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

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Long-acting HIV pre-exposure prophylaxis integrated with community-based sexual and reproductive health services in South Africa (LAPIS) : study protocol for a hybrid (1a) cluster randomised controlled phase 3B trial of effectiveness and implementation
Busang, Jacob; Zuma, Thembelihle; Chimbindi, Natsayi; Ngoma, Nqobile; Herbst, Carina; Okesola, Nonhlanhla; Dreyer, Jaco; Smit, Theresa; Bird, Kristien; Mtolo, Lucky; Behuhuma, Ngundu; Lebina, Limakatso; Hendrickson, Cheryl; Miot, Jacqui; Hanekom, Willem; Herbst, Kobus; Seeley, Janet; Copas, Andrew; Baisley, Kathy; Shahmanesh, Maryam (BioMed Central, 2026-01)
BACKGROUND : Barriers and challenges associated with daily oral HIV pre-exposure prophylaxis (PrEP) contribute to poor uptake, low retention, and adherence rates among youth. Offering a choice of PrEP modalities integrated with peer support and delivered through community-based sexual and reproductive health (SRH) services will overcome these challenges. We describe the design of a trial to evaluate this approach at a population level. METHODS : We are conducting a type 1a hybrid effectiveness, phase 3B, cluster randomised controlled trial (LAPIS) to evaluate the effectiveness and implementation of offering PrEP modality choices through community-based SRH services amongst youth aged 15-30 years living in rural Kwa-Zulu Natal, South Africa. LAPIS is nested within Thetha nami ngithethe nawe (Let's Talk), an ongoing stepped-wedge trial with two periods investigating the effectiveness, implementation, and cost effectiveness of peer-led social mobilisation into decentralised integrated HIV and SRH services on the population prevalence of sexually transmissible HIV amongst youth. In the second period of Thetha nami, 40 trial clusters were randomised 1:1 to receive either a choice of PrEP modalities (oral PrEP, long-acting PrEP, i.e., two-monthly injectable cabotegravir (CAB LA) or dapivirine vaginal ring and HIV post-exposure prophylaxis [PEP] packs) or enhanced standard of care (ESoC) with oral PrEP only. All trial clusters are supported by peer navigators offering peer support and visited monthly by a mobile nurse-led clinic offering adolescent and youth-friendly HIV and SRH services. There are two primary outcomes: (1) effective uptake of PrEP or PEP, and (2) retention on PrEP, defined as attending at least one follow-up appointment after PrEP/PEP initiation, which are based on clinic data. Implementation outcomes are assessed using a mixed-methods and process evaluation following the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. DISCUSSION : LAPIS is a pragmatic trial to evaluate the addition of long-acting PrEP modalities to daily oral PrEP within community-based SRH services. By offering PrEP choices, LAPIS adopts a person-centred approach to improve adherence and retention among youth, including hidden key populations. Findings will provide insights into the real-world implementation of CAB-LA. TRIAL REGISTRATION : ClinicalTrials.gov Identifier-NCT06250504. Registered: 01 February 2024.
