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

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Young women's perspectives on a user-friendly self-sampling intervention to improve the diagnosis of sexually transmitted infections in underserved communities in KwaZulu-Natal, South Africa
(BioMed Central, 2025-05) Jaya, Ziningi Nobuhle; Mapanga, Witness; Mashamba-Thompson, Tivani Phosa; u21848522@tuks.ac.za
INTRODUCTION : Young women are disproportionately affected by sexually transmitted infections (STIs), especially in the KwaZulu-Natal province of South Africa thus the need for availability and accessibility to STI healthcare services. The main objective of this study was to collaborate with young women, using a nominal group technique (NGT), to identify barriers to existing STI healthcare services to ultimately identify strategies to inform attributes for a discrete choice experiment (DCE) towards developing a user-friendly self-sampling intervention for STI diagnosis in young women. The NGT was underpinned by the theoretical domains framework to identify and analyse factors that influence healthcare seeking behaviour. METHODS : Eight young women, aged 18-24 years, were purposively selected from primary healthcare clinics in underserved communities. An NGT was conducted comprising the following steps: silent generation where individuals considered and recorded their responses to a question; round-robin sharing, recording and discussion of individual responses; followed by ranking of contributions. Thematic analysis was used to analyse data. RESULTS : The following barriers to accessing STI healthcare services were identified: the clinics were too far from home; young women feared judgement by clinic staff; young women feared being told to inform their partners; clinic hours clashed with school hours and other personal commitments; and young women did not know enough about the signs and symptoms of STIs. The following strategies to improve access to STI healthcare services were suggested: campaigns to promote self-sampling; self-sampling kits should be available free of charge; an online system to assess symptoms and register to receive self-sampling kits via delivery or collection to accommodate people with disabilities. CONCLUSION : The strategies identified informed the attributes for the DCE which is aimed towards the development of a user-friendly self-sampling intervention for STI diagnosis in young women in KwaZulu-Natal.
Enhancing HIV self-testing uptake among university students in Rwanda : the proportion, barriers, and opportunities
(BioMed Central, 2025-03) Mukashyaka, Ritah; Kaberuka, Gerald; Favina, Alain; Lutasingwa, Dan; Mulisa, Fred; Turatsinze, Everest; Karanja, Ann; Kansiime, Deborah; Niyotwagira, Egide; Ikuzo, Basile; Kaggwa, Mark Mohan; Kagaba, Aflodis; Mathebula, Evans Mantiri; Rwibasira, Gallican N.
INTRODUCTION : University students in Rwanda are at high risk for HIV, yet they have a low uptake of HIV self-testing, which is crucial for HIV diagnosis and prevention. This study investigated their knowledge, behaviors, and perceptions towards HIV self-testing, highlighting the barriers and opportunities whose consideration is necessary for the improvement of HIV self-testing uptake in this population. METHOD : A concurrent mixed-method design was used, and it involved 424 students from five universities across Rwanda. Quantitative data was collected through surveys, and descriptive statistics were performed. Chi-square tests were performed, and sociodemographic variables were stratified against the awareness of HIV self-testing and HIV self-testing for the past 12 months variables. Qualitative data was collected through in-depth interviews and focus group discussions using interview guides developed based on the Health Belief Model (HBM) framework; data was then analyzed thematically. RESULTS : The mean age was 23 (IQR: 21; 24), with 51.2% (n = 214/424) females. 64.7% (n = 261/424) of students had never heard of HIV self-testing, yet 37.74% (160/424) were sexually active. Among sexually active students, 17.87% were aware of HIV self-testing, but 35.82% had never used it. The reported perceived HIV self-testing barriers include high cost, unavailability of testing kits, lack of awareness, misinformation, and absence of post-test counseling. However, some HIV self-testing opportunities, like the availability of testing kits and motivating factors for university students to test, were also reported. CONCLUSION : Although university students reported the needs and benefits of HIV self-testing, uptake remains low due to misinformation, unawareness, unavailability, and the high cost of HIV self-testing kits. Increasing awareness, availing HIVST kits, and addressing the other reported barriers to HIV self-testing, is essential for the achievement of the universal goal of HIV status awareness among university students.
Correspondence on 'Increasing awareness and surveillance of sexually transmitted infections among adolescents is an essential element of HIV epidemic control in sub-Saharan Africa' by Murewanhema et al.
(BMJ Publishing Group, 2025-03) Murewanhema, Grant; Moyo, Enos; Dzinamarira, Tafadzwa
No abstract available.
