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

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Rare pathogenic structural variants show potential to enhance prostate cancer germline testing for African men
Gong , Tingting; Jiang, Jue; Uthayopas, Korawich; Bornman, Maria S. (Riana); Gheybi, Kazzem; Stricker, Phillip D.; Weischenfeldt, Joachim; Mutambirwa, Shingai B.A.; Jaratlerdsiri, Weerachai (Nature Research, 2025-03-10)
Prostate cancer (PCa) is highly heritable, with men of African ancestry at greatest risk and associated lethality. Lack of representation in genomic data means germline testing guidelines exclude for Africans. Established that structural variations (SVs) are major contributors to human disease and prostate tumourigenesis, their role is under-appreciated in familial and therapeutic testing. Utilising clinico-methodologically matched deep-sequenced whole-genome data for 113 African versus 57 European PCa patients, we interrogate 42,966 high-quality germline SVs using a best-fit pathogenicity prediction workflow. We identify 15 potentially pathogenic SVs representing 12.4% African and 7.0% European patients, of which 72% and 86% met germline testing standard-of-care recommendations, respectively. Notable African-specific loss-of-function gene candidates include DNA damage repair MLH1 and BARD1 and tumour suppressors FOXP1, WASF1 and RB1. Representing only a fraction of the vast African diaspora, this study raises considerations with respect to the contribution of kilo-to-mega-base rare variants to PCa pathogenicity and African-associated disparity.
Methylation reprogramming associated with aggressive prostate cancer and ancestral disparities
Craddock, Jenna; Lutsik , Pavlo; Soh, Pamela X.Y.; Louw, Melanie; Hasan, Md Mehedi; Patrick, Sean Mark; Mutambirwa, Shingai B.A.; Stricker, Phillip D.; Förtsch, Hagen E.A.; HEROIC PCaPH Africa1K; Bornman, Maria S. (Riana); Gerhäuser, Clarissa; Hayes, Vanessa M. (Springer, 2025-12)
African men are disproportionately impacted by aggressive prostate cancer (PCa). The key to this disparity is both genetic and environmental factors, alluding to epigenetic modifications. However, African-inclusive prostate tumour DNA methylation studies are lacking. Assembling a multi-geo-ancestral prostate tissue cohort, including men with (57 African, 48 European, 23 Asian) or without (65 African) PCa, we interrogate for genome-wide differential methylation. Overall, methylation appears to be driven by ancestry over geography (152 southern Africa, 41 Australia). African tumours show substantial heterogeneity, with universal hypermethylation indicating more pervasive epigenetic silencing, encompassing PCa suppressor genes and enhancer-targeted binding motifs. Conversely, African tumour-associated heterochromatic hypomethylation suggests chromatin relaxation and developmental pathway activation via enhancer targets. Notably, non-prostate lineage elements appeared preferentially exploited in African tumorigenesis, with ancestry potentially influencing the extent of lineage-inappropriate activation, and tumour progression marked by repression of developmental regulators. Together, these findings point to extensive epigenetic plasticity in African tumours, with intergenic regulatory remodelling promoting genomic instability, metastatic potential and aggressive disease phenotypes.
Assessing the burden and inequality in the unmet need for hypertension and type 2 diabetes care using a care cascade framework in Tanzania, Lesotho, and South Africa
Okova, Denis; Lukwa, Akim Tafadzwa; Oyando, Robinson; Akinsolu, Folahanmi Tomiwa; Olunike, Abodunrin; Chiwire, Plaxcedes; Hongoro, Charles (Cambridge University Press, 2026-02-25)
BACKGROUND : The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework. METHODS : We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence. RESULTS : Hypertension prevalence was 12.6% (95% CI: 11.7-13.4) in Tanzania, 46.7% (95% CI: 45.0-48.4) in South Africa, and 15.4% (95% CI: 13.8-17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8-10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania -0.19, South Africa -0.17, Lesotho hypertension -0.15, Lesotho diabetes -0.24; all p < 0.01), with poor men experiencing the most disparities. CONCLUSION : Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.
