Amir, Ida; Melariri, Paula (Wiley, 2026-01)
OBJECTIVE : This systematic review and meta-analysis sought to estimate the global and World Health Organization (WHO) regional prevalence and burden of cholesteatoma. DATA SOURCES : PubMed, APA PsycINFO, the Cochrane Library, Embase, and WHO International Clinical Trials Registry Platform (ICTRP) from 2010 to 2025. REVIEW METHODS : Teams of independent reviewers assessed each study for inclusion. Studies reporting primary data on cholesteatoma prevalence, recurrence, or its impact were included. The primary outcome was the global prevalence, whereas secondary outcomes were regional prevalence and recidivism rates, treatment, and complications. A random-effects meta-analysis was used to pool data, and study quality and publication bias were assessed. This study was registered with PROSPERO (CRD42024533132). RESULTS : Forty-six eligible studies were included in the meta-analysis. The pooled global prevalence of cholesteatoma was estimated at 4.02 per 1000 persons (95% CI 1.79-7.10). By the WHO regions, the pooled prevalence of cholesteatoma in the Western Pacific Region, European Region, South East Asian Region, Region of the Americas, and African Region was estimated at 5.73 per 1000 persons (95% CI 1.00-13.87), 2.32 per 1000 persons (95% CI 2.23-2.42), 3.30 per 1000 persons (95% CI 2.65-4.11), 0.06 per 1000 persons (95% CI 0.00-0.00), and 7.32 per 1000 persons (95% CI 2.77-13.96), respectively. The prevalence of hearing loss in cholesteatoma was estimated at 75.68 per 100 cases (95% CI 59.02-89.24). CONCLUSION : This meta-analysis is the first to systematically quantify global and regional cholesteatoma prevalence, complications, and treatment approaches, highlighting regional disparities and informing public health strategies and policy globally.
Two decades of tracking femicide in South Africa : an analysis of four national surveys from 1999 to 2020/2021
Abrahams, Naeemah; Chirwa, Esnat; Mhlongo, Shibe; Dekel, Bianca; Ketelo, Asiphe; Lombard, Carl; Shai, Nwabisa; Ramsoomar, Leane; Mathews, Shanaaz; Labuschagne, Gérard; Matzopoulos, Richard; Prinsloo, Megan; Martin, Lorna J.; Jewkesa , Rachel (Taylor & Francis Group, 2025-12)
The absence of reliable administrative data from many countries means that there is little global surveillance of femicide. We conducted femicide surveillance with four dedicated national retrospective mortuary-based surveys to understand its magnitude among women 14 years and older in South Africa from 1999 to 2020/21, including the first year of COVID-19. The surveys included data from police on the investigation to ascertain who perpetrated the femicide (i.e. an intimate partner or someone else). We found overall femicides declined between 1999 and 2009, but the rate of decline slowed in subsequent years. Intimate partner femicide increased during the first year of COVID-19, unlike non-intimate partner femicide. Firearm-related femicides also increased in parallel with the increased availability of firearms in the country during the same period. The data show that South Africa remains one of the countries with the highest recorded rate of intimate partner femicide globally (5.5/100,000 female population), almost five times the global average. We have shown that femicide is prevent-able, but the conditions of the COVID-19 response likely increased the risk for women in abusive relations. We have also shown the value of dedicated surveys in the absence of reliable information systems.
Systematic scoping review on HIV services for males in Sub-Saharan Africa : access, barriers, and research gaps
Manjengwa, Patience G.; Yah, Clarence S.; Musakwa, Nozipho; Musekiwa, Alfred (Taylor and Francis, 2026)
BACKGROUND : Access to HIV services among men and boys in Sub-Saharan Africa is a significant public health challenge, exacerbated by cultural norms surrounding masculinity. This scoping review systematically investigates disparities in the provision and utilisation of these services in Sub-Saharan Africa. METHODS : The review followed the Arksey and O'Malley framework, employing a five-step process with any disputes resolved through discussion. A comprehensive search across various databases was conducted for studies published from January 2010 to October 2023. Methodological quality was assessed using PRISMA-ScR and the Mixed Method Appraisal Tool, while NVivo supported thematic content analysis. EndNote and Rayyan software facilitated reference management and study screening. RESULTS : Out of 1 489 studies retrieved, 30 met the inclusion criteria, primarily qualitative (70%) and quantitative (16.7%). Most studies originated from South Africa (n = 10) and Uganda (n = 5). HIV testing services accounted for 36.7% of the studies, followed by treatment services (26.7%) and prevention services (20%). Facilitators of access included community health services and male catch-up plans. Barriers to accessing HIV services included stigma, masculinity norms, and fear of HIV-positive results, with low-risk perception also frequently noted. Male engagement strategies emerged as key to improving service delivery and utilisation. CONCLUSIONS : The findings revealed a moderate body of literature on HIV services for men in Sub-Saharan Africa, with research concentrated in South Africa and Uganda. Stigma, masculinity norms, and fear of HIV-positive results remain significant barriers, while community health services and male catch-up plans facilitate access. Implementing male engagement strategies and addressing these barriers is essential for improving service delivery, informing policy, and prioritising future research in underrepresented regions.