The effectiveness of an m-health intervention on the sexual and reproductive health of in-school adolescents : a cluster randomized controlled trial in Nigeria
(BioMed Central, 2024-01-13) Akande, Oluwatosin Wuraola; Muzigaba, Moise; Igumbor, Ehimario; Elimian, Kelly; Bolarinwa, Oladimeji Akeem; Musa, Omotosho Ibraheem; Akande, Tanimola Makanjuola
BACKGROUND : The implementation of the country-wide comprehensive sexuality education (CSE) curriculum among in-school adolescents remains abysmally low and mHealth-based interventions are promising. We assessed the effect of a mHealth-based CSE on the sexual and reproductive health (SRH) knowledge, attitude and behaviour of in-school adolescents in Ilorin, northcentral Nigeria. METHODS : Using schools as clusters, 1280 in-school adolescents were randomised into intervention and control groups. Data was collected at baseline (T0), immediately after the intervention (T1) and 3 months afterwards (T2) on SRH knowledge, attitude and practice of risky sexual behaviour (RSB). Data analysis included test of associations using Chi-square, independent t-test and repeated measures ANOVA. Predictors were identified using binary logistic regression. RESULTS : In the intervention group, there was a statistically significant main effect on mean knowledge score (F = 2117.252, p = < 0.001) and mean attitude score (F = 148.493, p = < 0.001) from T0 to T2 compared to the control group which showed no statistically significant main effects in knowledge (p = 0.073), attitude (p = 0.142) and RSB (p = 0.142). Though the mean RSB score declined from T0 to T2, this effect was not statistically significant (F = 0.558, p = 0.572). Post-intervention, being female was a positive predictor of good SRH knowledge; being male was a positive predictor of RSB while being in a higher-class level was a negative predictor of RSB. CONCLUSION : The mHealth-based CSE was effective in improving SRH knowledge and attitude among in-school adolescents. This strategy should be strengthened to bridge the SRH knowledge and attitude gap among in-school adolescents. Trial registration Retrospectively registered on the Pan African Clinical Trial Registry (pactr.samrc.ac.za) on 19 October 2023. Identification number: PACTR202310485136014. PLAIN LANGUAGE SUMMARY : In Nigeria, the implementation of a nationwide sex education programme for adolescents going to schools is below expectation but using mobile health (mHealth) interventions could help. In this study, we looked at how a mHealth-based sex education programme affected the sexual and reproductive health (SRH) knowledge, attitude, and behaviour of in-school adolescents in Ilorin, Nigeria. We divided 1280 students into two groups, one received the mHealth-based intervention and the other did not receive it. We collected data before the intervention, right after it, and 3 months later to see any changes in SRH knowledge, attitudes, and risky sexual behaviours. We used various statistical tests to analyze the data and find patterns. The results showed that the group that received the mHealth intervention had significant improvements in their knowledge and attitudes about SRH from the start of the study to 3 months after the intervention. However, the control group, which didn't get the intervention, didn't show these improvements significantly. While the risky sexual behaviour score decreased slightly in the intervention group, this change was not significant. After the intervention, we found that being female was associated with better SRH knowledge, while being male was linked to more risky sexual behaviours. Also, being in a higher class level was associated with low risky behaviour. In conclusion, using mHealth for sex education helped improve the SRH knowledge and attitudes of students. This approach could be scaled to fill the gap in SRH knowledge and attitudes among adolescents in schools.
Performance evaluation of SARS-CoV-2 rapid diagnostic tests in Nigeria : a cross-sectional study
(Public Library of Science, 2024-07-15) Omonkhua, Akhere A.; Faneye, Adedayo; Akinwande, Kazeem S.; Evaezi, Okpokoro; Shehu, Nathan Y.; Onayade, Adedeji; Ochu, Chinwe Lucia; Popoola, Mustapha; Emmanuel, Nnadi; Ojo, Temitope; Ohonsi, Cornelius; Abubakar, Abdullahi; Odeh, Elizabeth; Akinduti, Paul; Folarin, Onikepe; Bimba, John Samson; Igumbor, Ehimario; Elimian, Kelly; Edem, Victory Fabian; Luka, Pam D.; Olusola, Tunde; Ntoimo, Loretta; Olugbile, Michael; Opayele, Adewale Victor; Kida, Ibrahim; David, Shwe; Onyeaghala, Augustine; Igbarumah, Isaac; Maduka , Omosivie; Mahmoud, Magaji A.; El-Fulatty, Abdul Rahman; Olaleye, David O.; Simon, Omale; Osaigbovo, Iriagbonse Iyabo; Obaseki, Darlington Ewaen; Tolulupe, Afolaranmi; Happi, Christian; Jibrin, Yusuf Bara; Okonofua, Friday; Eliya, Timan; Simji, Gomerep; Izang, Joy Abi; Ameh, Emmanuel; Maigari, Ibrahim Mahmood; Alhaji, Sulaiman; Adetifa , Ifedayo; Salako, Babatunde; Bogoro, Suleiman; Ihekweazu, Chikwe; Odaibo, Georgina N.; COVID-19 RDT Validation in Nigeria (CORVAN) study group