HIV and ART status at baseline are associated longitudinally with increased pulse wave velocity : findings from the Ndlovu cohort study
Shilabye, Patane S.; Scheuermaier, Karine; Umunnakwe, Chijioke N.; Barth, Roos E.; Deville, Walter; Coutinho, Roel A.; Grobbee, Diederick E.; Venter, Willem Daniel Francois; Tempelman, Hugo; Vos-Seda, Alinda G.; Klipstein-Grobusch, Kerstin (Wolters Kluwer Health, 2026-05)
OBJECTIVES: People with HIV (PWH) have an increased risk of (CVD), but longitudinal data from middle-income settings remain limited. This study examined the association between HIV, antiretroviral therapy (ART), and pulse wave velocity (PWV), a marker of arterial stiffness and CVD risk. DESIGN : A longitudinal analysis from the Ndlovu Cohort Study, South Africa. METHODS : The study included 705 participants (325 PWH, 81% on ART at baseline, 19% initiating ART at baseline, and 380 HIV-negative people. Demographic data, HIV/ART status, and covariates were collected at baseline, while PWV was measured at 12 and 36 months. Mixed-effects models were used to analyze PWV changes over time, adjusting for age, sex, and systolic blood pressure (SBP). Results were reported as beta coefficients ( β ) with 95% confidence intervals (CIs). RESULTS : At baseline, PWH were older and predominantly female (67%) compared to HIV-negative people. At 12 months, median PWV was higher in PWH (7.3 m/s) than in HIV-negative people (7.0 m/s, P = 0.001). Over 36 months, PWV increased by 0.30 m/s in PWH and 0.20 m/s in HIV-negative people ( P = 0.002). ART-naïve individuals had the largest PWV increase after starting ART (6.8 m/s at 12 months to 7.4 m/s at 36 months, P = 0.001). HIV ( β = 0.65, 95% CI: 0.24-1.06, P = 0.002) and time ( β = 0.31 m/s per year, P < 0.001) were significantly associated with higher PWV. CONCLUSIONS : PWV increased over time, particularly in PWH, with ART initiation linked to rapid increases. These findings highlight the need for early CVD risk monitoring, especially post-ART initiation, in resource-limited settings.
High treatment success among individuals with rifampicin-resistant tuberculosis in Botswana : a retrospective cohort study
Mogashoa, Tuelo; Ngom, Justice T.; Choga, Ontlametse T.; Loubser, Johannes; Sabone, Phenyo; Molefi, Tuduetso; Makhondo, Topo; Stephen, One; Makhema, Joseph M.; Musonda, Rosemary M.; Fane, Keabetswe; Gaseitsiwe, Simani; Warren, Rob M.; Moyo, Sikhulile; Dippenaar, Anzaan; Streicher, Elizabeth M. (Elsevier, 2026-04)
BACKGROUND : Rifampicin-resistant tuberculosis (RR-TB) remains a global health challenge, which is often characterized by limited treatment options and increased morbidity and mortality. Despite advances in diagnostics and the introduction of new drug regimens, treatment success for drug-resistant TB remains low. There is limited data on clinical, sociodemographic, and microbiological factors that influence patient outcomes. The aim of the study is to evaluate TB treatment outcomes among individuals diagnosed with RR-TB and to identify predictors of favourable and unfavourable treatment outcomes. METHODS : We conducted a retrospective study to analyse treatment outcomes of 162 individuals diagnosed with RR-TB using GeneXpert MTB/RIF and phenotypic drug susceptibility testing (pDST) from 2016 to 2023. Treatment outcome proportions were estimated using the binomial exact method with 95 % confidence intervals (CI). Predictors associated with unfavourable treatment outcomes were assessed using logistic regression models. RESULTS : Of the 162 individuals, 102(62.7 %) were male with a median age of 39 (interquartile range (IQR): 29–50). Most individuals, 78(48.1 %), were from the Greater Gaborone health district, and 88(54.3 %) were people living with HIV (PLWH). Among included individuals, 137(84.6 %, 95 % CI: 78.2–89.7) were successfully treated. Males had higher odds of unfavourable treatment outcomes compared to females (OR = 1.70; 95 % CI: 0.73–3.98). Among those cured, a slightly higher proportion was observed among PLWH (71.8 %, 95 % CI: 62.1–80.3) compared to people not living with HIV (PNLWH) (69.2 %, 95 % CI: 58.7–78.5). However, the mortality rate was higher among PLWH (10.7 %; 95 % CI: 5.5–18.3) than among PNLWH (6.6 %; 95 % CI: 2.5–13.8). Those with a history of TB treatment had 1.03 odds of unfavourable treatment outcomes (95 % CI: 0.40–2.73); however, this association was not statistically significant. CONCLUSION : Our study shows a high rate of successful treatment outcomes among individuals with RR-TB, with no significant difference based on sex, TB treatment history, or HIV status. Higher mortality among PLWH highlights the need for targeted interventions among high-risk groups.