The COVID-19 vaccine procurement and supply chain in the Democratic Republic of Congo
Lobukulu Lolimo, Genèse; Kabadi, Yannick Musawu; Beshah, Senait Alemayehu; Khonde, Rodrigue; Beia, Aurore; Makongote, Héritier; Sumaili, Généros; Kabuya, Samue; Bongutu, Joél; Achala, Daniel Malik; Muriithi, Grace Njeri; Adote, Elizabeth Naa Adukwei; Zegeye, Elias Asfaw; Mbachu, Chinyere Ojiugo; Ataguba, John Ele-Ojo; Yaya Bocoum, Fadima Inna Kamina; Mayaka, Serge Manitu; Mafuta Musalu, et Éric (Frontiers Media, 2026-02)
The COVID-19 vaccine has been classified as an ‘essential medicine’, yet shortages and unequal distribution during the pandemic have reignited concerns about vaccine self-sufficiency in Africa. This study examined the mechanisms for acquiring, distributing, and administering existing COVID-19 vaccines in the Democratic Republic of Congo (DRC). A qualitative case study was conducted using semi-structured interviews with 23 key informants selected using reasoned choice, based on their professional roles in vaccine policy, logistics, and implementation. Participants were recruited from public institutions, with most being medical doctors and having experience in vaccination. Data were transcribed and analyzed were transcribed and analysis thematically using Atlas-ti 7.0. The study found that vaccine acquisition in the DRC relied heavily on international donations and multilateral initiatives, with limited national financial contribution. Distribution followed a five-tier supply chain managed by the Expanded Program on Immunization, moving vaccines from Kinshasa to provincial and field offices, then to selected health facilities. The Cold chain limitations, transport issues, and inconsistent vaccine availability challenged the administration. To improve vaccine access and coverage, stakeholders emphasized the need to strengthen logistical infrastructure and promote regional vaccine production. Honoring government commitments to co-finance procurement was also identified as a critical step toward sustainable vaccine supply.
Bridging immunization gaps in Sub-Saharan Africa : a narrative review of microplanning, geospatial, and machine learning approaches to reach zero-dose children and under-immunised children
Musuka, Godfrey; Umar, Al-umra; Dadari, Ibrahim; Moyo, Enos; Mano, Oscar; Iradukunda, Patrick Gad; Mbunge, Elliot; Murewanhema, Grant; Dhliwayo, Tapiwa; Mataruse, Noah; Sayem, Abu Sadat Mohammad; Dzinamarira, Tafadzwa (Elsevier, 2026-04)
Immunization inequities persist across Sub-Saharan Africa, with significant numbers of zero-dose and under-immunised children contributing to preventable morbidity and mortality. This narrative review critically examines the integration and effectiveness of machine learning, geospatial mapping, and microplanning strategies in identifying and reaching these vulnerable populations. The review's primary objective is to synthesise current evidence on how these innovative approaches are being applied within routine immunization systems to address persistent coverage gaps. A systematic search of peer-reviewed literature and grey sources was conducted, focusing on studies and programmatic reports from 2015 to 2025. The review analyses methodological trends, implementation experiences, and outcome data related to machine learning algorithms for risk profiling, geospatial technologies for mapping and targeting, and microplanning tools for local-level action. Data extraction and thematic synthesis were guided by the WHO framework for immunization equity. Findings demonstrate that machine learning models, utilizing demographic, health system, and mobility data, have enhanced the precision of zero-dose child identification, enabling more targeted outreach interventions. Geospatial mapping has further enabled real-time visualisation of immunization deserts and the spatial distribution of missed communities, supporting resource allocation and deployment of mobile teams. Microplanning, when integrated with digital tools and community engagement, has shown promise in translating high-level data into actionable local strategies, improving follow-up, and reducing missed vaccination opportunities. Despite these advancements, several challenges persist. Data quality and interoperability issues limit the scalability of machine learning and geospatial solutions, particularly in remote or fragile settings. Capacity gaps at the sub-national level, including technical skills and digital infrastructure, impede effective microplanning and data use. Furthermore, the sustainability of these approaches is threatened by fragmented investments and limited integration into national health information systems. Opportunities exist to strengthen the routine immunization system by standardising data collection, investing in workforce training, and fostering cross-sectoral collaboration. The review recommends prioritising the development of interoperable platforms, expanding context-specific pilot projects, and embedding evaluation mechanisms to track impact and equity outcomes. Policymakers are urged to leverage the demonstrated benefits of machine learning. HIGHLIGHTS • Immunization inequities persist across Sub-Saharan Africa. • We examined machine learning, geospatial mapping, and microplanning strategies in immunization programmes. • Machine learning models, geospatial and microplanning approaches have utility in zero-dose child identification. • Data quality and interoperability limit the scalability of these solutions