Impact of climatic factors on malaria in Senegal based on the surveillance system between 2015 and 2022
Talla, Cheikh; Diarra, Maryam; Diouf, Ibrahima; Thiam, Mareme S.; Gaye, Aboubacry; Barry, Mamadou A.; Igumbor, Ehimario Uche; Merle, Corinne Simone; Audu, Rosemary; Loucoubar, Cheikh (Frontiers Media, 2025-09-18)
INTRODUCTION : Malaria remains a major public health concern, particularly in sub-Saharan Africa, where climatic factors strongly influence its transmission dynamics. However, the delayed effects of these factors on malaria incidence remain poorly understood. METHODS : This study examines the relationship between meteorological variables (temperature, rainfall, and humidity) and malaria incidence in Senegal from 2015 to 2022, using a distributed lag non-linear model (DLNM). Daily malaria case data were obtained from the Senegal syndromic sentinel surveillance network (4S network), while daily climatic data were sourced from the Senegalese meteorology agency and NASA POWER DATA Access. RESULTS : The results reveal significant associations between climatic factors and malaria cases. High maximum temperatures were associated with increased malaria risk at lag periods of 2–6 days, whereas extreme rainfall initially reduced mosquito breeding but contributed to increased malaria cases after 10–15 days. Similarly, relative humidity displayed non-linear, time-dependent effects on malaria incidence, underscoring the importance of considering lag effects in climate-health modelling. DISCUSSION : These findings highlight the necessity of integrating climate variability into malaria control strategies. Adaptive interventions, such as predictive modelling and early warning systems, could enhance response efficiency by enabling proactive vector control and healthcare resource allocation. Future research should explore additional factors, such as socio-economic and behavioural influences, to refine prediction models and optimise malaria prevention efforts in the context of climate change.
Attempted femicide : a mixed methods approach to deriving an operational definition for the Fedisa Modikologo Study, South Africa
Jewkes, Rachel; Mhlongo, Shibe; Chirwa, Esnat; Ramsoomar, Leane; Willan, Samantha; Woollett, Nataly; Christofides, Nicola; Seepamore, Boitumelo; Govindasamy, Darshini; Nothling, Jani; Mbowane, Venice; Phakoe, Maureen; Pass, Desire; Zembe, Amanda; Paile, Charntel; Washington, Laura; Shai, Nwabisa; Machisa, Mercilene; Mahlangu, Pinky; Carries, Stanley; Abrahams, Naeemah (Springer, 2026-02)
PURPOSE : Women often do not recognize when they experience attempted femicide, so another way of measuring it is needed for research. We examined narrative accounts of femicide attempts, and analysed data to determine whether we could systematically expand the definition of attempted femicide, for the purposes of research. METHODS : We recruited a non-probability sample of 3742 women into the Fedisa ModikologoStudy. They were 18–45 years and had experienced severe intimate partner violence in the previous year. They completed an interview with two closed and one open question about attempted femicide experiences. RESULTS : Strangulation, suffocation, stabbing, bludgeoning, gun shots, fire, mocked suicides and accidents were all used in attempted femicides, which 32.4% (1211/3742) of women said they had experienced. These were significantly more common among this sub-group of women. Gunshot injuries and loss of consciousness due to strangulation were the most strongly associated with a recognized femicide attempt, however other injuries were also associated. Assuming unrecognized femicide attempts were broadly similar, we conducted an analysis with recognized femicide attempts as a putative gold standard, and examined change in the sensitivity, specificity and ROC AUC of including different elements in the attempted femicide definition. After incrementally adding elements, we optimized the model with a sensitivity to 85.0%, specificity of 52.7% and ROC AUC of 67.1. CONCLUSIONS : Our findings point to a working definition of attempted femicide as having a recognized femicide attempt, or injuries leading to loss of consciousness, acts of strangulation, suffocation, gunshots, burns, or stabbing to the neck, torso or genitals.