Spatial distribution and multilevel analysis of full vaccination coverage among children aged 12–23 months in Democratic Republic of Congo
Birhan, Nigussie Adam; Asmare, Abebew Aklog; Getahun, Kefale Tilahun; Alemayehu, Gedif Mulat; Wolde, Zelalem Meraf; Belay, Denekew Bitew (Elsevier, 2026-06)
BACKGROUND : Vaccination is one of the most cost-effective public health interventions for reducing child morbidity and mortality. However, full vaccination coverage remains suboptimal in many low- and middle-income countries, including Democratic Republic Congo (DRC). This study aimed to assess spatial distribution and risk factors of full vaccination coverage among children aged 12–23 months in DRC. METHODS : A cross sectional secondary data analysis on 2023/24 DRC Demographic and Health Survey data with a total weighted sample of 3897 children aged 12–23 months was used. Moran's I and Getis-Ord Gi* statistics was used to identify clustering patterns of full vaccination coverage. Multilevel analysis was used to examine factors associated with full vaccination coverage. RESULT : The prevalence of full vaccination was 14.9% (95% CI: 13.8, 16.0). Moran's I 0.4 (p value = 0.01) indicated spatial clustering of full vaccination coverage. Full vaccination coverage was associated with maternal age 25–34 years (AOR = 1.54, 95% CI: 1.06–2.24), secondary and above education (AOR = 1.84, 95% CI: 1.18–2.88), being married (AOR = 1.55, 95% CI: 1.15–2.09), rich household wealth (AOR = 1.64, 95% CI: 1.06–2.51), 1–7 antenatal care visits (AOR = 2.25, 95% CI: 1.40–3.62), health facility delivery (AOR = 3.34, 95% CI: 1.87–5.97), and rural residence (AOR = 0.59, 95% CI: 0.39–0.89). CONCLUSION : Full vaccination coverage in DRC is low and unevenly distributed; with cold spots in Mongala, part of Bas Uele and Tshuapa regions. Hence, targeted interventions focusing on identified cold spot areas, improving maternal education, expanding healthcare access, and promoting antenatal care and institutional delivery are essential to increase vaccine coverage.
Quantum-mechanically refined, dynamics-coupled, and AI-augmented elucidation of epigenetic inhibition : an in silico paradigm targeting HDAC8of Schistosoma mansoni
Imran, Mohd; Jawaid, Talha; Alhuthali , Hayaa M.; Alrehaili, Amani A.; Alzahrani, Abdullah R.; Rehman, Zia Ur; Mbunge, Elliot; Dzinamarira, Tafadzwa (Wiley, 2025-12)
The increasing burden of schistosomiasis, compounded by the restriction imposed by monotherapeutic regimens, highlights the pressing need for new molecules that target specific molecular pathways. Schistosoma mansoni histone deacetylase 8 (SmHDAC8), a zinc-dependent epigenetic regulator, has emerged as a nonredundant and druggable enzyme, critical for parasite survival, fertility, and chromatin homeostasis. In this study, we outline multiple-mode computational analysis involving structure-based virtual screening against a chemically diverse ligand library, frontier molecular orbital analysis through DFT, large-scale molecular dynamics (MD) simulations (500 ns), and molecular mechanics/gas-phase/Generalized Born (MM/GBSA) energy component analysis, complemented with machine learning-guided pIC50 model building and prediction. Our screening cascade comprising docking, MM, and MD identified the lead candidate, 24374890, with the best docking score (-9.5 kcal/mol) and desirable electronic configuration (HOMO-LUMO gap: 4.143 eV) for its optimal reactivity-stability balance. MD simulations confirmed its stability in the short term, as well as its conformational preservation in the SmHDAC8 catalytic pocket, as evidenced through low RMSD values, stable free energy basins, and sustained intermolecular interactions. Hydrogen bond analysis proved that compounds 24374890 and 24280440 kept 1-4 stable hydrogen bonds for the entire 500 ns simulation, supporting their strong and stable binding in SmHDAC8's active site. Thermodynamic calculations through MM/GBSA indicated 24374890 has the best energetics for binding (ΔG_total = -65.11 kcal/mol), comprising largely van der Waals and nonpolar solvation energies. Finally, the pIC50 value for 24374890 was predicted, through supervised machine learning, as 8.1, better than the reference molecule. These convergent findings from quantum mechanical, molecular mechanical, and AI-based computations validate 24374890 as an SmHDAC8 inhibitor that is structurally and dynamically sound. These calculations need to be supported with in vitro enzyme inhibition experiments against recombinant SmHDAC8 and cytotoxicity profiling in schistosome cultures. Moreover, X-ray crystallography or cryo-EM analysis of the SmHDAC8-24374890 complex would reveal detailed binding conformations.
