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

Permanent URI for this collectionhttp://hdl.handle.net/2263/1723

For inquiries regarding this collection or items in the collection, please contact : Estelle Grobler
Tel.: +27 12 354 1433

Browse

Now showing 1 - 20 of 1228

Predictors of unsuppressed HIV viral load and low CD4 count among ZIMPHIA 2020 survey participants
(Texila International Journal, 2024-12-27) Mukwenha, Solomon; Dzinamarira, Tafadzwa; Mapingure, Munyaradzi; Chingombe, Innocent; Makota, Rutendo Birri; Mbunge, Elliot; Moyo, Enos; Chemhaka, Garikayi; Batani, John; Moyo, Brian; Musuka, Godfrey
Unsuppressed Viral load and low CD4 counts pose a significant challenge to HIV/AIDS management. Understanding the predictors of unsuppressed viral load and CD4 is critical for developing strategies to mitigate its impact. This study aimed to identify predictors of unsuppressed HIV viral load and low CD4 counts among Zimbabwe population-based HIV impact assessment survey (ZIMPHIA 2020) study participants. We analysed data from the ZIMPHIA 2020 survey. Data collection was done using structured interviews, home-based HIV testing and laboratory testing. Blood samples from participants were tested for HIV and those positive were analysed for CD4 counts and Viral load tests. We then calculated odds ratios for predictors of unsuppressed viral load (viral load ≥1000 copies/mL) and low CD4 counts (CD4< 350). The prevalence of unsuppressed viral load and low CD4 count were 20.7% and 34.7%, respectively. Males were more likely to be virally unsuppressed (25.1%) than females (18.8%) adjusted odds ratio (aOR) (95% confidence interval) 1.74 (1.43-2.11) p-value < 0.001. The odds of having a low CD4 count were higher among males (41%) than females (19%) aOR (95% confidence interval) 3.07 (2.57-3.66). Urban dwellers were more likely to have a low CD4 count (31.1%0 than rural dwellers (23.8%) aOR (95% confidence interval) 1.45 (1.21-1.73) p-value <0.001. The common predictors of both unsuppressed viral load and low CD4 were gender, never tested for HIV and never had a viral load test.
Household fuel use and severe asthma symptoms among preschool children in Gauteng province, South Africa : a cross-sectional study
(BMJ Publishing Group, 2024-12) Bhuda, Mandla; Wichmann, Janine; Shirinde, Joyce
BACKGROUND : Household air pollution continues to be a major public health hazard due to the continued use of household fuel sources. Globally, approximately 4 million people die prematurely each year due to exposure to household air pollution sources. Children are more susceptible to health effects associated with air pollution because their immune systems and lungs are not fully developed. OBJECTIVE : The objective of the study was to investigate the association between household fuel use and current severe asthma symptoms among preschool children in Gauteng province, South Africa. METHODS : This was a cross-sectional study conducted in the City of Tshwane Metropolitan Municipality in Gauteng province, South Africa. A total of 1844 parents and guardians of preschool children completed the modified International Study of Asthma and Allergies in Childhood questionnaire. However, a total of four questionnaires were discarded due to incorrect completion. Therefore, a total of 1840 questionnaires were included in the data analysis. Data were analysed using multiple logistic regression analysis. RESULTS : The prevalence of current severe asthma symptoms was 15.4%. The use of gas for cooking or heating significantly increased the likelihood of current severe asthma symptoms among preschool children (OR=3.20;95% CI 2.08 to 4.91; p<0.001). The use of open fire sources (paraffin, wood or coal) increased the likelihood of severe asthma symptoms among preschool children by 87% (95% CI 0.98 to 3.55; p=0.057). CONCLUSION : The study observed that using gas and open fire sources for cooking or heating was associated with current severe asthma symptoms among preschool children in Gauteng, South Africa. Household air quality regulations should be developed to mitigate child exposure to household air pollution in the study setting.
Schools of public health as a cornerstone for pandemic preparedness and response : the Africa COVID-19 experience
(BioMed Central, 2024-11-21) Ndejjo, Rawlance; Mitonga, Honore Kabwebwe; Amde, Woldekidan; Lubega, Grace Biyinzika; Muula, Adamson S.; Mariam, Damen Haile; Kabwama, Steven N.; Haufiku, Desderius; Amour, Maryam; Bosonkie, Marc; Mukama, Trasias; Bello, Segun; Dwomoh, Duah; Nja, Glory Mbe Egom; Bulafu, Douglas; Halake, Galgalo; Frumence, Gasto; Leye, Mamadou Makhtar Mbacke; Katangolo-Nakashwa, Ndasilohenda; Abaya, Samson Wakuma; Diallo, Issakha; Egbende, Landry; Worku, Netsanet; Bassoum, Oumar; Mbunga, Branly; Musoke, David; Mohamed, Hussein; Seck, Ibrahima; Fobil, Julius; Kiwanuka, Suzanne N.; Fawole, Olufunmilayo I.; Mapatano, Mala Ali; Alfven, Tobias; Gilson, Lucy; Muinde, Jacinta Victoria Syombua; Van Marwijk, Harm; Lehmann, Uta; Speybroeck, Niko; Kaseje, Margaret; Wanyenze, Rhoda K.; Patrick, Sean Mark
BACKGROUND : The Coronavirus disease (COVID-19) pandemic caused significant morbidity and mortality in Africa, in addition to other socio-economic consequences. Across the continent, Schools of Public Health (SPHs) played several roles in supporting national, regional, and global response to the pandemic. Following a published and grey literature search, this paper reviews and analyses the contribution of SPHs in Africa during the COVID-19 pandemic. CONTRIBUTION OF THE SCHOOLS OF PUBLIC HEALTH : SPH faculty in most countries contributed their expertise through COVID-19 task forces and advisory committees where they guided and supported decision-making. Faculty also supported the identification, review, and synthesis of rapidly evolving global and local evidence, adapting it to the local context to guide policy decisions. Through research, SPHs contributed to a better understanding of the disease epidemiology, response interventions, as well as prevention and control measures. SPHs engaged in training field epidemiologists, frontline health workers, and district response teams. SPH staff, students and field epidemiology trainees also supported field activities including surveillance, contact tracing, as well as managing quarantine facilities and points of entry. SPHs engaged in public education and awareness-raising initiatives to share information and dispel misinformation. In partnership with other stakeholders, SPHs also developed important innovations and technologies. CONCLUSION : SPHs are a critical pillar for pandemic prevention, preparedness, and response, that support health systems with important functions. To further enhance their capacity, efforts to improve coordination of SPHs, strengthen collaboration among schools, harmonize training and curricula, and enhance capacity for advanced research are needed. There is also a need to bridge the inequities in capacity and resources that exist among SPHs across regions and countries.