The COVID-19 pandemic challenged health systems globally. Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting the presence of SARS-CoV-2 in clinical samples. Rapid diagnostic test (RDT) kits for COVID-19 have been widely used in Nigeria. This has greatly improved test turnover rates and significantly decreased the high technical demands of RT-PCR. However, there is currently no nationally representative evaluation of the performance characteristics and reliability of these kits. This study assessed the sensitivity, specificity, and predictive values of ten RDT kits used for COVID-19 testing in Nigeria. This large multi-centred cross-sectional study was conducted across the 6 geo-political zones of Nigeria over four months. Ten antigen (Ag) and antibody (Ab) RDT kits were evaluated, and the results were compared with RT-PCR. One thousand, three hundred and ten (1,310) consenting adults comprising 767 (58.5%) males and 543 (41.5%) females participated in the study. The highest proportion, 757 (57.7%), were in the 20–39 years’ age group. In terms of diagnostic performance, Lumira Dx (61.4, 95% CI: 52.4–69.9) had the highest sensitivity while MP SARS and Panbio (98.5, 95% CI: 96.6–99.5) had the highest specificity. For predictive values, Panbio (90.7, 95% CI: 79.7–96.9) and Lumira Dx (81.2, 95% CI: 75.9–85.7) recorded the highest PPV and NPV respectively. Ag-RDTs had better performance characteristics compared with Ab-RDTs; however, the sensitivities of all RDTs in this study were generally low. The relatively high specificity of Ag-RDTs makes them useful for the diagnosis of infection in COVID-19 suspected cases where positive RDT may not require confirmation by molecular testing. There is therefore the need to develop RDTs in-country that will take into consideration the unique environmental factors, interactions with other infectious agents, and strains of the virus circulating locally. This may enhance the precision of rapid and accurate diagnosis of COVID-19 in Nigeria.
Triage of HPV positivity in a high HIV prevalence setting : a prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana
(Wiley, 2024-05) Luckett, Rebecca; Ramogola-Masire, Doreen; Gompers, Annika; Moraka, Natasha; Moyo, Sikhulile; Sedabadi, Leatile; Tawe, Leabaneng; Kashamba, Thanolo; Gaborone, Kelebogile; Mathoma, Anikie; Noubary, Farzad; Kula, Maduke; Grover, Surbhi; Dreyer, Greta; Botha, Matthys H.; Makhema, Joseph; Shapiro, Roger; Hacker, Michele R.
OBJECTIVE : Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. METHODS : We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). RESULTS : Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8-type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92–92.85) and women without HIV 85.92% (95% CI: 75.62–93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39–70.65], women without HIV 44.29% [95% CI: 32.41–56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15–78.41], women without HIV 45.71% [95% CI: 33.74–58.06]). However, 8-type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06–34.90) and women without HIV 37.06% (95% CI: 32.85–41.41). These results were similar when CIN3+ was used as the outcome. When combining 8-type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18–84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18–64.84). CONCLUSIONS : Eight-type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade-off between sensitivity and specificity with currently available options. CLINICAL TRIALS REGISTRATION : This study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823.
Concentrations of potentially toxic metals and trace elements in pregnant women and association with birth outcomes : a cross-sectional study in Malawi
(Public Library of Science, 2024-11-14) Mwapasa, Mphatso; Xu, Shanshan; Chakhame, Bertha Magreta; Maluwa, Alfred; Rollin, Halina B.; Choko, Augustine; Huber, Sandra; Odland, Jon Oyvind
Potentially toxic metals and trace elements have been used in Malawi for a long time. However, data on exposure to these elements by susceptible groups like pregnant women and its associations with reproductive health outcomes in Malawi and southern hemisphere is limited. We investigated the concentrations of potentially toxic metals as well as trace elements in pregnant women and assessed the relationship between the levels these elements in maternal blood and sociodemographic factors, dietary habits and birth outcomes. Maternal data was collected from 605 pregnant women. Provider administered questionnaire was used to collect data on maternal sociodemographic factors, life style and immediate birth outcomes. Maternal venous blood samples were collected from 506 pregnant women in southern Malawi between August 2020 and July 2021. An inductively coupled plasma mass spectrometry (ICP-MS) technique was used to analyse maternal blood samples for concentrations of arsenic (As), copper (Cu), lead (Pb), mercury (Hg), nickel (Ni), selenium (Se) and zinc (Zn). Maternal age emerged as the primary predictor for Cu (p = 0.023), As (p = 0.034) and Hg (p = 0.013) blood concentrations, followed by area of residence, which had significant impact on Ni (p = 0.024) and As (p < 0.001) concentrations. High maternal blood concentrations of Ni were associated with increased birth weight (p = 0.047), birth length (p = 0.026), head circumference (p = 0.029) and gestational age (p = 0.035). Negative associations were observed between maternal whole blood total arsenic (combining organic and inorganic As) concentration and neonatal birth length (p = 0.048) and head circumferences (p < 0.001). Similarly, higher maternal blood Pb concentrations were associated with smaller head circumference (p = 0.002) and birth weight (p = 0.016). This study demonstrates the need to introduce biomonitoring studies in Malawi and countries with similar settings in the global south.