Factors associated with mortality in patients diagnosed with COVID-19 in the Manzini Region, Eswatini, 2020-2021
Mavundla, Sincobile Victory; Lokotfwako, Vusie; Kuonza, Lazarus; Musekiwa, Alfred; Makamu, Masingita; Ravhuhali, Khuliso (African Field Epidemiology Network, 2025-12-08)
INTRODUCTION : Coronavirus disease 2019 (COVID-19) emerged in late 2019 and rapidly evolved into a global public health crisis. After more than 118,000 cases in 114 countries and 4,291 mortalities were reported, the WHO declared COVID-19 a worldwide pandemic on 11 March 2020. This study aims to determine demographic and clinical factors associated with COVID-19 case fatality among patients diagnosed in the Manzini Region, Eswatini, between March 2020 and August 2021. METHODS : This retrospective cross-sectional study was based on an analysis of secondary data for patients with a positive diagnosis of COVID-19 in the Manzini region who had an outcome of either recovery or death. It then excluded all suspected cases that were not confirmed by laboratory results. A COVID-19 mortality was defined as a death resulting from a clinically compatible illness in a confirmed COVID-19 case. Descriptive statistics were used to summarise demographic, clinical characteristics. The Pearson chi-square test was used to assess differences in categorical variables, and finally used logistic regression was used to investigate factors associated with COVID-19 mortality. RESULTS : After excluding 189 medical records, 15,124 cases and 336 COVID-19 mortalities were analyzed. Most of the participants were Females (54.5%), and the mortality rate in patients with SARS due to COVID-19 was 2.2%. Multivariate logistic regression identified the Year 2021 as the strongest independent predictor of mortality, increasing the odds of death over 15 times compared to 2020 (AOR 15.26, 95% CI: 6.60–35.24). Advanced age was also strongly associated with fatality, with patients aged ≥60 years (AOR 9.27, 95% CI: 3.12–25.92) and 50–59 years (AOR 8.12, 95% CI: 2.81–23.49) showing markedly higher odds of death compared with younger adults. Risk increased significantly with disease severity, ranging from mild (AOR 5.89, 95% CI: 2.94–11.80) and moderate (AOR 12.67, 95% CI: 5.54–29.01) to severe disease (AOR 123.71, 95% CI: 53.44–286.38). Hypertension also remained a significant risk factor (AOR 3.57, 95% CI: 2.01–6.36). Notably, Diabetes Mellitus appeared to be a protective factor (AOR 0.35, 95% CI: 0.18–0.71). CONCLUSION : Age, severity, and hypertension were confirmed risks. Crucially, the protective factor of diabetes suggests effective local prioritization and early management of high-risk patients during the pandemic.
Antiretroviral therapy status and factors associated with ART use among orphaned and vulnerable children (OVC) living with HIV in Namibia
Moyo, Enos; Mangwana, Hadrian; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Nyoni, Ntombizodwa Makurira; Dzinamarira, Tafadzwa (Taylor and Francis, 2026)
This study assessed the antiretroviral therapy (ART) status and factors associated with ART use among Children and adolescents living with HIV (C/ALHIV) enrolled in the Namibia OVC program. This retrospective cross-sectional secondary analysis study used data collected at enrolment of C/ALHIV participating in the OVC program, implemented by Project HOPE Namibia (PHN) from 1 August 2023. Data were analyzed utilizing IBM Statistical Package for Social Sciences (SPSS) version 29. Among the 4599 participants included in this analysis, 4441 (96.6%) participants were on ART, with a 95% confidence interval (CI) (96.1% − 97.1%). Participants more likely to be on ART were from households with little or no hunger (Crude Odds Ratio (COR) = 2.19, 95% CI (1.40 – 3.43)), from Eenhana (adjusted odds ratio (AOR) = 8.24, 95% CI (2.58 – 26.37)), Engela (AOR = 3.72, 95% CI (1.63 – 8.50)), Okongo (AOR = 5.22, 95% CI (1.22 – 22.38)), Oshakati (AOR = 2.50, 95% CI (1.04 – 6.01)), and Oshikuku (AOR = 3.70, 95% CI (1.18 – 11.55)). In contrast, participants who were less likely to be on ART were aged 0–9 years, never enrolled at a school (COR = 0.26, 95% CI (0.18 – 0.37)), and were diagnosed or presumed to be with TB (AOR = 0.10, 95% CI (0.01 – 0.73)). Additionally, participants from child-headed households, those who were sexually abused or sexually exploited, were less likely to be on ART, COR = 0.02, 95% CI (0.01 – 0.03), COR = 0.04, 95% CI (0.02 – 0.06), and COR = 0.12, 95% CI (0.10 – 0.15), respectively. The findings indicate that integrating food support into HIV programs may enhance ART uptake among C/ALHIV. Strategies should be implemented to improve the enrolment for OVC in educational institutions.
Atmospheric PM2.5 and its trace element compositions in Bloemfontein, South Africa : an inhalation health risk assessment
Nkelende, Roland Tshibwabwa; Van der Westhuizen, Deidre; Boman, Johan; Molnar, Peter; Von Eschwege, Karel G.; Howlett-Downing, Chantelle Margaret; Wichmann, Janine (Taylor and Francis, 2026)
Please read abstract in the article.