Paternal factors affecting under-five immunization status in Sub-Saharan Africa : a systematic review and meta-analysis
(Elsevier, 2025-10) Musuka, Godfrey; Moyo, Enos; Mano, Oscar; Madziva, Roda; Pierre, Gashema; Iradukunda, Patrick Gad; Sayem, Abu Sadat Mohammad; Dhliwayo, Tapiwa; Herrera, Helena; Mutata, Constantine; Dzinamarira, Tafadzwa
Please read abstract in the article.
Factors contributing to extended length of stay in the emergency department and potential strategies for improving patient flow in a central hospital in the Gauteng Province, South Africa
(Elsevier, 2025-12) Motimele, Lerato; Lalloo, Vidya; Sefala, T.; Engelbrecht, Andreas; Majake-Mogoba, L.; Basu, Debashis; lerato.motimele@up.ac.za
BACKGROUND : Length of stay (LOS) is an integral part of inpatient care in hospitals, particularly in Emergency Departments (EDs). It is an essential performance indicator for the National Indicator Data Set in South Africa. Multiple studies have indicated a correlation between an increased LOS and worse patient outcomes in a variety of acute medical conditions. The study aims to establish the key factors of LOS in the ED at a central hospital in the Gauteng Province of South Africa. METHODOLOGY : A cross-sectional study was conducted over seventeen months (Aug 2023 to Dec 2024) based on 2927 entries of patients admitted at the ED for more than 48 hours. No intervention was done as part of this study. RESULTS : The median LOS was 2.81 days (IQR: 2-3) with a minimum of 2 days and a maximum of 12 days. A regression analysis demonstrated that the most significant determinants for prolonged LOS were gender and disease group of boarded patients awaiting ward transfer.Significant differences (p < 0.001) in the LOS between clinical disciplines were noted, with medical (45%) and surgical departments (46%) accounting for most boarding patients compared to all other clinical disciplines. CONCLUSIONS : Data demonstrated that 80% of patients in the ED wait an average of 3 days before transfer into the wards. This extended ALOS in the ED has consequences for patient outcomes and the quality of healthcare provided. Based on the findings of this study, strategies to improve patient flow are essential in facilitating timeous discharge from wards and to prioritise the forward flow of patients waiting in ED.
SARS-CoV-2 seroprevalence and COVID-19 vaccination coverage in two states of Nigeria from a population based household survey
(Nature Research, 2025-08) Enyereibe, Nwachukwu William; Ilori, Elsie; Steinhardt, Laura; Stafford, Kristen; Dan-Nwafor, Chioma; Ochu, Chinwe Lucia; Ibrahim, Dalhatu; Alagi, Matthias; Ibrahim, Baffa Sule; Iwara, Iwara Emem; Mba, Nwand; Ibrahim, Zainab; Ahmed, Rabiatu Aliyu; Botson, Iliya; Ogbonna, Stanley Uche; Igumbor, Ehimario Uche; Abubakar, Jafiya; Ahmed, Nasir; Nwiyi, Gloria Ogochukwu; Ihemeje, Chima Emmanuel; Okoi, Catherine; John, Doris; Ashikeni, Matthew; Muhammad, Basheer Lawan; Iriemenam, Nnaemeka C.; Okunoye, Olumide; Greby, Stacie M.; Bassey, Orji; Okoye, Mcpaul; Blanco, Natalia; Mitchell, Andrew; Ipadeola, Oladipupo; Antonza, Gladys S.; Mpamugo, Augustine; Makava, Favour; Charurat, Manhattan; Adebajo, Sylvia; Swaminathan, Mahesh; Ifedayo, Adetifa; Ihekweazu, Chikwe
SARS-CoV-2 population-based seroprevalence surveys are useful for estimating the extent of SARS-CoV-2 infections, which may be underestimated by COVID-19 case counts. Surveys conducted in October 2020 in four Nigerian states showed that SARS-CoV-2 seroprevalence ranged from 9.3% in Gombe (northeast) to 25.2% in Enugu (southeast) after the first COVID-19 wave, more than 100 and 700 times higher than the official number of COVID-19 cases in these two states, respectively. We conducted a serosurvey after the second COVID-19 wave to evaluate the extent of SARS-CoV-2 infections, attitudes to COVID-19 vaccines, and COVID-19 vaccination coverage in two regions of Nigeria. Using the World Health Organization (WHO) Unity protocol, 34 enumeration areas (EAs) each in the Federal Capital Territory (FCT) (Northcentral Zone) and Kano State (Northwest Zone) were sampled in June 2021, using probability proportional to estimated size; 20 households in one EA were randomly selected. All consenting and assenting members of a household were asked about risk behaviors; adults who were 18 years and above (the eligible population for COVID-19 vaccination in Nigeria) responded to questions on COVID-19 vaccine attitudes and receipt. Blood and nasal/oropharyngeal samples were taken from all consenting and assenting household members. Blood samples collected were tested with the Luminex xMAP® SARS-CoV-2 Multi-Antigen IgG Assay and swabs by reverse-transcriptase-PCR (RT-PCR). Overall response rates were 76.8% in the FCT (n = 1,505 blood draws) and 80.4% in Kano State (n = 2,178 blood draws). Following the second COVID-19 wave in Nigeria, more than 40% of residents in the FCT (40.3%, 95% CI: 34.7–45.9) and Kano State (42.6%, 95% CI: 39.4–45.8) had evidence of prior SARS-CoV-2 infection. There were no active SARS-CoV-2 infections detected by RT-PCR in either the