Improving health professionals’ capacity to respond to the climate crisis in Africa : outcomes of the Africa climate and health responder course
Magalhães , Danielly de P.; Sorensen, Cecilia; Hamacher , Nicola; Campbell, Haley; Weinstein, Hannah N.W.; Owili, Patrick O.; Ario, Alex R.; Nja, Glory M.E.; Michael, Charles A.; Alimi, Yewande Alimi; Hien, Hervé; Amde, Woldekidan; Thiam , Sokhna; Pagiwa, Vincent; D’Andrea, Shawn M.; Gichuki, Caroline M.; Offei, Marian; Atela, Joanes; Patrick, Sean Mark; Struminger , Bruce; Kaseje, Margaret (Frontiers Media, 2025-10-15)
INTRODUCTION : The fragile health systems in Africa worsen climate-related health impacts, making capacity building essential to strengthen adaptation and resilience. The Africa Climate and Health Responders Course was developed to address the urgent need for climate and health education among African health professionals. Organized by the Global Consortium on Climate and Health Education (GCCHE) in collaboration with ASPHA, Africa CDC, WHO AFRO, Project ECHO, and other regional partners, the course aimed to enhance awareness, communication skills, and preparedness in responding to climate-related health challenges. METHODS : Delivered online via Zoom with over 11 sessions (September 17–October 22, 2024), the course featured expert lectures, case studies, and live discussions. Simultaneous interpretation in English, French, and Portuguese ensured broad accessibility. Participants who attended at least 70% of live sessions and passed the final exam received a certificate. A longitudinal survey was applied to understand the course impact. RESULTS : The course attracted 7,572 registrants, with 89% from Africa. While 3,500 participants attended at least one session, only 1,657 participated (1,607 from Africa) attended 70% or more of the sessions and completed the final survey. Participants held positions in government (31%), Non-Governmental Organizations (NGOs) (27%), academia (24%), private sector (11%), and others (7%). Their main professional backgrounds were public health (33.2%), medicine (16.3%), and environmental health (13.2%). The majority of participants (66%, n = 1,100) had never received prior training in climate and health; among them, 36% (n = 392) were students and 64% (n = 708) were not students. DISCUSSION : The course significantly improved participants’ self-reported confidence and perceived preparedness, with increases in: climate-health awareness (+22%); confidence in risk communication (+40%); preparedness for adaptation and resilience (+36-37%), and professional responsibility in climate-health action (+21%). These findings highlight not only the feasibility and effectiveness of virtual training in this context, but also the opportunity for scaling such initiatives to build a climate-resilient health workforce across Africa. Skilled professionals are key to fostering multi-stakeholder collaboration, integrating climate-health education, and engaging communities—efforts that require sustained investment in capacity building to institutionalize competencies and strengthen public health systems and policies over the long term.
Perceptions of South Africa's master of public health graduates on the degree's contribution to their leadership at work and in society
Zweigenthal , Virginia; Christofides, Nicola; Dlungwane, Thembelihle; Matlala, Sogo France; Mokgatle, Mathildah Mpata; Opare, Abraham; Patrick, Sean Mark; Schaay , Nikki; Shung-King , Maylene; Tshitangano, Takalani; Rispel, Laetitia (Frontiers Media, 2025-10-08)
INTRODUCTION : Integrating public health functions into national health systems is essential to enhance population health. The Master of Public Health (MPH) degree is an important foundation for public health practice in low-and middle-income countries such as South Africa. However, insufficient evidence on individual motivations for undertaking the MPH and the perceptions of graduates on the utility of the degree at work and in society and its contribution to their leadership skills informed this study. METHODS : A consortium of academics from eight South African universities developed a self-administered questionnaire to measure inter alia the socio-demographic characteristics, motivations, career paths, perceptions of the utility of the degree, and its contribution to their professional and personal development. The study population comprised the 2012–2016 cohort of MPH graduates from eight universities. Following informed consent, eligible graduates completed an online survey via REDCap. The data were analyzed using Stata. RESULTS : A total of 221 graduates completed the survey. The mean age of respondents was 35 years, and the majority were from South Africa (53.2%) or other African countries (43.2%). The majority (91.1%) completed the MPH to improve their skills or to promote their personal development for senior management and leadership roles. Approximately 75% used identified leadership skills at work, but only half these skills were obtained from the MPH. Over 80% of respondents positively impacted on their workplace and in society, using skills mostly derived from the MPH in all domains. DISCUSSION : This cohort of MPH graduates exercised leadership in different settings, but many stated that these skills were not obtained from the MPH programs. The COVID-19 pandemic underscored the need for public health leaders skilled in communication, collaboration, and crisis management, amidst considerations of social justice and equity. Hence, leadership skills need to be intentionally included in MPH programs in South Africa.