Factors associated with recent physical violence against orphaned and vulnerable children (OVC) in Namibia : a cross-sectional analysis of programmatic data from 2023 to 2024
Moyo, Enos; Mangwana, Hadria; Melese, Endalkachew; Takawira, Simon; Harases, Bernadette; Indongo, Rosalia; Moyo, Perseverance; Robert, Kopano; Dzinamarira, Tafadzwa (Elsevier, 2026-03)
BACKGROUND : An estimated one billion children aged two to 17 years globally have experienced physical, sexual, or emotional violence or neglect. In Namibia, nearly 50% of girls and boys encounter physical, sexual, or emotional violence during childhood. Orphaned and vulnerable children (OVC) experience significant adverse effects as a result of their living conditions. OBJECTIVE : This study assessed the rate of physical violence and its associated factors against OVC in Namibia. PARTICIPANTS AND SETTING : The study included OVC aged 0 to 20 years in 13 primary health administrative districts in Namibia. METHODS : This retrospective cross-sectional study utilized programmatic data collected from 2023 to 2024 from OVC participating in the Reach program, implemented by Project Hope Namibia. The study included OVC aged 0 to 20 years. Data were analyzed utilizing IBM Statistical Package for Social Sciences (SPSS) version 29. Chi-square tests and binomial and multivariable logistic regression analyses were conducted. RESULTS : Among the 16,507 participants included in this analysis, 1803 (10.9%) participants were recently physically abused, 95% confidence interval (CI) (10.4% – 11.4%). Omuthiya had the highest physical abuse rate (n = 73; 18.2%), while Outapi had the lowest (n = 47; 8.4%). Participants aged 10-14 years were less likely to have experienced recent physical abuse than those aged 15-20, adjusted odds ratio (AOR) = 0.81, 95% CI (0.70 – 0.95). Disabled participants had a lower likelihood of reporting recent physical abuse than the non-disabled ones (AOR = 0.62, 95% CI (0.41 – 0.93)). Furthermore, participants who had caregivers who were HIV-positive were less likely to have experienced recent physical abuse than those whose caregivers were HIV-negative (crude odds ratio (COR) = 0.25, 95% CI (0.06 – 0.99). In contrast, participants from Omuthiya were more likely to have experienced recent physical abuse than those from Windhoek (AOR = 1.74, 95% CI (1.25 – 2.43)). CONCLUSION : Violence against children (VAC) awareness campaigns in high-risk districts, focusing on physical violence and community-level behavior change, must be expanded. Periodical regional VAC assessments must be conducted to identify and address localized drivers of violence. HIGHLIGHTS • 10.9% of OVC were recently physically abused. • Omuthiya had the highest physical abuse rate, while Outapi had the lowest. • Participants aged 10-14 years and the disabled were less likely to have experienced recent physical abuse.
Factors affecting equitable access and uptake of COVID-19 vaccines in Ghana : a scoping review
Akazili, James; Anaseba, Dominic; Chatio, Samuel; Amenah, Michel Adurayi; Achala, Daniel Malik; Beshah, Senait Aleamyehu; Nwosu, Chijioke O.; Masuka, Nyasha; Tlhakanelo, John Thato; Chikezie, Ifeanyi; Adote, Elizabeth Naa Adukwei; Muriithi, Grace Njeri; Ataguba, John Ele-Ojo (Frontiers Media, 2026-02-16)
BACKGROUND : The coronavirus disease (COVID-19) emerged as one of the most serious pandemics that impacted health systems and world economies. Vaccination against the pandemic was considered as an effective tool for the prevention and containment of the virus. Following the outbreak of the Coronavirus pandemic, efforts were made to enhance procurement and distribution of vaccines across countries with the view to containing the pandemic. However, evidence suggested that several factors hindered access, acceptance and use of the COVID-19 vaccines across the globe. This scoping review, thus, explored factors that influenced access, acceptance and use of the COVID-19 vaccines among Ghanaians and strategies that were needed to improve vaccine uptake especially for the vulnerable populations. METHODS : We adopted the five-stage analytic framework developed by Arksey and O’Malley to map existing literature on what has been done and documented on the subject. We searched various electronic databases such as PubMed, Cochrane, African journal online (AJOL), and Google Scholar for relevant articles for the review. RESULTS : In all, fifty-four (54) articles retrieved met our eligibility criteria and were included in this review. Health system factors including untimely payment of vaccinators allowances, shortfalls in logistics and vaccines, lack of transport and long queues at vaccination centers affected access and uptake of the COVID-19 vaccines in Ghana. Additionally, beliefs and perceptions including myths, misconceptions and misinformation around the virus and the vaccines affected people’s decision-making to participate in the vaccination exercise. Also, negative reportage through social media platforms created mistrust in COVID-19 vaccine intensions. CONCLUSION : Even though Ghana made significant progress in addressing the Coronavirus pandemic, hesitancy factors played a crucial role in diminishing Ghana’s effort towards meeting global targets in containing the virus and reducing its impact. Strengthening Ghana’s public health preparedness and response strategy, through a community-based approach and multi-stakeholder engagement, could improve immunization programs and vaccines uptake in addressing future pandemics.