FCT or Kano State. In the FCT and Kano State, 3.4% and 1.6% of people surveyed reported receipt of any COVID-19 vaccine, three months after vaccines were available in country. In the FCT, 77.5% of adults were aware of COVID-19 vaccines, of whom 46.9% reported willingness to receive them. In Kano State, 48.7% of adults were aware of COVID-19 vaccines, of whom 61.1% were willing to receive them. In both regions, about 84% of those reporting unwillingness to accept COVID-19 vaccines cited concerns over vaccine safety. “Serosurvey findings revealed that SARS-CoV-2 infection was far more widespread in both the Federal Capital Territory and Kano State than indicated by reported case numbers. Despite high awareness, COVID-19 vaccine uptake remained low, primarily due to concerns about vaccine safety. These results highlight the urgent need for targeted risk communication to address vaccine hesitancy and improve coverage. Serosurveys provide valuable insights that can guide public health interventions and future pandemic preparedness in Nigeria.”
Low-level viremia among adults living with HIV on dolutegravir-based first-line antiretroviral therapy is a predictor of virological failure in Botswana
(MDPI, 2024-05-01) Bareng, Ontlametse T.; Moyo, Sikhulile; Mudanga , Mbatshi; Sebina , Kagiso; Koofhethile , Catherine K.; Choga, Wonderful T.; Moraka , Natasha O.; Maruapula , Dorcas; Gobe , Irene; Motswaledi, Modisa S.; Musonda, Rosemary; Nkomo , Bornapate; Ramaabya , Dinah; Chebani , Tony; Makuruetsa, Penny; Makhema , Joseph; Shapiro , Roger; Lockman, Shahin; Gaseitsiwe, Simani
We evaluated subsequent virologic outcomes in individuals experiencing low-level virem ia (LLV) on dolutegravir (DTG)-based first-line antiretroviral therapy (ART) in Botswana. We used a national dataset from 50,742 adults who initiated on DTG-based first-line ART from June 2016-December 2022. Individuals with at least two viral load (VL) measurements post three months on DTG-based first-line ART were evaluated for first and subsequent episodes of LLV (VL:51-999 copies/mL). LLV was sub-categorized as low-LLV (51-200 copies/mL), medium-LLV (201-400 copies/mL) and high-LLV (401-999 copies/mL). The study outcome was virologic failure (VF) (VL ≥ 1000 copies/mL): virologic non-suppression defined as single-VF and confirmed-VF defined as two-consecutive VF measurements after an initial VL < 1000 copies/mL. Cox regression analysis identified predictive factors of subsequent VF. The prevalence of LLV was only statistically different at timepoints >6-12 (2.8%) and >12-24 (3.9%) (p-value < 0.01). LLV was strongly associated with both virologic non-suppression (adjusted hazards ratio [aHR] = 2.6; 95% CI: 2.2-3.3, p-value ≤ 0.001) and confirmed VF (aHR = 2.5; 95% CI: 2.4-2.7, p-value ≤ 0.001) compared to initially virally suppressed PLWH. High-LLV (HR = 3.3; 95% CI: 2.9-3.6) and persistent-LLV (HR = 6.6; 95% CI: 4.9-8.9) were associated with an increased hazard for virologic non-suppression than low-LLV and a single-LLV episode, respectively. In a national cohort of PLWH on DTG-based first-line ART, LLV > 400 copies/mL and persistent-LLV had a stronger association with VF. Frequent VL testing and adherence support are warranted for individuals with VL > 50 copies/mL.
High prevalence of hepatitis B virus drug resistance mutations to lamivudine among people with HIV/HBV coinfection in rural and peri-urban communities in Botswana
(MDPI, 2024-04-11) Phinius , Bonolo B.; Anderson , Motswedi; Gobe , Irene; Mokomane , Margaret; Choga, Wonderful T.; Phakedi , Basetsana; Ratsoma , Tsholofelo; Mpebe , Gorata; Makhema , Joseph; Shapiro, Roger; Lockman , Shahin; Musonda, Rosemary; Moyo, Sikhulile; Gaseitsiwe, Simani
BACKGROUND : We aimed to determine the prevalence of hepatitis B virus (HBV) resistance-associated mutations (RAMs) in people with HBV and human immunodeficiency virus (HBV/HIV) in Botswana. METHODS : We sequenced HBV deoxyribonucleic acid (DNA) from participants with HBV/HIV from the Botswana Combination Prevention Project study (2013-2018) using the Oxford Nanopore GridION platform. Consensus sequences were analyzed for genotypic and mutational profiles. RESULTS : Overall, 98 HBV sequences had evaluable reverse transcriptase region coverage. The median participant age was 43 years (IQR: 37, 49) and 66/98 (67.4%) were female. Most participants, i.e., 86/98 (87.8%) had suppressed HIV viral load (VL). HBV RAMs were identified in 61/98 (62.2%) participants. Most RAMs were in positions 204 (60.3%), 180 (50.5%), and 173 (33.3%), mostly associated with lamivudine resistance. The triple mutations rtM204V/L180M/V173L were the most predominant (17/61 [27.9%]). Most participants (96.7%) with RAMs were on antiretroviral therapy for a median duration of 7.5 years (IQR: 4.8, 10.5). Approximately 27.9% (17/61) of participants with RAMs had undetectable HBV VL, 50.8% (31/61) had VL < 2000 IU/mL, and 13/61 (21.3%) had VL ≥ 2000 IU/mL. CONCLUSIONS : The high prevalence of lamivudine RAMs discourages the use of ART regimens with 3TC as the only HBV-active drug in people with HIV/HBV.