Adapting the emotional dysregulation questionnaire for South Africa : methods of adaptation and psychometric properties of the South African emotional dysregulation scale
Jewkes, Rachel; Chirwa, Esnat; Willan, Samantha; Gigaba, Gugulethu; Abrahams, Naeemah; Ramsoomar, Leane; Mahlangu, Pinky; Machisa, Mercilene; Paile, Charntel; Nöthling, Jani (Elsevier, 2026-06)
PURPOSE : Emotional dysregulation is an important aspect of psychopathology, especially borderline personality disorder, and is prevalent in populations exposed to multiple traumas, like South Africa. We describe adaptation of the emotional dysregulation questionnaire (EDQ) for South Africa and its psychometric performance. METHODS : We enrolled 58 ethnically-diverse women, who had experienced severe intimate partner violence, in eight group discussions held in three Provinces. They were asked what they did when they were upset, and related questions. During the groups, cognitive interviews focused on the EDQ. We adapted the EDQ using these findings, removing very similar or poorly understood items, and drafted new items for matters raised by the women. The resulting 23 items were tested with 236 women in a pilot study. RESULTS : Women described a range of behaviours when they were upset that indicated loss of control such as drinking heavily, being abusive, breaking things and beating their children. In the pilot, two items were highly skewed and three, measuring restricted emotional expression, were also poorly correlated with the rest of the scale and performance was poorer with them included. The remaining 18 items performed well with Cronbach's alpha = 0.862, acceptable item-rest correlations, and KMO = 0.865 (all items were above 0.80). On confirmatory factor analysis, the 18-item measure had the best fit. The measure was positively associated with depression, borderline personality disorder, PTSD and complex PTSD. CONCLUSION : The adapted emotional dysregulation questionnaire had robust psychometric properties and is positioned to be a useful scale with traumatised populations in South Africa. HIGHLIGHTS • The population of South Africa is exposed to multiple traumas and emotional dysregulation is common. • We asked trauma-exposed women to explore what they did when they were upset and their views on a standard measure. • We used information provided by South African trauma-exposed women to adapt and test the measure. • Our measure performed well in tests and was correlated with mental health problems in the way we expected. • We concluded that an 18-item measure of emotional dysregulation can be useful for mental health research in South Africa.
Acceptability of cardiovascular disease point-of-care diagnostics in primary care settings : a scoping review
Moswete, Nakedi; Nxele, Siphesihle Robin; Modipane, Penelope; Duah, Evans; Chale-Matsau, Bettina; Thompson, Gabrielle; Mashamba-Thompson, Tivani Phosa (Wiley, 2026-03)
BACKGROUND AND AIMS : Cardiovascular disease (CVD) remains the leading global cause of death, with 80% of deaths occurring in low- and middle-income countries (LMICs). Improving access to screening and early diagnosis is essential. Point-of-care testing (POCT), which provides rapid results near the patient, is particularly valuable in resource-limited settings. While POCT has been successfully implemented for infectious diseases like HIV and TB, investment in CVD-focused POCT remains limited. This scoping review maps global evidence on the acceptability of CVD POCT, guided by the World Health Organization's REASSURED criteria, to inform future implementation strategies. METHODOLOGY : This review followed the Arksey and O'Malley framework. A comprehensive search was conducted across PubMed, Scopus, Science Direct, Google Scholar, Web of Science, and EBSCOhost databases. A preliminary search confirmed feasibility. Two reviewers independently screened studies at all stages, with agreement assessed statistically. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT), version 2018. RESULTS : Out of 738 articles identified, 13 primary studies conducted in primary care settings were included. Themes emerging from the review included POCT availability, influence on triage and clinical decision-making, ease of use, sample volume, and feasibility. Only two studies were randomized controlled trials; the rest were observational, mostly comparing POCT accuracy to central laboratory testing. Inter-reviewer agreement was high (Kappa = 0.92), and MMAT scores ranged from 71.4% to 85.7%. CONCLUSIONS : CVD POCTs are generally acceptable and demonstrate strong potential for clinical integration. However, a lack of robust evidence on patient outcomes, particularly from LMICs, limits the establishment of their effectiveness. More randomized controlled trials and economic evaluations in LMICs, where the burden of CVD is highest, are needed to support broader implementation and inform global strategies to reduce the impact of CVD.