Explaining socioeconomic inequality in food consumption patterns among households with women of childbearing age in South Africa
(Public Library of Science, 2024-10-21) Nglazi, Mweete D.; Ataguba, John E.
The changing food environment shifts peoples’ eating behaviour toward unhealthy food, including ultra-processed food (UPF), leading to detrimental health outcomes like obesity. This study examines changes in socioeconomic inequalities in food consumption spending between 2005/06 and 2010/11 in South African households with women of childbearing age (15 to 49) (WCBA). Data come from the 2005/06 and 2010/11 Income and Expenditure Surveys. The distribution of spending according to the NOVA food classification system groupings (unprocessed or minimally processed foods, processed culinary ingredients, processed and UPF products) was analysed using standard methodologies. Changes in spending inequalities between 2005/06 and 2010/11 were assessed using the concentration index (C), while the factors explaining the changes in spending inequalities were identified using the Oaxaca decomposition approach. The Kakwani index (K) was used to assess progressivity. Results show that average real spending on all food categories, including UPF, increased between 2005/06 and 2010/11. Socioeconomic inequality in UPF consumption spending decreased (C = 0.498 in 2005/06 and C = 0.432 in 2010/11), and spending on processed foods (C = 0.248 in 2005/06 and C = 0.209 in 2010/11). Socioeconomic status, race, and urban residence contributed to overall socioeconomic inequality and changes in UPF consumption inequality between 2005/06 and 2010/11. Spending on all food categories was regressive in 2005/06 (K = -0.173 for UPF and -0.425 for processed foods) and 2010/11 (K = -0.192 for UPF and -0.418 for processed foods) because such spending comprises a larger share of poorer household’s income than their wealthier counterparts. The government should address these contributors to inequality to mitigate the risks associated with UPF consumption, especially among less affluent households.
Did socioeconomic inequalities in overweight and obesity in South African women of childbearing age improve between 1998 and 2016? A decomposition analysis
(Public Library of Science, 2024-11-14) Nglazi, Mweete D.; Ataguba, John E.
Overweight and obesity in adult women contribute to deaths and disability from non-communicable diseases (NCDs) and obesity-related health problems in their offspring. Globally, overweight and obesity prevalence among women of childbearing age (WCBA) has increased, but associated socioeconomic inequality remains unclear. This study, therefore, assesses the changing patterns in the socioeconomic inequality in overweight and obesity among South African non-pregnant WCBA between 1998 and 2016. It uses data from the 1998 and 2016 Demographic and Health Surveys. Socioeconomic inequality in overweight and obesity was assessed using the concentration index (C). The index was decomposed to identify contributing factors to obesity and overweight inequalities. Factors contributing to changes in inequalities between 1998 and 2016 were assessed using the Oaxaca-type decomposition approach. Socioeconomic inequalities in overweight and obesity among WCBA in South Africa increased between 1998 (C of 0.02 and 0.06, respectively) and 2016 (C of 0.04 and 0.08, respectively). Socioeconomic status was the biggest contributor to overweight and obesity inequalities for both years. The Oaxaca-type decomposition showed that race and urban residence are major contributors to changes in overweight and obesity inequalities. Policies such as the current tax on sugar-sweetened beverages and subsidising fruits and vegetables, among others, are needed to prioritise WCBA, especially for those from disadvantaged socioeconomic backgrounds, in addressing inequalities in overweight and obesity in South Africa.
Practical recommendations for artificial intelligence and machine learning in antimicrobial stewardship for Africa
(Wiley, 2025-04) Dzinamarira, Tafadzwa; Mbunge, Elliot; Steiner, Claire; Moyo, Enos; Akinjeji, Adewale; Yamba, Kaunda; Mwila, Loveday; Muvunyi, Claude Mambo; u19395419@up.ac.za
The challenge of antimicrobial resistance (AMR) represents one of the most pressing global health crises, particularly, in resource-constrained settings like Africa. In this paper, we explore artificial intelligence (AI) and machine learning (ML) potential in transforming the potential for antimicrobial stewardship (AMS) to improve precision, efficiency, and effectiveness of antibiotic use. The deployment of AI-driven solutions presents unprecedented opportunities for optimizing treatment regimens, predicting resistance patterns, and improving clinical workflows. However, successfully integrating these technologies into Africa's health systems faces considerable obstacles, including limited human capacity and expertise, widespread public distrust, insufficient funding, inadequate infrastructure, fragmented data sources, and weak regulatory and policy enforcement. To harness the full potential of AI and ML in AMS, there is a need to first address these foundational barriers. Capacity-building initiatives are essential to equip healthcare professionals with the skills needed to leverage AI technologies effectively. Public trust must be cultivated through community engagement and transparent communication about the benefits and limitations of AI. Furthermore, technological solutions should be tailored to the unique constraints of resource-limited settings, with a focus on developing low-computational, explainable models that can operate with minimal infrastructure. Financial investment is critical to scaling successful pilot projects and integrating them into national health systems. Effective policy development is equally essential to establishing regulatory frameworks that ensure data security, algorithmic fairness, and ethical AI use. This comprehensive approach will not only improve the deployment of AI systems but also address the underlying issues that exacerbate AMR, such as unauthorized antibiotic sales and inadequate enforcement of guidelines. To effectively and sustainably combat AMR, a concerted effort involving governments, health organizations, communities, and technology developers is essential. Through collaborations and sharing a common goal, we can build resilient and effective AMS programs in Africa.