Emergence of Omicron FN.1 a descendent of BQ.1.1 in Botswana
(Oxford University Press, 2024-11) Choga, Wonderful T.; Gustani-Buss, Emanuele; Tegally, Houriiyah; Maruapula, Dorcas; Yu, Xiaoyu; Moir, Monika; Zuze, Boitumelo J.L; James, San Emmanuel; Ndlovu, Nokuthula S.; Seru, Kedumetse; Motshosi, Patience; Blenkinsop , Alexandra; Gobe , Irene; Baxter, Cheryl; Manasa, Justen; Lockman , Shahin; Shapiro, Roger; Makhema , Joseph; Wilkinson, Eduan; Blackard, Jason T.; Lemey , Phillipe; Lessells, Richard J.; Martin, Darren P.; De Oliveira , Tulio; Gaseitsiwe, Simani; Moyo, Sikhulile
Botswana, like the rest of the world, has been significantly impacted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In December 2022, we detected a monophyletic cluster of genomes comprising a sublineage of the Omicron variant of concern (VOC) designated as B.1.1.529.5.3.1.1.1.1.1.1.74.1 (alias FN.1, clade 22E). These genomes were sourced from both epidemiologically linked and unlinked samples collected in three close locations within the district of Greater Gaborone. In this study, we assessed the worldwide prevalence of the FN.1 lineage, evaluated its mutational profile, and conducted a phylogeographic analysis to reveal its global dispersal dynamics. Among approximately 16 million publicly available SARS-CoV-2 sequences generated by 30 September 2023, only 87 were of the FN.1 lineage, including 22 from Botswana, 6 from South Africa, and 59 from the UK. The estimated time to the most recent common ancestor of the 87 FN.1 sequences was 22 October 2022 [95% highest posterior density: 2 September 2022—24 November 2022], with the earliest of the 22 Botswana sequences having been sampled on 7 December 2022. Discrete trait reconstruction of FN.1 identified Botswana as the most probable place of origin. The FN.1 lineage is derived from the BQ.1.1 lineage and carries two missense variants in the spike protein, S:K182E in NTD and S:T478R in RDB. Among the over 90 SARS-CoV-2 lineages circulating in Botswana between September 2020 and July 2023, FN.1 was most closely related to BQ.1.1.74 based on maximum likelihood phylogenetic inference, differing only by the S:K182E mutation found in FN.1. Given the early detection of numerous novel variants from Botswana and its neighbouring countries, our study underscores the necessity of continuous surveillance to monitor the emergence of potential VOCs, integrating molecular and spatial data to identify dissemination patterns enhancing preparedness efforts.
Hepatitis B surface antigen loss in individuals with chronic hepatitis B virus and HIV-1 infections in Botswana
(Lippincott, Williams and Wilkins, 2024-02) Mpebe, Gorata G.A.; Phinius, Bonolo B.; Mutenga, Sharon; Baruti, Kabo; Bhebhe, Lynnette; Choga, Wonderful T.; Jongman, Mosimanegape; Pretorius-Holme, Molly; Gaolathe, Tendani; Mmalane, Mompati; Shapiro, Roger; Makhema, Joseph; Lockman, Shahin; Moyo, Sikhulile; Anderson, Motswedi; Gaseitsiwe, Simani
OBJECTIVES : We sought to determine hepatitis B surface antigen (HBsAg) loss and its predictors among people with chronic hepatitis B (CHB) infections and HIV (PWH) in Botswana. METHODS : Archived plasma samples from a cohort of PWH in Botswana (2013–2018) with 3 yearly time-points were used. Samples were screened for HBsAg, immunoglobulin M HBV core antibodies (anti-HBc IgM) and HBV e-antigen (HBeAg) at all time points. HBV deoxyribonucleic acid (DNA) quantification was done at baseline. The Wilcoxon rank-sum was used to compare continuous variables while the chi-squared test and Fishers exact test were used for categorical data wherever appropriate. Logistic regression was used to assess predictors of seroclearance. RESULST : Of 141 participants with HBsAg-positive serology (HBsAg+) at baseline, 92.2% (131/141) [95% confidence interval (CI) 87.4–96.1] were persistently HBsAg+ at year 1. We report a HBsAg loss of 7.1% (10/141) (95% CI 3.9–12.6) among participants with negative HBeAg and negative IgM serologies. HBsAg loss was 6.3% (7/111) among antiretroviral therapy (ART)-experienced participants and 10.7% (3/28) (95% CI 0.4–5.0) in ART-naive participants. Most participants who had positive anti-HBc IgM serology and did not lose HBsAg were on either lamivudine (3TC)-based therapy or non-tenofovir disoproxil fumarate (TDF)-based therapy, except for one participant. The participants also had varying HBeAg status. HBsAg loss was independent of HIV viral load, CD4+ cell count, age, and sex. CONCLUSION : We report a HBsAg loss of 6.3% over a 3-year period among ART-experienced CHB participants. Future studies that focus on HBsAg loss in mono-infected patients and the possible correlation between HBeAg status and HBsAg loss are warranted.