Prevalence of depressive and generalized anxiety features among patients with chronic care conditions
Phaahla, R. Dorothy; Musekiwa, Alfred (Taylor and Francis, 2026)
BACKGROUND : Mental illness remains a major public health concern globally. Patients with chronic conditions are vulnerable. OBJECTIVES : The study determined the proportion and associated factors of depression and anxiety among patients with chronic conditions, as it explores the implications for integrated mental healthcare delivery, by determining the prevalence of depressive and generalized anxiety features among patients receiving chronic care. Exploring how the coexistence of chronic physical illness and psychological distress may inform strategies for integrated, patient-centred care within primary healthcare settings. METHODS : Cross-sectional study of adult patients receiving chronic care. A PHQ-9 score of ≥10 indicated positive screening for depression and a GAD-7 score of ≥10 indicated anxiety. Multivariable logistic regression analysis was applied. RESULTS : Out of 286 patients, 30.4%(n = 87) were treated for hypertension and 26.9%(n = 77) for HIV. Depression was positively screened in 60.5%(n = 173) and anxiety in 66.1%(n = 189) patients. The odds of screening positive for depression were higher among patients with diabetes (aOR 1.92, 95%CI: 1.0-3.7), TB(aOR 3.66, 95%CI: 1.4-9.5). Positive screening for anxiety was higher among female residents. CONCLUSION : High rates of undiagnosed depression and anxiety are present in patients with chronic care conditions.
Prevalence and determinants of time to first intimate partner violence incidents among ever-married Ethiopian women
Mengste, Ashefet Agete; Belay, Denekew Bitew; Fenta, Haile Mekonnen; Chen, Ding-Geng (Din) (Elsevier, 2026-03)
BACKGROUND : Intimate partner violence (IPV), including physical, emotional, and sexual abuse disproportionately affects women globally, particularly in sub-Saharan Africa. OBJECTIVE : This study examined the timing and determinants of first experiences of IPV among ever-married Ethiopian women. PARTICIPANTS AND SETTING : The study analyzed nationally representative data from 4720 ever-married women who participated in the 2016 Ethiopian Demographic and Health Survey. METHODS : Cox proportional hazards and parametric accelerated failure time (AFT) models were used to identify factors influencing time to first IPV. Women who had not experienced IPV by the survey date or who reported IPV occurring before marriage were treated as right-censored. Multiple AFT distributions were compared, and the best-fitting models were selected. RESULTS : Approximately 30 % of women reported experiencing at least one form IPV, most commonly emotional (22.3 %). The log-normal AFT model best fit physical and sexual violence, while the Weibull AFT model fit emotional violence. Older women (35–49 years) experienced IPV later than younger women (time ratios [TR]: 2.09 physical, 2.82 sexual, 3.00 emotional). Husband's alcohol use, controlling behavior, family violence history, and fear of the husband were associated with earlier IPV occurrence (TR < 1). More children delayed physical and emotional violence (TR > 1), while older age at marriage predicted earlier emotional violence (TR = 0.7). CONCLUSIONS : Age, regional differences, family background, and husbands' behaviors significantly influence the timing of IPV onset among Ethiopian women. Targeted prevention programs addressing harmful partner behaviors, alcohol use, and intergenerational violence are essential to delay or prevent IPV and safeguard women's wellbeing.
PM2.5 chemical composition and geographic origin of air masses in Mabopane, South Africa
Bhuda, Mandla Freddy; Molnar, Peter; Boman, Johan; Shirinde, Joyce; Wichmann, Janine (Wiley, 2026)
Please read abstract in the article.