Violence against children in sub-Saharan Africa : a call for action
(Frontiers Media, 2025-04) Moyo, Enos; Moyo, Perseverance; Mangwana, Hadrian; Murewanhema, Grant; Dzinamarira, Tafadzwa; u19395419@up.ac.za
No abstract available.
Whole genomic analysis uncovers high genetic diversity of rifampicin-resistant Mycobacterium tuberculosis strains in Botswana
(Frontiers Media, 2025-02) Mogashoa, Tuelo; Loubser, Johannes; Choga, Ontlametse T.; Ngom, Justice Tresor; Choga, Wonderful T.; Mbulawa, Mpaphi B.; Molefi, Tuduetso; Stephen, One; Makhondo, Topo; Seru, Kedumetse; Motshosi, Patience; Zuze, Boitumelo; Makhema, Joseph; Musonda, Rosemary M.; Otukile, Dimpho; Modongo, Chawangwa; Kgwaadira, Botshelo T.; Fane, Keabetswe; Gaseitsiwe, Simani; Warren, Rob M.; Moyo, Sikhulile; Dippenaar, Anzaan; Streicher, Elizabeth M.
BACKGROUND : The emergence of drug-resistant Mycobacterium tuberculosis (M. tb) strains remains a threat to tuberculosis (TB) prevention and care. Understanding the drug resistance profiles of circulating strains is crucial for effective TB control. This study aimed to describe the genetic diversity of rifampicin-resistant M. tb strains circulating in Botswana using whole genome sequencing (WGS). METHODS : This study included 202 stored M. tb isolates from people diagnosed with rifampicin-resistant TB (RR-TB) between January 2016 and June 2023. Genomic DNA was extracted using the cetyltrimethylammonium bromide (CTAB) method. Library preparation was performed using the Illumina DNA prep kit following the manufacturer's instructions. Sequencing was done on Illumina NextSeq2000. TBProfiler software was used to identify known M. tb lineages and drug resistance profiles. Statistical analyses were performed on STATA version 18. RESULTS : WGS analysis revealed multidrug resistance (57.9%: 95% CI; 50.7–64.8), Pre-XDR (16.8%, 95% CI: 11.9–22.7), RR-TB (20.2%: 95% CI: 14.98–26.5), and HR-TB (0.5%, 95% CI; 0.01–2.7). We identified a high genetic diversity with three predominant lineages: lineage 4 (60.9%, 95% CI; 53.8–67.7), lineage 1 (22.8%: 95% CI; 17.2–29.2), and lineage 2 (13.9%, 95% CI: 9.4–19.4). The most frequently observed drug resistance mutations for rifampicin, isoniazid, ethambutol, streptomycin, pyrazinamide, and fluoroquinolones were rpoB S450L (28.6%), katG S315T (60.5%), embA_c.-29_-28delCT, embB Q497R (31.7%), rrs_n.517C>T (47.1%), pncA_c.375_389delCGATGAGGTCGATGT (36.0%) and gyrA A90V (79.4%), respectively. No bedaquiline and delamanid resistance-associated mutations were detected. CONCLUSIONS : This study highlights the high genetic diversity of M. tb strains, with a predominance of lineage 4 among people with RR-TB in Botswana. It provides valuable insights into the genetic diversity of rifampicin-resistant M. tb strains circulating in Botswana.
Insights into healthcare workers' perceptions of electronic medical record system utilization : a cross-sectional study in Mafeteng district, Lesotho
(BioMed Central, 2025-05) Sekoai, Tebeli E.; Turner, Astrid Chrisilda; Mitchell, Janine Sonia
BACKGROUND : Electronic medical record (EMR) systems have significantly transformed how healthcare data is created, managed, and utilized, offering improved legibility, accessibility, and support for clinical decision-making compared to paper records. In Lesotho, the system was implemented to enhance patient care, track patients, and generate reports for evidence-based programming. It is imperative to understand how healthcare workers (HCWs) perceive the system as frontline end-users; thus, the aim of the study was to explore HCWs’ perceptions of the system, focusing on perceived usefulness (PU) and perceived ease of use (PEU) and factors influencing acceptance and utilization in Mafeteng district. METHODS : A descriptive cross-sectional study design was conducted; 145 healthcare workers from 17 health facilities were invited to participate. The Technology Acceptance Model was incorporated into a self-administered questionnaire. The analysis employed descriptive statistics and the constructs of PU and PEU using Stata/BE 18.0. Multiple regression examined HCWs’ perceptions, while verbatim text from participants clarified quantitative findings. RESULTS : The study had a 49% response rate (n = 71). Most participants were female (70.42%; n = 50), with registered nurse midwives as the most common profession (45.07%; n = 32). A large proportion reported ‘good’ or ‘very good’ computer skills (43.66%; n = 31). For PU, 87.32% found the EMR system useful, 83.1% agreed it improves job performance, and 83.1% said it saves time. For PEU, 85.91% found the system easy to use, 81.69% could recover from errors, and 85% could remember task procedures. Network connectivity and electricity supply were cited as barriers to the effective use of the EMR system in health facilities, resulting in interruptions in service delivery. The characteristics of sex and profession had no significant impact on PU and PEU, while both qualification (p = 0.035) and computer skills (p = 0.007) were significant, indicating a positive association with greater PEU of the EMR system. CONCLUSION : HCWs in the Mafeteng District exhibited positive attitudes toward the EMR system, recognising its usefulness, ease of use, and efficiency. Sustaining computer literacy and addressing infrastructural challenges could further enhance the successful implementation and adoption of the system, ultimately improving patient care outcomes.