A guide to implementation science for Phase 3 clinical trialists : designing trials for evidence uptake
(Elsevier, 2024-11) Van Spall, Harriette G.C.; Desveaux, Laura; Finch, Tracy; Lewis, Cara C.; Mensah, George A.; Rosenberg, Yves; Singh, Kavita; Venter, Francois; Weiner, Bryan J.; Zannad, Faiez
The delayed and modest uptake of evidence-based treatments following cardiovascular clinical trials highlights the need for greater attention to implementation early in the development and testing of treatments. However, implementation science is not well understood and is often an afterthought following phase 3 trials. In this review, we describe the goals, frameworks, and methods of implementation science, along with common multilevel barriers and facilitators of implementation. We propose that some of the approaches used for implementation well after a trial has ended can be incorporated into the design of phase 3 trials to foster early post-trial implementation. Approaches include, but are not limited to, engaging broad stakeholders including patients, clinicians, and decision-makers in trial advisory boards; using less restrictive eligibility criteria that ensure both internal validity and generalizability; having trial protocols reviewed by regulators; integrating trial execution with the health care system; evaluating and addressing barriers and facilitators to deployment of the intervention; and undertaking cost-effectiveness and cost utility analyses across jurisdictions. We provide case examples to highlight concepts and to guide end-of-trial implementation. HIGHLIGHTS • Cardiovascular disease remains inadequately treated, highlighting the need for greater attention to implementation science. • Trialists and clinicians could harness key principles of implementation science to foster better end-of-trial uptake. • Phase 3 trials could use less restrictive eligibility criteria, engage broad stakeholders in trial design, use existing health care systems to execute the trial, evaluate barriers and facilitators to implementation, and improve workflow processes within the trial. • When trial results are positive, trial sites could be engaged in early implementation research and deployment of the intervention.
Validation of screening instruments for common mental disorders and suicide risk in South African primary care settings
(Elsevier, 2024-10) Stockton, Melissa A.; Mazinyo, Ernesha Webb; Mlanjeni, Lungelwa; Sweetland, Annika C.; Scharf, Jodi Y.; Nogemane, Kwanda; Ngcelwane, Nondumiso; Basaraba, Cale; Bezuidenhout, Charl; Sansbury, Griffin; Olivier, David; Grobler, Christoffel; Wall, Melanie M.; Medina-Marino, Andrew; Nobatyi, Phumza; Wainberg, Milton L.
INTRODUCTION : In South Africa, there is limited mental health infrastructure and resources. Valid screening tools are needed to facilitate identification and linkage to care. We evaluated the performance of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5), and the Columbia Suicide Severity Rating Scale (C-SSRS) among adults in South Africa against a diagnostic gold standard. METHODS : Adults present at healthcare facilities were screened with the PHQ-9, GAD-7, PC-PTSD-5, and the C-SSRS. Nurses used a structured diagnostic interview to identify depression, anxiety, panic disorder, PTSD and elevated suicide risk. We assessed the internal consistency, criterion validity, and the sensitivity and specificity of these tools. RESULTS : Of the 1885 participants, the prevalence of common mental disorders and suicide risk was 24.4 % and 14.9 %, respectively. The PHQ-9, GAD-7, and PC-PTSD-5 showed good internal consistency (0.80–0.89). All screeners demonstrated good criterion validity. For depression, a cut-off of ≥5 on the PHQ-9 yielded sensitivity of 84.24 %, while ≥10 yielded sensitivity of 48.77 %. For anxiety, the GAD-7 performed similarly. A cut-off of ≥4 on the PC-PTSD yielded sensitivity of 61.96 %. The C-SSRS yielded lower sensitivity than expected. LIMITATIONS : The prevalence data is not generalizable to the larger South African adult population given the use of a targeted, healthcare facility-based sampling and recruitment strategy. CONCLUSIONS : The performance of the PHQ-9, GAD-7, and PC-PTSD-5 demonstrated good internal consistency and criterion validity, though sensitivity and specificity trade-offs were enhanced with lower cut-offs. Further research into suicide risk screening is warranted. HIGHLIGHTS • The performance of PHQ-9, GAD-7, PC-PTSD-5 was acceptable among adults in South Africa. • Sensitivity and specificity trade-offs were enhanced using lower cut-offs. • The C-SSRS yielded lower sensitivity than expected.