Factors associated with composite anthropometric failures (CIAF) among under five children in Lesotho : an insight from the 2023 to 2024 Demographic and Health Survey Data
Birhan, Nigussie Adam; Belay, Denekew Bitew (Wiley, 2026-03)
Under nutrition is the main cause of child death in developing countries. The Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess the nutrition status of children. Thus, the objective of this was to identify factors associated with CIAF of under‐five children in Lesotho. A secondary analysis of the Lesotho Demographic and Health Survey 2023–24 was conducted, using the data for 1089 children under the age of 5 years. The CIAF was used to classify children based on stunting, wasting, and underweight. Descriptive summary statistics were computed. A binary logistic regression model was employed to identify predictors of CIAF for under‐five children. Adjusted odds ratio with 95% confidence interval was estimated. The prevalence of CIAF in Lesotho was 34.68% (95% CI: 31.76–37.73). Female child 0.54 (AOR = 0.54; 95% CI: 0.375, 0.776), age group 24–59 months 2.42 (AOR = 2.42; 95% CI: 1.149, 5.109), rich households 0.29 (AOR = 0.29; 95% CI: 0.151, 0.554), multiple births 12.02 (AOR = 12.02; 95% CI: 1.199, 120.426), rural residence (AOR = 0.56: 95% CI: 0.335, 0.946), living children 3 to 4 were 2.54 (AOR = 2.54; 95% CI: 1.522, 4.226), and larger size at birth were 0.38 (AOR = 0.38; 95% CI: 0.211, 0.683) were found to be significantly associated with CIAF. The prevalence of CIAF among children under five in Lesotho was high. Child's age, child's sex, child's type of birth, wealth tercile, residence, number of living children, and child's birth size were found to be significantly associated with CIAF. We suggest that the government adapt CIAF as a metric for assessing children's nutritional status in order to estimate the overall prevalence of malnutrition and strengthening adequate nutrition intervention programs in rural areas. Furthermore, highlighting the factors influencing child CIAF will help inform future policies and programs designed to approach this major problem in Lesotho.
Perceptions of e-learning amongst public health students at a South African university
Naicker, Kavitha; Van Wyk, Mari (IJISRT Publisher, 2024-12)
Since the introduction of technological advancements in the 1990s, technology has permeated various aspects of our homes and livelihoods, including the educational system. This shift has led to a greater reliance on web-based tools in education, further accelerated by the COVID-19 pandemic in 2020, which forced many institutions to transition to fully online programs to ensure safety and continuity. In this context, understanding students' perceptions of e-learning and the challenges they face is crucial, as these factors significantly impact the success of their academic experiences and outcomes. Therefore, this study aimed to understand Public Health students' perceptions, experiences, and attitudes toward online learning, seeking insights into their level of satisfaction on this mode of education. The study involved 227 students in a South African University's Postgraduate Diploma in Public Health program. All students received a study information link and the Perceptions towards e-learning Questionnaire, with their e-learning perceptions evaluated through descriptive and inferential statistics, covering aspects such as attitude, social influences, effectiveness, accessibility, ease of use, and satisfaction. The study found robust support for online learning, with 98% preferring it and 97% showing increased interest. While 76% valued in-person interactions, 94% noted improved work-school-family balance with online learning. It proved effective, with 90% endorsing benefits for test preparation and 79% favoring it over in-class learning. Accessibility was positive, as 91% reported no information loss, and 86% faced no internet access issues. Regarding ease of use, students preferred the learning management system, choosing online over face-to-face. Overall, students reported enhanced computer skills and high e-learning satisfaction. The study indicates online learning effectively achieves educational goals, providing convenience, enhancing engagement, and boosting overall satisfaction. Surveyed individuals generally express high acceptance and contentment with online education.
Reasons for hesitancy and acceptance of COVID-19 vaccination among the Congolese population : a scoping review
Lobukulu Lolimo, Genese; Khonde, Rodrigue; Matondo, Herve; Kabele, Junias; Yannick, K. Musawu; Beshah, Senait Alemayehu; Achala, Daniel Malik; Njeri Muriithi, Grace; Adote, Elizabeth Naa Adukwei; Zegeye, Elias Asfaw; Mbachu, Chinyere Ojiugo;; Ataguba, John Ele-Ojo; Yaya Bocoum, Fadima Inna Kamina; Manitu, Serge Mayaka (Frontiers Media, 2026-02-17)
INTRODUCTION : Despite over 9.6 billion COVID-19 vaccine doses administered globally, vaccination access remains highly unequal. North America and Western Europe have over 50% vaccination coverage, contrasting sharply with African nations, like the Democratic Republic of Congo (DRC), which has under 10%. This scoping review explores the key factors contributing to the low COVID-19 vaccination rate in the Congolese population. METHODS : We conducted a scoping review using the Arksey and O'Malley framework, searching PubMed, ProQuest, and Scopus databases for peer-reviewed manuscripts published between 2019 and 2023. Six studies met the inclusion criteria, and focused on the factors of COVID-19 vaccine acceptance, hesitancy, and access in the DRC. RESULTS : Although surveys indicated a high willingness on the part of the people to get vaccinated, only 2.7% of the population were fully vaccinated. The primary barrier to vaccination was safety concerns, specifically, perceptions of the vaccine as new and experimental (84.4%) and fear of side effects (83.3%). Additional hesitancy factors included mistrust in vaccine effectiveness (60.4%) and a general lack of confidence (60.0%). Facilitators of acceptance included prior family vaccination, perceived risk of infection, belief in the existence of the virus, and awareness of vaccination strategies. Sociodemographic factors such as being a healthcare professional or male also positively influenced uptake. DISCUSSION : These findings highlight the gap between vaccine willingness and actual coverage in the DRC. Addressing safety concerns and building trust through targeted outreach, especially among key professional groups, may improve vaccine acceptance and equity.