Factors associated with the initiation of daily oral pre-exposure prophylaxis among adolescent girls and young women : findings from the Namibia DREAMS program
Moyo , Enos; Melese, Endalkachew; Mangwana, Hadrian; Takawira, Simon; Indongo, Rosalia; Harases, Bernadette; Moyo, Perseverance; Peresu, Ernest; Robert, Kopano; Dzinamarira, Tafadzwa (Frontiers Media, 2025-09-17)
BACKGROUND : Adolescent girls and young women (AGYW) aged 15–24 years in sub-Saharan Africa continue to face a significant risk of HIV acquisition. Oral pre-exposure prophylaxis (PrEP) can reduce the likelihood of HIV acquisition by more than 90% when adherence is optimal. The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. The DREAMS program addresses factors that increase HIV vulnerability among AGYW. The objective of this secondary analysis of DREAMS program data is to assess the rate of daily oral PrEP initiation among AGYW aged 15–24, as well as the participants’ characteristics and HIV risk factors associated with PrEP initiation. METHODS : The program’s target populations for PrEP included AGYW aged 15–24 years, who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Site-level personnel utilized the District Health Information Software 2 (DHIS2) Android Application for regular data collection. Data from 2018 to 2024 were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 29. Data analysis employed Chi-squared tests and binomial and multivariate logistic regression. RESULTS : Among the 29,828 AGYW eligible for PrEP, 24,182 (81.1%) were newly initiated on PrEP. AGYW from Windhoek and Oshakati, those enrolled between 2018 and 2023, those with 1–2 biological children, and those who perceived themselves at risk of HIV were more likely to initiate PrEP. In contrast, participants from Omuthiya and Tsumeb, those unaware of their partners’ HIV status, those with HIV-positive partners during pregnancy or breastfeeding, those with recent or recurrent sexually transmitted infections, those engaging in sexual activity while under the influence of alcohol or drugs, and those with multiple or concurrent sexual partners were less likely to initiate PrEP. CONCLUSION : The findings highlight the need for improved HIV education in smaller urban and rural communities to reduce stigma and discrimination against individuals taking PrEP. Additionally, enhancing HIV education to increase risk perception among AGYW at substantial risk for HIV is essential.
High prevalence of undisclosed antiretroviral drug use among individuals initiating HIV treatment in Gaborone, Botswana
Moraka, Natasha O.; Moyo, Sikhulile; Mohammed , Terence; Molebatsi , Kesaobaka; Wiesner, Lubbe; Mokgethi , Patrick T.; Gobe, Irene; Mokomane, Margaret; Moutswi, Salang T.; Rabatoko, Laone; Leteemane, Queen; Strachan-Amaro, Vanessa; Sabone, Phenyo; Gaseitsiwe, Simani (Frontiers Media, 2025-06-05)
BACKGROUND : Antiretroviral therapy (ART) uptake is critical for evaluating the effectiveness of HIV epidemic control. We evaluated the extent of undisclosed ARV drug use among individuals newly diagnosed and initiating ART in greater Gaborone, Botswana. METHODOLOGY : Plasma samples from an ongoing longitudinal cohort study were screened for antiretroviral drug (ARV) traces using the liquid chromatography with tandem mass spectrometry assay. The ARV drug screening panel used detects 4 ARV drugs: Integrase Strand Transfer Inhibitor [INSTI]—dolutegravir (DTG), two non-nucleoside reverse transcriptase inhibitors [NNRTIs]—Efavirenz (EFV), Nevirapine (NVP), and a protease inhibitor [PI]—Lopinavir. We estimated adjusted prevalence ratios (aPR) for factors associated with undisclosed ART use using modified Poisson regression. RESULTS : We enrolled 192 participants, between October 2023 and January 2024, and a total of 120 (63.4%) were screened for plasma ARV drug traces. Participants were of median age 32 (IQR 26, 39), mostly female (66.7%) and of Botswana nationality (75.0%). Among those screened for ARV drug traces 36 (30.0%; 95%CI: 30–39) participants had at least one of the ARVs in the panel detected. One participant (0.8%) was positive for EFV, and 35 (29%) had DTG traces at baseline. Undisclosed ART use was associated with lower viral load (aPR = 0.84; 95%CI: 0.70–1.00) and being of non-Motswana nationality (aPR = 2.6; 95%CI: 1.5–4.5). CONCLUSION : We report a relatively high proportion of individuals with undisclosed drug use in their baseline plasma. Our results suggest the need to implement pre-drug screening for routine HIV incidence surveillance, including pre-treatment drug resistance evaluations before ART initiation.