HIV-1 infection recency among individuals newly diagnosed with HIV in Greater Gaborone, Botswana
(Lippincott Williams and Wilkins, 2025) Moraka, Natasha O.; Ralegoreng, Charity; Lemogang, Goitseone M.; Makwakwa, Richard; Pema, Marea N.; Mokgethi, Patrick T.; Choga, Ontlametse T.; Gobe, Irene; Mokomane, Margaret; Maruapula, Dorcas; Moutswi, Salang T.; Rabatoko, Laone; Leteemane, Queen; Strachan-Amaro, Vanessa; Sabone, Phenyo; Mohammed, Terence; Moyo, Sikhulile; Gaseitsiwe, Simani
OBJECTIVE : We characterized individuals with human immunodeficiency virus type 1 (HIV-1) recent infection using a two-step recent infection testing algorithm (RITA) in recently diagnosed, antiretroviral therapy (ART) naive individuals within the Greater Gaborone area in Botswana. DESIGN : Plasma samples from a prospective longitudinal cohort study of individuals recently diagnosed with HIV within the Greater Gaborone area (2023 – 2024), the Tekodiso study, were used. METHODS : Recent infection classification was determined using Limiting Antigen Avidity (LAg-Avidity), as well as HIV viral load (VL) > 1000 copies/mL. LAg-normalized optical density (ODn) ≤ 1·5 represented a recency window of within 130 days post-infection. HIV VL in plasma was quantified by Abbott m2000sp/Abbott m2000rt. RESULTS : A total of 157 participants were included in this analysis. Median age at enrolment was 34 years (Q1, Q3: 27, 41) and majority 102 (65%) were female. The median log10 HIV VL was 4.6 copies/mL (Q1, Q3: 3.9, 5.2). A total of 12/157: 7.6% (95% CI 4.0: 13.0) individuals were classified as having a recent infection. Recent infection was not associated with age, employment status, or nationality. We observed a lower likelihood of recent HIV infection with secondary or higher education level (OR = 0.1; 95% CI: 0.1– 0.9). CONCLUSIONS : We report a 7.6% rate of HIV recent infection by LAg-based RITA in recently diagnosed ART naïve individuals in Botswana. Our results highlight the need for continued HIV infection surveillance to improve targeted interventions for the prevention of HIV acquisition within the country.
Protocol for the first cycle of the Collaborative Open Research Initiative Study (CORIS-1) : an international survey of personnel in health professions schools in 16 countries
(European Publishing, 2024-03) Agaku, Israel Terungwa; Nkosi, Lungile; Aldosari, Muath; Obadan, Enihomo M.; Odukoya, Oluwakemi; Zhang, Weifang; Alqaderi, Hend; Kennedy, Erinne N.; Vardavas, Constantine; Ayo-Yusuf, Olalekan Abdulwahab
The Collaborative Open Research Initiative Study (CORIS) is an inclusive and innovative international research project that welcomes contributors from across the globe. CORIS fosters a democratic and collaborative approach, shaping research actively and offering publication opportunities for newcomers in health professions education. In this protocol, we describe the aims and approach of CORIS, which is designed as an annual cross-sectional, web-based survey that seeks to explore critical topics in health professions education. The target population comprises faculty and staff in accredited, degree-granting medical, dental, nursing, pharmacy, and public health schools at undergraduate and postgraduate levels across 16 countries (n=14400). Collaborators within CORIS will actively engage in survey design, question formulation, and the entire research process. The first iteration, CORIS-1, scheduled for 2024, covers themes such as post-COVID-19 patient care, epidemic preparedness, burnout, artificial intelligence, remote learning, conflict's impact on mental health, substance use, and workplace discrimination. Data will be collected on the Chisquares™ survey platform, and results, codebook, questionnaire, and methods report will be publicly accessible. No sensitive data or identifying information will be collected. CORIS-1 fosters diversity by letting contributors suggest survey questions, aiming to provide novel data, identify gaps, and influence health education policies. It provides an opportunity for early-stage researchers to engage in the research process from start to finish and to obtain publications. Contributors must meet ICMJE authorship criteria. Collaborators can also explore the collected data for their independent projects. CORIS redefines research, fostering open collaboration and meaningful contributions. Diverse perspectives and collaborators' contributions are expected to enhance the research process. Graduate students working on theses or dissertations can propose questions in CORIS-1, and early career professionals can also enroll as collaborators to gain a comprehensive understanding of the research process from start to finish.