Strengthening local capacity for mathematical modelling in low- and middle-income countries : the process and lessons learnt in implementing the first cohort of Nigeria malaria modelling fellowships
(BioMed Central, 2025-04) Kaduru, Chijioke; Ibe, Uche; Aladeshawe, Shina; Eche-George, Adaeze; Eshikhena, Ganiyat; Aadum, Dumale; Okon, Bassey; Iorkase, Emmanuel D.; Leghemo, Kesiye; Ogunbode, Oladipo; Okoronkwo, Chukwu; Okoro, Onyebuchi; Igumbor, Ehimario Uche; Oyeyemi, Abisoye; Uhomoibhi, Perpetua; Babatunde, Seye
BACKGROUND : Mathematical modelling plays a crucial role in understanding malaria epidemiology and evaluating anti-malarial interventions. In sub-Saharan Africa, National Malaria Control Programs are increasingly collaborating with modellers to optimize impact within constrained fiscal environments and evaluate the effectiveness of ongoing malaria control efforts. Despite Nigeria’s National Malaria Elimination Program soliciting modelling expertise, there remains a significant capacity gap in low- and middle-income countries (LMICs), including Nigeria. To address this, the Nigerian Malaria Modelling Fellowship (MMF) adopts a one-health approach within the Nigerian Field Epidemiology and Laboratory Training Program. METHODS : The MMF aims to enhance mathematical modelling capacity among Nigerian public health professionals by increasing the number of doctoral and postdoctoral graduates proficient in using modelling for planning, program evaluation, and outcome assessment. This paper highlights the initiative’s innovative aspects and shares initial implementation insights. RESULTS : Implemented using a human-centred design, MMF is a collaborative effort involving multiple public health stakeholders. The curriculum spans four courses—Malaria, Mathematical Modelling, Evidence Translation, and Project Management—each with targeted modules. The first cohort recruitment attracted 2173 applications, rigorously screened through a five-step process, selecting 33 Fellows from all geopolitical zones of Nigeria. The cohort applies a one-health lens and includes 48% female representation. Key findings highlight the importance of government leadership, gender mainstreaming, stakeholder co-creation, leveraging existing investments, adopting best practices, and expanding engagement to meet national needs. CONCLUSION : MMF demonstrates a collaborative effort to build modelling capacity among epidemiologists and healthcare professionals in LMICs, particularly for malaria. The rigorous recruitment process underscores a strong interest in mathematical modelling. The human-centred approach has fostered government leadership, multi-stakeholder engagement, and national ownership. This paper recommends increased commitments to local capacity strengthening in LMICs and advocates for evaluating the project, including assessing Fellows’ competencies post-training to ensure effective capacity development.
Between-and within-socioeconomic groups temporal inequality in the uptake of malaria prevention strategies among pregnant women and under-five children in Ghana (2003-2022)
(BioMed Central, 2025-08) Okova, Denis; Lukwa, Akim Tafadzwa; Edusei, Marian; Bodzo, Paidamoyo; Atta-Obeng, Christian; Chiwire, Plaxcedes; Hongoro, Charles
BACKGROUND : Malaria remains a leading cause of morbidity and mortality among pregnant women and children under five in sub-Saharan Africa. Despite over two decades of efforts including insecticide-treated net (ITN) distribution and intermittent preventive treatment in pregnancy (IPTp), universal and equitable coverage has not been achieved. In Ghana, coverage disparities persist, particularly along socioeconomic and geographic lines. This study investigates temporal trends and decomposes both within-group and between-group socioeconomic inequalities in ITN use and IPTp coverage among children and pregnant women in Ghana. METHODS : This study analysed nationally representative data from the Ghana Demographic and Health Surveys (2003, 2008, 2014, and 2022), focusing on ITN use among pregnant women and children under five, and IPTp uptake. Inequality was assessed using the Erreygers normalized concentration index (ENCI) and the Theil index (GE 2). Theil indices were then decomposed to quantify within- and between-group contributions by socioeconomic status (SES) and residence (urban versus. rural). RESULTS : ITN use among under-five children increased modestly from 58.1% (2003) to 62.9% (2022); among pregnant women, usage fluctuated but returned to 60% in 2022. IPTp coverage rose markedly from 0.85% (2003) to 60% (2022). ENCI values showed that ITN use was consistently pro-poor, becoming more concentrated among the poor over time (e.g., ENCI for pregnant women: − 0.04 in 2003 to − 0.32 in 2022). In contrast, IPTp coverage shifted to a pro-rich distribution from 2008 onwards. Theil decomposition revealed that most observed inequalities were driven by within-group disparities (e.g., within SES or residence categories), though between-group inequality increased over time particularly for IPTp. For example, in 2022, 85% of ITN inequality among pregnant women was within SES groups, while 18% was attributable to between-group differences. CONCLUSION : Despite overall improvements in malaria prevention uptake, substantial socioeconomic inequalities persist especially within social and geographic subgroups. Equity-focused strategies must complement national-level efforts by addressing barriers specific to underserved populations, including informal urban settlements and remote rural communities. Policymakers must prioritize targeted, locally responsive interventions to reduce both within- and between-group disparities and achieve Ghana’s malaria elimination and health equity goals.
Assessing Anopheles species collection techniques in a low malaria transmission area: implications for vector surveillance and control
(BioMed Central, 2025-07) Mashatola, Thabo; Tshikae, Power; Govere, John; Mazarire, Theresa T.; Brooke, Basil; Munhenga, Givemore
BACKGROUND : Effective entomological surveillance is crucial for malaria control, especially in low transmission settings. This study aimed to compare the performance of three mosquito collection methods (clay pots, carbon dioxide (CO2)-baited tents, and human landing catches (HLC)) for malaria vector surveillance in the low transmission area of Nkomazi, South Africa. METHODS : From March 2019 to March 2020, adult mosquitoes were collected monthly from three different sites over five consecutive nights and mornings. Each collection method was used at each site to capture both outdoor resting and host-seeking mosquitoes. The collected mosquitoes were morphologically identified to the Anopheles genus and species, followed by confirmation using molecular PCR assays. The species composition, relative abundance, and diversity were evaluated, and statistical tests, including Kruskal–Wallis and ANOVA, were used to assess differences in abundance and diversity across collection sites and methods. A Generalized Linear Mixed Model was applied to assess the impact of various factors on species abundance. RESULTS : A total of 1337 Anopheles mosquitoes were collected, with 98.5% being females. CO2-baited tents yielded the highest number of mosquitoes (57.6%), followed by HLC (39.1%) and clay pots (3.3%). Species composition included 52.4% of the Anopheles gambiae complex and 13.6% of the Anopheles funestus group. While species richness varied significantly between collection methods, with CO2-baited tents showing the highest richness, no significant differences were observed in abundance across sites or methods. The clay pot method was associated with significantly lower species abundance compared to HLC and CO2-baited tents. Species abundance fluctuated across months, with February and November showing a higher record. Males were less prevalent than females. Additionally, species abundance was lower in Block C and Vlakbult compared to Block A. CONCLUSIONS : This study highlights the importance of choosing appropriate mosquito collection methods based on specific entomological indicators and transmission dynamics. While CO2-baited tents provided the highest species richness, clay pots, despite yielding fewer mosquitoes, are effective for capturing outdoor resting malaria vectors. These findings suggest that a combination of collection methods is essential for inclusive malaria vector surveillance, facilitating tailored strategies for effective malaria control and resource optimization.