“I will take PrEP because that’s what will help me not to get infected with HIV” : barriers to and facilitators of pre-exposure prophylaxis and condom use among adolescent girls and young women enrolled in a school-based HIV prevention program in South Africa
Bergh , Kate; Jonas, Kim; Toska, Elona; Abdullah, Fareed; Blom, Nomtopi; Mathews, Catherine; Mthanti, Ngkatiseng; Slingers, Nevilene; Van Blydenstein, Nathanael; Duby, Zoe (Frontiers Media, 2025-11-20)
INTRODUCTION : The Imagine programme is a school-based HIV prevention program offering preexposure prophylaxis (PrEP), condoms and other social and structural interventions to adolescent girls and young women (AGYW) in South Africa. PrEP uptake and adherence together with the provision of condoms has not been extensively studied in the school context. We explored the barriers to and facilitators of PrEP and condom usage among Imagine programme beneficiaries using the HIV prevention cascade framework. METHODS : Sixteen AGYW aged 16–20 years who had never taken PrEP, were on PrEP or had stopped PrEP were interviewed between November 2023 and March 2024. Interviews were audio-recorded, and transcripts were deductively coded according to the HIV prevention cascade steps: (1) Knowledge, (2) Motivation, (3) Access and (4) Effective use. RESULTS : HIV and pregnancy risk awareness was high. For condom use, the risk of HIV transmission and pregnancy was outweighed by fear of sexual or physical violence from male partners and a desire to maintain relationships, as asking to use condoms demonstrated a lack of trust. High levels of PrEP knowledge motivated participants to use PrEP, especially if their partner refused to use condoms. Fear of side effects and daily pill taking were barriers to PrEP uptake. PrEP and condom services in school were highly acceptable, while anticipated stigma remained a challenge at the community clinic. DISCUSSION : Barriers to condom use persist in South Africa, but positive attitudes toward PrEP described in this study suggest that opinions about PrEP are still forming and can be strongly influenced by youth-friendly HIV programming in schools.
The implication of aberrant NRF2 activation in management of female cancers
Kgatle, Mankgopo; Mbambara, Saidon; Fadebi, Olalekan; Kabunda, Joseph; Kaoma, Chimbabantu; Dlangalala, Thobeka Nomzamo; Nxele, Siphesihle Robin; Modipane, Ndimo; Serite, Thato; Mokoala, Kgomotso M.G.; Mashamba-Thompson, Tivani Phosa; Sathekge, Mike Machaba (Frontiers Media, 2025-11-17)
The overactivation of NRF2 (Nuclear factor erythroid 2-related factor 2) in female malignancies is an emerging field of study with significant implications for treatment efficacy. NRF2 plays a pivotal role in managing inflammation-induced oxidative stress, which is crucial components of the tumor microenvironment. Acting as a transcription factor and basic leucine zipper protein, it regulates the expression of various antioxidant genes that safeguard cells from oxidative stress and damage. While NRF2 activation is beneficial for the survival of normal cells, its overactivation in cancer cells can enhance tumor cell survival, proliferation, and resistance to treatments. Importantly, NRF2 has a dual context-dependent role, functioning as a tumor suppressor when transiently activated in normal cells to prevent carcinogenesis, but as an oncogene when persistently activated in established tumors. Understanding NRF2’s transcriptional alterations and developing targeted therapies could improve cancer management, prognosis and treatment outcomes, making it a promising target for precision oncology. This review aims to provide a comprehensive overview of NRF2 activation in female malignancies, including cervical, endometrial, ovarian, vaginal, vulvar and, breast cancers, and its association with chemoresistance, highlighting challenges and opportunities for developing more effective cancer treatments.