One month preexposure prophylaxis retention rate and associated factors among adolescent girls and young women who participated in the Namibia DREAMS program (2018–2024)
Moyo , Enos; Melese, Endalkachew; Mangwana, Hadrian; Takawira, Simon; Indongo, Rosalia; Harases, Bernadette; Moyo, Perseverance; Nyoni, Ntombizodwa Makurira; Robert, Kopano; Dzinamarira, Tafadzwa (MDPI, 2025-09-10)
BACKGROUND : Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). 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. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. 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. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. RESULTS : Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. CONCLUSIONS : Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences.
Clustering of lifestyle risk behaviours and food insecurity in a population of South African adults : a cross-sectional study
Nkosi, Lungile; Ayo-Yusuf, Olalekan Abdulwahab (Springer, 2026-02)
BACKGROUND : Unhealthy lifestyle behaviours may be associated with food insecurity, yet limited research in low- and middle-income countries has examined the clustering of such behaviours and their association with food access challenges. This study explores the clustering of lifestyle risk behaviours, including polytobacco use, and their association with food insecurity among South African adults. METHODS : Data were drawn from the 2021 Tobacco and Other Modifiable Risk Behaviours Online Survey, comprising 11,093 adults aged 18 years or older. Weighted logistic regression models were used to examine associations between lifestyle risk behaviours (any or poly tobacco/nicotine product use, heavy drinking, unhealthy diet, physical inactivity, inadequate sleep) and food insecurity. Statistical significance was set at p < 0.05. RESULTS : Overall, 84.1% (95% CI: 72.90–96.65) were found to engage in two or more risk behaviours, while 7.0% (95% CI: 5.29–9.30) reported all five. The most common clustering involved physical inactivity and inadequate sleep (10.8%; 95% CI: 8.17–14.10). Concurrent daily polytobacco use and heavy drinking were significantly associated with food insecurity (OR = 2.20; 95% CI: 1.10–4.40). Severe financial difficulty (OR = 9.30; 95% CI: 4.78–18.11), Black African race (OR = 8.94; 95% CI: 6.44–12.43), unemployment and lower education were also associated with increased odds. CONCLUSION : Addressing financial hardship, racial disparities, and co-occurring lifestyle risk behaviours is critical to mitigating food insecurity and reducing non-communicable disease risk in South Africa.
Long-acting HIV pre-exposure prophylaxis integrated with community-based sexual and reproductive health services in South Africa (LAPIS) : study protocol for a hybrid (1a) cluster randomised controlled phase 3B trial of effectiveness and implementation
Busang, Jacob; Zuma, Thembelihle; Chimbindi, Natsayi; Ngoma, Nqobile; Herbst, Carina; Okesola, Nonhlanhla; Dreyer, Jaco; Smit, Theresa; Bird, Kristien; Mtolo, Lucky; Behuhuma, Ngundu; Lebina, Limakatso; Hendrickson, Cheryl; Miot, Jacqui; Hanekom, Willem; Herbst, Kobus; Seeley, Janet; Copas, Andrew; Baisley, Kathy; Shahmanesh, Maryam (BioMed Central, 2026-01)
BACKGROUND : Barriers and challenges associated with daily oral HIV pre-exposure prophylaxis (PrEP) contribute to poor uptake, low retention, and adherence rates among youth. Offering a choice of PrEP modalities integrated with peer support and delivered through community-based sexual and reproductive health (SRH) services will overcome these challenges. We describe the design of a trial to evaluate this approach at a population level. METHODS : We are conducting a type 1a hybrid effectiveness, phase 3B, cluster randomised controlled trial (LAPIS) to evaluate the effectiveness and implementation of offering PrEP modality choices through community-based SRH services amongst youth aged 15-30 years living in rural Kwa-Zulu Natal, South Africa. LAPIS is nested within Thetha nami ngithethe nawe (Let's Talk), an ongoing stepped-wedge trial with two periods investigating the effectiveness, implementation, and cost effectiveness of peer-led social mobilisation into decentralised integrated HIV and SRH services on the population prevalence of sexually transmissible HIV amongst youth. In the second period of Thetha nami, 40 trial clusters were randomised 1:1 to receive either a choice of PrEP modalities (oral PrEP, long-acting PrEP, i.e., two-monthly injectable cabotegravir (CAB LA) or dapivirine vaginal ring and HIV post-exposure prophylaxis [PEP] packs) or enhanced standard of care (ESoC) with oral PrEP only. All trial clusters are supported by peer navigators offering peer support and visited monthly by a mobile nurse-led clinic offering adolescent and youth-friendly HIV and SRH services. There are two primary outcomes: (1) effective uptake of PrEP or PEP, and (2) retention on PrEP, defined as attending at least one follow-up appointment after PrEP/PEP initiation, which are based on clinic data. Implementation outcomes are assessed using a mixed-methods and process evaluation following the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. DISCUSSION : LAPIS is a pragmatic trial to evaluate the addition of long-acting PrEP modalities to daily oral PrEP within community-based SRH services. By offering PrEP choices, LAPIS adopts a person-centred approach to improve adherence and retention among youth, including hidden key populations. Findings will provide insights into the real-world implementation of CAB-LA. TRIAL REGISTRATION : ClinicalTrials.gov Identifier-NCT06250504. Registered: 01 February 2024.