Anopheles arabiensis larval habitats characterization and Anopheles species diversity in water bodies from Jozini, KwaZulu-Natal Province
(BioMed Central, 2025-02) Marubini, Elliot; Musekiwa, Alfred; Maposa, Innocent; Mazarire, Theresa; Sekgele, Windy; Mabaso, Nondumiso; Dlamini, Dumsani; Mdose, Hetani; Kuonza, Lazarus R.; Munhenga, Givemore
BACKGROUND : The South African government is now implementing winter larviciding as a supplementary vector control tool. To achieve effective larviciding programme there is a need to understand the distribution of the breeding sites of vectors and their corresponding ecology. This study aimed to determine larval breeding sites of anophelines and characterize the physicochemical properties of water that promote the proliferation of Anopheles arabiensis immature stages. METHODS : A desktop survey of water bodies was carried out followed by a physical search of potential Anopheles breeding sites. Anopheline larvae were sampled from breeding sites in January and April 2021. At each breeding site, physicochemical characteristics of the water, including pH, electrical conductivity, total dissolved solids, salinity and turbidity, were measured. The collected Anopheles larvae were reared to adults and identified to genus and species level using morphological and molecular techniques. Factors associated with the presence of An. arabiensis larvae in the breeding sites were determined. RESULTS : Out of the 72 water bodies identified using desktop survey only 53% (n = 38/72) were identified through physical search. Of these 84% (n = 32/38) were positive for Anopheles larvae. A total of 598 Anopheles larvae were collected, of which 59.4% (n = 355/598) emerged into adults. Morphological identification of these adults, showed that the Anopheles gambiae complex accounted for 70% (n = 250/355) of the collections. From the 250 An. gambiae complex collected, 94% (235/250) were identified to species level by PCR and 6% (n = 15/250) failed to amplify. Of the 235 An. gambiae complex that were identified to species level, 62.5% (n = 147/235) were from January collections and 37.4% (n = 88/235) were from April collections. Molecular identification of the An. gambiae complex to species level showed predominance of An. arabiensis in April, 91% (n = 80/88). All physicochemical parameters differed significantly between the breeding site classes (p < 0.05 in all instances), except for electrical conductivity (p = 0.07). The aquatic habitats surveyed showed that the impermanency of the water bodies, neutral to alkaline pH, moderate salinity and low total dissolved solids were associated with the occurrence of An. arabiensis larvae. CONCLUSION : This study showed that An. arabiensis primarily breed in small temporary water bodies characterized by neutral pH.
Scaling for African inclusion in high-throughput whole cancer genome bioinformatic workflows
(MDPI, 2025-08) Jiang, Jue; Samaha, Georgina; Willet, Cali E.; Chew, Tracy; Hayes, Vanessa M.; Jaratlerdsiri, Weerachai
Sub-Saharan Africa is experiencing the highest mortality rates for several cancer types. While cancer research globally has entered the genomic era and advanced the deployment of precision oncology, Africa has largely been excluded and has received few benefits from tumour profiling. Through a thorough literature review, we identified only five whole cancer genome databases that include patients from Sub-Saharan Africa, covering four cancer types (breast, esophageal, prostate, and Burkitt lymphoma). Irrespective of cancer type, these studies report higher tumour genome instability, including African-specific cancer drivers and mutational signatures, suggesting unique contributory mechanisms at play. Reviewing bioinformatic tools applied to African databases, we carefully select a workflow suitable for large-scale African resources, which incorporates cohort-level data and a scalable design for time and computational efficiency. Using African genomic data, we demonstrate the scalability achieved by high-level parallelism through physical data or genomic interval chunking strategies. Furthermore, we provide a rationale for improving current workflows for African data, including the adoption of more genomic techniques and the prioritisation of African-derived datasets for diverse applications. Together, these enhancements and genomic scaling strategies serve as practical computational guidance, lowering technical barriers for future large-scale African-inclusive research and ultimately helping to reduce the disparity gap in cancer mortality rates across Sub-Saharan Africa. SIMPLE SUMMARY Africa faces the highest mortality rates across eight cancer types. However, cancer studies are biased toward European populations, leading to major concerns that cancer treatments may be ineffective for African patients. Providing a systematic review of African-inclusive whole cancer genome studies, African-derived tumours reveal distinct clinically relevant drivers, molecular taxonomies, and overall increased genomic instability, highlighting challenges associated with non-African-derived computational workflows. We provide a rationale for parallelism strategies to accelerate the processing steps of those distinctly intensive data, allowing for required scalability. Advocating for further resources that capture the rich African ancestral diversity, a concerted global effort will be required to improve and ultimately standardise bioinformatic workflows, thereby enhancing health outcomes for African cancer patients.
A randomized controlled trial combining house screening and insecticide-treated nets reduces malaria transmission in northwestern Ethiopia
(Nature Research, 2025-05) Belay, Aklilu; Asale, Abebe; Sole, Catherine L.; Yusuf, Abdullahi Ahmed; Torto, Baldwyn; Abro, Zewdu; Kassie, Menale; Mutero, Clifford Maina; Tchouassi, David P.