A qualitative analysis exploring barriers and enablers to distribution, delivery, and access to COVID-19 vaccines in Botswana
Tlhakanelo, John Thato; Ataguba, John Ele Ojo; Pagiwa, Vincent; Ramabu, Nankie; Kadimo, Khutsafalo; Muriithi, Grace Njeri; Achala, Daniel Malik; Adote, Elizabeth Naa Adukwei; Mbachu, Chinyere Ojiugo; Beshah, Senait Alemayehu; Masuka, Nyasha; Nwosu, Chijioke Osinachi; Akazili, James; Ifeanyi, Chikezie; Molosiwa, Dintle (Frontiers Media, 2025-11-18)
INTRODUCTION : The COVID-19 pandemic highlighted pre-existing weaknesses, revealing deep-rooted issues in infrastructure, access, and resource allocation that have long impeded African countries' ability to effectively meet population health needs. It also became evident during the pandemic that there were discrepancies in how vaccines were distributed, delivered and accessed in these countries. We aimed to identify vaccine distribution, service delivery processes and related barriers in Botswana to contextually explore practices that either enhance or hinder access and equity in vaccine distribution and delivery. METHODS : We conducted in-depth interviews, using a semi-structured interview guide, with a purposive sample of 18 key informants, including public health sector officials, non-state actors, policy makers, regulatory bodies and other stakeholders. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted following a deductive approach according to the six-step analysis framework by Braun and Clarke: (i) familiarization with the data; (ii) generation of initial codes; (iii) searching for themes; (iv) reviewing themes; (v) refining and naming themes; and finally, (vi) producing the report. Steps i–iii were conducted by two researchers. Attention was given to aspects of credibility, dependability, and transferability of the findings through key strategies, including team data review, coding, consensus on themes and review of both secondary and grey literature on vaccine roll-out in the country. RESULTS : Seven primary themes emerged from the findings. COVID-19 vaccine distribution and delivery in Botswana followed the existing primary health care system structures for routine vaccine delivery. Traditional mechanisms such as static public health facilities, private facilities, outreach campaigns, and mobile stops, were augmented through different roles played by stakeholders in the private sector, civil society organizations and non-governmental organizations. Religious and cultural norms were reported to affect vaccine uptake centered around smaller population groups that are historically known to be anti-vaccines. There is no deliberate gender and the disabled population programming for vaccine distribution and delivery in Botswana. The private sector improved access to vaccines by supporting supply chain logistics with transportation, especially to hard-to-reach areas. DISCUSSIONS : Achieving equitable vaccine access involves not only logistical and infrastructural considerations, but also coordination and collaboration across several sectors, enhancing gender diversity and inclusivity in planning, coordination, and decision making and implementation of strategies tailored to the needs of a wide range of vulnerable population groups.
Health risks of atmospheric fine particulate matter (PM2.5) and its trace elements in Mabopane, South Africa
Bhuda, Mandla Freddy; Molnar, Peter; Boman, Johan; Shirinde, Joyce; Wichmann, Janine (Wiley, 2025)
Atmospheric fine particulate matter (PM2.5) contributes to approximately 4 million premature deaths globally each year. This study aimed to investigate the health risks of atmospheric PM2.5 and its trace elements in Mabopane, South Africa. PM2.5 samples were collected every sixth day from June 15, 2022 to February 28, 2023 using a GilAir-5 sampler at 4.0 L/min on the Mabopane Fire Station rooftop. Health risks were evaluated using US EPA guidelines, WHO air quality limits, South African National Ambient Air Quality Standards (SANAAQS), and US EPA trace element reference levels. The mean PM2.5 level was 10 µg/m3 (range: 1.1─29 µg/m3), exceeding the WHO annual air quality limit (5 µg/m3) but below SANAAQS (20 µg/m3). PM2.5 posed health risks (hazard quotient > 1) across all age groups. Among 18 trace elements, Ca, Fe, K, S, and Si showed the highest levels (110─240 ng/m3). The excess cancer risk from Ni was 1.2 × 10−6. These findings underscore the need for targeted air quality controls to reduce PM2.5 and trace elements from dust and anthropogenic sources, to protect public health in Mabopane and similar areas.
Predictors of recent alcohol and substance use among adolescent girls and young women in Namibia
Moyo, Enos; Mangwana, Hadrian; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Robert, Kopano; Dzinamarira, Tafadzwa (MDPI, 2025-09)
BACKGROUND : Adolescent girls and young women (AGYW) who engage in alcohol and substance abuse face more significant health and social consequences compared to the general population. This study evaluated the prevalence and associated factors of alcohol abuse and substance use among AGYW in Namibia. METHODS : We conducted a retrospective analysis of programmatic data from AGYW aged 10–24 who participated in the Determined, Resilient, Empowered AIDS-free, Mentored, and Safe (DREAMS) component of the Reducing HIV Vulnerability: Integrated Child and Youth Health (REACH) Project HOPE Namibia from March to December 2024. Data analysis was conducted employing chi-squared tests alongside binomial and multinomial logistic regression. RESULTS : Among the 19,662 participants included in this analysis, 2068 (10.5%) abused alcohol and/or substances in the previous six months. Participants who were HIV-negative or did not know their status (AOR = 1.57, 95% CI (1.15–2.14), and AOR = 1.50, 95% CI (109–2.07), respectively), from outside Windhoek, those who had failed or repeated school in the previous year (COR = 1.77, 95% CI (1.54–2.05)), those not disabled (AOR = 1.27, 95% CI (1.06–1.52)), those who had dropped out of school or had completed their studies, and those with no adult emotional support (AOR = 1.25, 95% CI (1.11–1.40)), were more likely to have abused alcohol and/or substances recently. In contrast, participants who were not depressed were less likely to have recently abused alcohol and substances. CONCLUSIONS : The prioritization of strategies to identify AGYW experiencing depression and to provide them with treatment is essential. Moreover, it is important to encourage parents and guardians to provide emotional support to AGYW, as it prevents them from abusing alcohol and substances.