Healthcare workers' perspectives on the availability and use of mobile health technologies for disease diagnosis and treatment support in the Ashanti Region of Ghana
(Public Library of Science, 2024-04-16) Osei, Ernest; Apiribu, Felix; Kissi, Jonathan; Asante, Lydia Sarpomaa; Ampon-Wireko, Sabina; Mashamba‑Thompson, Tivani Phosa
INTRODUCTION : Considering the usefulness of mobile health (mHealth) technologies in healthcare delivery in low- and middle-income countries, including Ghana; there is a need to explore healthcare professionals’ perspectives on the availability and use of mHealth for disease screening and treatment of patients’ conditions. The study’s main aim is to explore healthcare professionals’ perspectives regarding the availability and use of mHealth applications for disease screening and management at point-of-care in Ghana’s Ashanti Region. MATERIALS AND METHODS : We conducted in-depth interviews with healthcare professionals who use mHealth applications daily between July and September 2020. A purposive sampling strategy was employed to select healthcare professionals who have been using mobile health application tools to support healthcare delivery. The researchers conducted 14 in-depth interviews with healthcare professionals on the availability and use of mHealth applications to support disease diagnosis and treatment of patients’ conditions. Data were transcribed, coded, arranged, and analyzed to determine categories and themes. RESULTS : The study results demonstrated that healthcare workers had positive perceptions towards mHealth applications. Healthcare professionals identified significant challenges concerning mHealth applications: the high cost of data; lack of education or limited awareness; poor mobile networks; unstable internet connectivity; erratic power supply; and unavailability of logistics. Healthcare professionals identified the following prerequisite strategies to strengthen the use and scale-up of mHealth applications: stable internet connectivity; creating awareness; supplying logistics; reducing the cost of data; and developing local mobile apps. CONCLUSIONS : The study results revealed the availability of mHealth applications at the individual level for disease screening and treatment support of patients’ conditions. The study also showed several significant challenges facing mHealth applications which need to be addressed to guarantee the successful implementation and scaling-up of mHealth activities at all levels of healthcare delivery. Hence, future research should incorporate healthcare professionals’ perspectives to completely understand mHealth implementation and scaling-up challenges and measures to inform policy regulations.
From diagnosis to therapy : the critical role of lncRNAs in hepatoblastoma
(Elsevier, 2024-08) Alzahrani, A. Khuzaim; Khan, Abida; Singla, Neelam; Hai, Abdul; Alzahrani, Abdullah R.; Kamal, Mehnaz; Asdaq, Syed Mohammed Basheeruddin; Alsalman, Abdulkhaliq Jassem; Hawaj, Maitham Abdullah Al; Odaini, Lulu Homeed Al; Dzinamarira, Tafadzwa; Imran, Mohd
According to findings, long non-coding RNAs (lncRNAs) serves an integral part in growth and development of a variety of human malignancies, including Hepatoblastoma (HB). HB is a rare kind of carcinoma of the liver that mostly affects kids and babies under the age of three. Its manifestations include digestive swelling, abdominal discomfort, and losing weight. This thorough investigation digs into the many roles that lncRNAs serve in HB, giving views into their varied activities as well as possible therapeutic consequences. The function of lncRNAs in HB cell proliferation, apoptosis, migratory and penetrating capacities, epithelial-mesenchymal transition, and therapy tolerance is discussed. Various lncRNA regulatory roles are investigated in depth, yielding information on their effect on essential cell processes such as angiogenesis, apoptosis, immunity, and growth. Circulating lncRNAs are currently acknowledged as potential indications for the initial stages of identification of cancer, with the ability to diagnose as well as forecast. In addition to their diagnostic utility, lncRNAs provide curative opportunities as locations and actors, contributing to the expanding landscape of cancer research. Several HB-linked lncRNAs have been demonstrated to exhibit abnormal expression and are involved in tumor-like characteristics via DNA, RNA, or protein binding or encoding short peptides. As a result, a better knowledge of lncRNA instability might bring fresh perspectives into HB etiology as well as innovative strategies for HB early diagnosis and therapy. We describe the abnormalities of lncRNA expression in HB and their tumor-suppressive or carcinogenic activities during HB carcinogenesis in this study. Furthermore, we explore lncRNAs' diagnostic and therapeutic possibilities in HB.