House screening (HS) of doors, eaves, and windows using wire-mesh has demonstrated potential in the integrated vector management of malaria. However, limited epidemiological data are available to guide its implementation across different ecological settings. In a 16-month randomized controlled trial (follow-up period) conducted across three agroecological areas (dry mountain, plateau highland, and semi-arid) in Jabi Tehnan district, northwestern Ethiopia, treatment houses were equipped with HS combined with insecticide-treated nets (ITNs), while control houses received ITNs only. The intervention led to a significant 2.3-fold reduction in indoor malaria vector density, the primary entomologic outcome, largely influenced by An. gambiae s.l. mosquitoes. Fewer blood-fed mosquitoes were found in screened houses, indicating reduced human bites, which translated to six-fold decline in malaria prevalence (0.7%), the primary epidemiologic outcome, compared to control houses (4.3%). In contrast, Plasmodium sporozoite infection rates showed no differences between screened and control houses or agroecological zones, with An. arabiensis and An. funestus s.l. identified as the primary vectors. A modest protective effectiveness (22.6%) was observed, based on the estimated entomological inoculation rate of 0.24 and 0.31 infectious bites/person/night in screened and control houses, respectively, with no variation by agroecology. Despite the synergistic impact of HS with existing ITNs in reducing vector densities, human bite rates, and household malaria prevalence, sustained transmission persisted, partly due to the presence of highly competent vectors such as An. funestus s.l. which had an overall sporozoite rate of 68%. Future research should explore the interactions between vector behavioral adaptations, ecological and social factors contributing to residual transmission, even with seemingly effective control measures.
Evolving landscape of sickle cell anemia management in Africa : a critical review
(MDPI, 2024-11-29) Musuka , HazelW.; Iradukunda , Patrick Gad; Mano , Oscar; Saramba , Eric; Gashema , Pierre; Moyo, Enos; Dzinamarira, Tafadzwa
Sickle cell disease (SCD) is a prevalent inherited blood disorder, particularly affecting populations in Africa. This review examined the disease’s burden, its diverse clinical presentations, and the challenges associated with its management in African settings. Africa bears a significant burden of SCD, with prevalence varying across countries and age groups. Newborn screening programs have highlighted the high prevalence of SCD at birth, emphasizing the need for early diagnosis and intervention. The clinical manifestations of SCD in Africa are multifaceted, encompassing acute complications like vaso-occlusive crises, acute chest syndrome, and stroke, as well as chronic complications such as organ damage and leg ulcers. Biological factors, including fetal hemoglobin levels, and demographic factors, like age and sex, influence disease severity and outcomes. The management of SCD in Africa faces numerous challenges. Limited access to resources, including diagnostic tools, medications, and trained healthcare professionals, hinders optimal care. The high cost of advanced therapies further restricts patient access. Cultural stigma and a lack of awareness create additional barriers to effective management. To address these challenges, early diagnosis through newborn screening programs and point-of-care testing is crucial. Comprehensive care models, including hydroxyurea therapy, pain management, and patient education, are essential for improving outcomes. Collaboration with international networks and leveraging local resources can enhance the sustainability of SCD programs. In conclusion, SCD significantly impacts African populations. Overcoming the challenges associated with its management requires addressing resource limitations, affordability issues, and cultural barriers. Early diagnosis, comprehensive care models, and ongoing research focused on affordability and accessibility are crucial for improving the lives of individuals living with SCD in Africa.
Enhancing global health security in Sub-Saharan Africa : the case for integrated One Health surveillance against zoonotic diseases and environmental threats
(Elsevier, 2025-12) Gashema, Pierre; Sesonga, Placide; Iradukunda, Patrick Gad; Muvunyi, Richard; Mugisha, Jean Claude; Ndayisenga, Jerome; Musafiri, Tumusime; Habimana, Richard; Bigirimana, Radjabu; Kabanda, Alice; Gashegu, Misbah; Gahamanyi, Noel; Izudi, Jonathan; Siddig, Emmanuel Edwar; Ngabonziza, Jean Claude Semuto; Ahmed, Ayman; Dzinamarira, Tafadzwa; Mutesa, Leon; Muvuny, Claude Mambo
Integrated One Health surveillance is pivotal to Africa's future health security, particularly in preventing and managing zoonotic and environmental health threats. The One Health strategy recognizes the interconnectedness of human, animal, and environmental health, allowing a holistic framework for tracking and responding to emerging and re-emerging pathogens. The One Health approach facilitates cross-sectoral data sharing and enhances surveillance, enabling the early detection and response to potential outbreaks. This proactive approach shifts the paradigm from reactive crisis management to preventive containment strategies. However, challenges such as funding gaps, limited infrastructure, limited diagnostic capacity, and weak multi-sectoral and cross-border collaborations remain. This perspective paper aims to 1) explore the effectiveness of integrated One Health surveillance in early detection and response to zoonotic diseases and environmental threats in Sub-Saharan Africa (SSA), and 2) identify key challenges and proposed solutions to strengthen regional health security. A multisectoral laboratory working group (MLWG) emerged as a pillar to enable active surveillance targeting humans, animals, and the environment. This paper highlighted essential strategies for enhancing One Health surveillance in SSA in light of the recent Marburg virus disease in Rwanda. It emphasizes environmental sampling through animal excreta and wastewater surveillance for early zoonotic detection, advocates for point-of-care polymerase chain reaction (PCR) testing platforms, and multiplex models to improve decentralized diagnostics. With 48 % of African nations incorporating One Health in national agendas, a unified continental framework is needed to support broader adoption and advance regional health security.

Browse

Recent Submissions