The COVID-19 vaccine procurement and supply chain in the Democratic Republic of Congo
Lobukulu Lolimo, Genèse; Kabadi, Yannick Musawu; Beshah, Senait Alemayehu; Khonde, Rodrigue; Beia, Aurore; Makongote, Héritier; Sumaili, Généros; Kabuya, Samue; Bongutu, Joél; Achala, Daniel Malik; Muriithi, Grace Njeri; Adote, Elizabeth Naa Adukwei; Zegeye, Elias Asfaw; Mbachu, Chinyere Ojiugo; Ataguba, John Ele-Ojo; Yaya Bocoum, Fadima Inna Kamina; Mayaka, Serge Manitu; Mafuta Musalu, et Éric (Frontiers Media, 2026-02)
The COVID-19 vaccine has been classified as an ‘essential medicine’, yet shortages and unequal distribution during the pandemic have reignited concerns about vaccine self-sufficiency in Africa. This study examined the mechanisms for acquiring, distributing, and administering existing COVID-19 vaccines in the Democratic Republic of Congo (DRC). A qualitative case study was conducted using semi-structured interviews with 23 key informants selected using reasoned choice, based on their professional roles in vaccine policy, logistics, and implementation. Participants were recruited from public institutions, with most being medical doctors and having experience in vaccination. Data were transcribed and analyzed were transcribed and analysis thematically using Atlas-ti 7.0. The study found that vaccine acquisition in the DRC relied heavily on international donations and multilateral initiatives, with limited national financial contribution. Distribution followed a five-tier supply chain managed by the Expanded Program on Immunization, moving vaccines from Kinshasa to provincial and field offices, then to selected health facilities. The Cold chain limitations, transport issues, and inconsistent vaccine availability challenged the administration. To improve vaccine access and coverage, stakeholders emphasized the need to strengthen logistical infrastructure and promote regional vaccine production. Honoring government commitments to co-finance procurement was also identified as a critical step toward sustainable vaccine supply.
Bridging immunization gaps in Sub-Saharan Africa : a narrative review of microplanning, geospatial, and machine learning approaches to reach zero-dose children and under-immunised children
Musuka, Godfrey; Umar, Al-umra; Dadari, Ibrahim; Moyo, Enos; Mano, Oscar; Iradukunda, Patrick Gad; Mbunge, Elliot; Murewanhema, Grant; Dhliwayo, Tapiwa; Mataruse, Noah; Sayem, Abu Sadat Mohammad; Dzinamarira, Tafadzwa (Elsevier, 2026-04)
Immunization inequities persist across Sub-Saharan Africa, with significant numbers of zero-dose and under-immunised children contributing to preventable morbidity and mortality. This narrative review critically examines the integration and effectiveness of machine learning, geospatial mapping, and microplanning strategies in identifying and reaching these vulnerable populations. The review's primary objective is to synthesise current evidence on how these innovative approaches are being applied within routine immunization systems to address persistent coverage gaps. A systematic search of peer-reviewed literature and grey sources was conducted, focusing on studies and programmatic reports from 2015 to 2025. The review analyses methodological trends, implementation experiences, and outcome data related to machine learning algorithms for risk profiling, geospatial technologies for mapping and targeting, and microplanning tools for local-level action. Data extraction and thematic synthesis were guided by the WHO framework for immunization equity. Findings demonstrate that machine learning models, utilizing demographic, health system, and mobility data, have enhanced the precision of zero-dose child identification, enabling more targeted outreach interventions. Geospatial mapping has further enabled real-time visualisation of immunization deserts and the spatial distribution of missed communities, supporting resource allocation and deployment of mobile teams. Microplanning, when integrated with digital tools and community engagement, has shown promise in translating high-level data into actionable local strategies, improving follow-up, and reducing missed vaccination opportunities. Despite these advancements, several challenges persist. Data quality and interoperability issues limit the scalability of machine learning and geospatial solutions, particularly in remote or fragile settings. Capacity gaps at the sub-national level, including technical skills and digital infrastructure, impede effective microplanning and data use. Furthermore, the sustainability of these approaches is threatened by fragmented investments and limited integration into national health information systems. Opportunities exist to strengthen the routine immunization system by standardising data collection, investing in workforce training, and fostering cross-sectoral collaboration. The review recommends prioritising the development of interoperable platforms, expanding context-specific pilot projects, and embedding evaluation mechanisms to track impact and equity outcomes. Policymakers are urged to leverage the demonstrated benefits of machine learning. HIGHLIGHTS • Immunization inequities persist across Sub-Saharan Africa. • We examined machine learning, geospatial mapping, and microplanning strategies in immunization programmes. • Machine learning models, geospatial and microplanning approaches have utility in zero-dose child identification. • Data quality and interoperability limit the scalability of these solutions

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