Modeling timing of sexual debut among women in Zimbabwe using a geoadditive discrete-time survival approach
(BioMed Central, 2025-03) Bere, Alphonce; Maposa, Innocent; Matsena-Zingoni, Zvifadzo; Twabi, Halima S.; Batidzirai, Jesca M.; Singini, Geoffrey C.; Mchunu, Nobuhle; Nasejje, Justine B.; Moyo-Chilufya, Maureen; Ojifinni, Oludoyinmola; Nevhungoni, Portia; Musekiwa, Alfred
BACKGROUND : Early sexual debut has undesirable health consequences such as an increased risk of contracting sexually transmitted infections (STIs) including HIV, mental health problems, pregnancy-related complications and death including abortion-related deaths. Despite a global decline in adolescent birth rates, Zimbabwe continues to face a high prevalence of underage pregnancies, highlighting significant early sexual debut among Zimbabwean adolescents. This study examined the spatial variation and the demographic and socio-economic determinants of the timing of early sexual debut among Zimbabwean women. METHODS : Data for 9,882 Zimbabwean women of reproductive age were drawn from the 2015 Zimbabwe Demographic and Health Survey (ZDHS). We defined early sexual debut as having first sexual intercourse before the 18 years of age. A fully Bayesian geoadditive discrete-time survival model was used. Adjustments for unequal sampling probabilities were done using the provided survey weights. RESULTS : Our findings show that women with primary education (aOR = 0.62,95% Crl:0.47–0.81), secondary education (aOR = 0.25,95% Crl:0.19–0.33) and higher education (aOR = 0.06,95% Crl:0.04–0.09) had lower odds of early sexual debut than those with no education. In comparison to those with middle household wealth index, women with higher household wealth index (aOR = 0.83, 95% CrI: 0.71–0.98) had lower odds of early sexual initiation. On the other hand, women with lower household wealth index had higher likelihood of early sexual debut (aOR = 1.13, 95% CrI: 1.03–1.26) than those with middle household wealth index. The type of place of residence and birth year cohort did not have a significant association with the odds of early sexual debut. The hotspots of early sexual debut were in Matabeleland North and Matabeleland South provinces. CONCLUSION : To mitigate early sexual debut in Zimbabwe, targeted interventions are essential in Matabeleland North and Matabeleland South provinces as well as in the identified high-risk groups.
Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa
(Public Library of Science, 2024-07-18) Dlangalala, Thobeka Nomzamo; Musekiwa, Alfred; Mashamba‑Thompson, Tivani Phosa
Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson’s pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.
Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption : a population attributable fraction analysis
(Elsevier, 2024-11) Rumgay, Harriet; Nethan, Suzanne; Shah, Richa; Vignat, Jerome; Ayo-Yusuf, Olalekan Abdulwahab; Chaturvedi, Pankaj; Guerra, Eliete N.S.; Gupta, Prakash C.; Gupta, Ruchika; Liu, Shiwei; Magnusson, Cecilia; Parascandola, Mark; Paulino, Yvette C.; Rezaei, Negar; Siddiqi, Kamran; Warnakulasuriya, Saman; Lauby-Secretan, Beatrice; Soerjomataram, Isabelle
BACKGROUND : Consuming products that contain smokeless tobacco or areca nut increases the risk of oral cancer. We aimed to estimate the burden of oral cancer attributable to smokeless tobacco or areca nut consumption globally and by type of smokeless tobacco or areca nut product in four major consuming countries. METHODS : We calculated population attributable fractions (PAFs) using prevalence of current use of smokeless tobacco or areca nut products from national surveys and corresponding risks of oral cancer from the literature. We applied PAFs to national estimates of oral cancer incidence in 2022 from the Global Cancer Observatory's Cancer Today database to obtain cases attributable to smokeless tobacco or areca nut consumption. We modelled 95% uncertainty intervals (UIs) using Monte Carlo simulations. FINDINGS : Globally, an estimated 120 200 (95% UI 115 300–124 300) cases of oral cancer diagnosed in 2022 were attributable to smokeless tobacco or areca nut consumption, accounting for 30·8% (95% UI 29·6–31·9) of all oral cancer cases (120 200 of 389 800). An estimated 77% of attributable cases were among male patients (92 600 cases, 95% UI 88 000–96 500) and 23% were among female patients (27 600 cases, 26 000–29 000). Regions with the highest PAFs were Melanesia, Micronesia, and Polynesia (78·6%, 95% UI 74·4–80·5), southcentral Asia (57·5%, 54·8–59·5), and southeastern Asia (19·8%, 19·0–20·6). Lower-middle-income countries represented 90·2% of the world total attributable cases (108 400 cases, 95% UI 103 400–112 200). INTERPRETATION : Our findings suggest that one in three cases of oral cancer globally are attributable to smokeless tobacco or areca nut consumption, and could be prevented through smokeless tobacco and areca nut control. Global cancer control efforts must incorporate further measures to reduce smokeless tobacco and areca nut consumption in populations with the largest attributable burden.

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