A scoping review of the health and health-related sustainable development goals (HHSDGs) in Ghana : progress and challenges
Doku, David Teye; Nartey, Yvonne Ayerki; Cudjoe, Obed; Sakyi, Gladys Akotoaa; Duah, Evans; Adjei, George; Syal, Ruby; Johnson, Fiifi Amoako; Armah, Frederick Ato; Bhutta, Zulfiqar Ahmed (BioMed Central, 2026-02)
BACKGROUND : Sustainable Development Goal (SDG) 3 prioritises the promotion of equitable health outcomes and universal health coverage. In Ghana, there is limited information on the current implementation progress and challenges of the health and health-related SDGs (HHSDGs). The aim of this review was to conduct a situational analysis of the HHSDGs in Ghana whilst providing in-depth and updated literature on their implementation progress and challenges. METHODS : We conducted a scoping review guided by the Arksey and O’Malley framework. The Population, Concept and Context (PCC) framework was used to select literature. Peer-reviewed and grey literature with data collected between September 2015 and October 2022 were used. Exclusion criteria included non-HHSDG topics and studies outside the timeframe. Data were retrieved from Scopus, PubMed, Medline, CINAHL, EBSCOhost and grey literature sources. The process yielded 37 peer-reviewed articles and 14 grey literature records, comprising 11 organisational reports from websites, 2 theses, and 1 blog post. Systematic screening, guided by the PRISMA-ScR, and quality appraisal, using the Mixed Methods Appraisal Tool, were performed. Thematic synthesis was employed for the analysis of the data. RESULTS : Health and wellbeing (SDG 3), climate change and climate action (SDG 13), gender equality (SDG 5), zero hunger (SDG 2), and clean water and sanitation (SDG 6) were the identified HHSDGs. Mental health emerged as a key HHSDG, although not a stand-alone SDG. Our review indicates that Ghana has made progress in meeting some critical HHSDG targets, with further work needed to meet all targets. Ghana has made important progress toward the HHSDGs, including improvements in infectious disease control, access to clean water, gender equality initiatives, and the adoption of health innovations. Also, Ghana has significantly reduced the prevalence of overweight in children underfive. However, significant gaps remain in maternal and child health, mental health, sanitation, universal health coverage, and food security. These gapsare driven by persistent structural and socioeconomic barriers. CONCLUSIONS : These findings highlight the need for strengthened policies and targeted interventions to accelerate Ghana’s progress toward achieving the HHSDGs by 2030.
Medical students as journal reviewers : a project concept to consider them peers
Clithero-Eridon, Amy; Jeza Narvaez, Ma Angelica; Spal, Simran; Wolvaardt, Jacqueline Elizabeth (Liz); Chao, Luke; Burdick, William (Towards Unity for Health, 2025-09)
BACKGROUND : The peer review process is widely accepted to benefit the education of health professionals. However, formal experience in peer reviewing is rare at the undergraduate level. A substantial pool of potential reviewers exists among health profession students, who are as rigorous in peer reviewing as those with more experience. In this study, we aimed to evaluate the impact of a mentorship experience designed to teach health professions students peer review skills using experienced peer reviewers as mentors. METHODS : Within the student organization section of The Network: Towards Unity for Health (SNO), student leaders hosted student-led journal clubs. Active SNO students were directly recruited and paired with experienced journal reviewers who served as their mentors. Each mentor/mentee pairing independently reviewed an article for either the journals Education for Health or Undergraduate Research in Health. They then met to discuss the results and provide feedback. Students who completed at least two reviews “graduated” from mentorship and were invited to join the pool of journal reviewers. RESULTS : The program effectively guided students to become effective peer reviewers. Students reported several benefits to participating in the program, including feeling more confident as peer reviewers, feeling more effective at delivering constructive feedback, and experiencing personal growth, such as becoming more effective at designing their research. DISCUSSION : A mentor/mentee peer review experience effectively produced a pool of competent peer reviewers while providing participants with several opportunities for personal growth. Ultimately, similar programs could lead to a larger community of peer reviewers and improved research literacy and capabilities among health professions students.
Stakeholder perceptions of a workplace-based screening programme for artisanal and small-scale miners in Zimbabwe
Malhotra, A.M.; Kavenga, F.; Ncube, R.T.; Madziva, G.; Moyo, F.; Chigaraza, B.; Marambire, E.; Kasozi, S.; Timire, C.; Calderwood, C.J.; Nyambo, A.; Ndlovu, K.; Zungu, Muzimkhulu; Moyo, D. (Oxford University Press, 2026)
BACKGROUND : Artisanal and small-scale miners (ASMs) experience high prevalence of disease, notably tuberculosis (TB), human immunodeficieny virus (HIV), silicosis, sexually transmitted infections, substance misuse, and mercury and cyanide toxicity. Despite this, targeted healthcare interventions are limited. AIMS : To explore the perceptions of ASMs and their leaders/representatives in relation to a 5-year targeted health screening intervention for ASMs in Zimbabwe. Screening included TB, HIV and silicosis. Insights were also gathered from healthcare staff, academics and national stakeholders involved in the project. METHODS : Focus-group discussions (FGDs) were conducted with 31 participants (13 ASMs and ASMs’ representatives, 6 healthcare staff and academics, and 12 representatives from national organizations). Participants were asked to reflect on their experience and understanding of health screening activities for ASMs, as well as what further healthcare activity is required. RESULTS : Artisanal and small-scale miners felt that screening activity was beneficial. Fear and stigma were the main barriers to healthcare access during initial implementation; however, this was alleviated through collaboration with ASMs leadership and peer-officers. Health priorities identified for future healthcare activity included development of a health-screening checklist for ASMs, strengthening access to information, decentralization of occupational health services and addressing a greater package of health. Cross-collaboration between the mining sector, Ministry of Health and Childcare and other national stakeholders was identified as a priority. CONCLUSIONS : Targeted health screening and care is needed for this neglected and vulnerable group. The workplace screening offered a model to address this; however, more work is needed to ensure that ASMs in other locations and with additional health priorities are reached.
Usability of a blood-based HIV self-test kit in Lusaka province, Zambia : a cross-sectional analysis
Mwamba, Fales Z.; Mwape, Mwansa; Simfukwe, Brenda C.; Musunga, Nowella M.; Mathebula, Evans Mantiri; Mupeta, Geofrey (AOSIS, 2025-12-20)
BACKGROUND : Despite progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, Zambia faces persistent gaps in HIV testing coverage. The Ministry of Health implemented blood-based HIV self-testing (HIVST) to improve accessibility. This study evaluated the CheckNOW™ HIVST kit’s usability in Lusaka province health facilities. OBJECTIVE : To determine usability, awareness and user-friendliness of the CheckNOW™ HIVST among Zambian adults. METHODS : We conducted a cross-sectional study from 04 September 2023 – 22 September 2023 across four high-volume healthcare facilities. A total of 323 CheckNOW™ HIVST kits were distributed, with 316 consenting adults successfully enrolled in the study. Data were collected through structured questionnaires administered via face-to-face interviews following test completion, capturing information on socio-demographics, HIV testing history and user perception of the self-testing process. Descriptive statistics were employed for data analysis. RESULTS : Among 316 participants, 56.3% (178/316) were female, and 41.5% (131/316) were aged 25–34 years. The majority (95.0%, 300/316; p < 0.001) found the CheckNOW™ kit easy to use, while 65.0% (206/316) had prior awareness of HIVST. Additionally, 83.6% (264/316; p < 0.001) followed the test instructions correctly and independently. A high proportion (98.7%, 312/316; p < 0.001) expressed willingness to test again, and 99.7% (315/316; p < 0.001) would recommend it to others. CONCLUSION : The CheckNOW™ blood-based HIVST kit demonstrated high usability and ease of use, supporting its potential to expand HIV testing coverage in Zambia. However, increased awareness efforts are necessary to maximise uptake and ensure broader accessibility. What this study adds: This study provides the first evidence that blood-based HIV self-testing is feasible and acceptable within Zambian clinical settings. It offers a critical new strategy to expand testing coverage and reach key populations by integrating self-testing into routine health services.

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