The burden of HPV35 in African cervical pathologies : prevalence, contributing factors, and vaccine prospects
Murahwa, Alltalents T.; Dzobo, Mathias; Mahenge, Anifrid; Rantshabeng, Patricia; Dube Mandishora, Racheal S. (Wiley, 2026-03)
Human papillomavirus (HPV35) is globally associated with only 2% of invasive cervical cancers (ICC) but demonstrates a disproportionately higher prevalence in sub-Saharan Africa, reaching up to 10% in previous reports. In this review, we provide updated data from multiple African countries, revealing high HPV35 prevalence rates in women with precancerous and ICC lesions. Among women with ICC, the highest prevalence of HPV35 was observed in Mozambique (30% and 19%), Kenya (26% and 22%), South Africa (17%), Burkina Faso (13.7%), Zimbabwe (11%), and Tanzania (11.2%). Similarly, in women with precancerous lesions (LSIL/HSIL/CIN1-3), the highest rates were recorded in Tanzania (26%) and Botswana (23% and 20%). These findings highlight a significant and underappreciated burden of HPV35-associated cervical disease in African populations, particularly among women with precancerous and invasive lesions. The findings call for an urgent re-evaluation of current HPV vaccination strategies to consider the inclusion of HPV35, which could profoundly enhance the effectiveness of cervical cancer prevention programs in sub-Saharan Africa.
Humoral and cellular immunogenicity of COVID-19 vaccine boosters in participants with advanced HIV disease
Nesamari, Rofhiwa; Crowther, Carol; Chiveto, Dexter Tadiwanashe; Pillay, Thanusha; Kgagudi, Prudence; Shusha, Nomcebo; Manamela, Nelia; Steel, Helen Carolyn; Van der Mescht, Mieke Adri; Slingers, Nevilene; Davids, Lee-Ann; Tshabalala, Khanyisile; Ueckermann, Veronica; Seocharan, Ishen; Reddy, Tarylee; Richardson, Simone I.; Moyo-Gwete, Thandeka; Abdullah, Fareed; Moore, Penny L.; Rossouw, Theresa M. (Elsevier, 2026-02)
BACKGROUND : People living with HIV (PLWH) who experience advanced immunosuppression are susceptible to severe COVID-19 and demonstrate compromised vaccine responses due to low CD4 counts and uncontrolled HIV viral load. Although vaccine boosters enhance immunity in the general population, their immunogenicity in individuals with advanced HIV remains inadequately characterised. METHODS : This study evaluated the humoral and cellular immunogenicity of COVID-19 vaccine boosters in 41 individuals with advanced HIV at baseline and 4 weeks post-vaccination. Binding antibodies, neutralising antibodies, antibody-dependent cellular cytotoxicity (ADCC), as well as spike-specific CD4+ and CD8+ T-cell responses were quantified and characterised. RESULTS : Booster vaccination was found to increase binding antibody titres (8.0-fold) and neutralising activity (3.9-fold), even among participants with CD4 counts <100 cells/mm³, although absolute responses remained lower than the controls. ADCC activity also modestly increased post-vaccination (2.1-fold). Spike-specific CD4+ T-cell responses increased in magnitude (0.001% to 0.160%, p=0.0001) and responder frequency (49% to 83%, p=0.0167) post-vaccination, while CD8+ T-cell responses remained low. Compared to the controls, PLWH had similar magnitudes of spike-specific CD4+ T-cell responses but significantly lower CD8+ T-cell responses. CONCLUSION : COVID-19 vaccine boosters enhance immunity in PLWH, however, the responses remain suboptimal compared to immunocompetent individuals, emphasising the need for tailored vaccination strategies. HIGHLIGHTS • COVID-19 booster vaccination increased binding and neutralising antibodies in PLWH. • PLWH with CD4 <100 cells/mm³ had lower antibody titres. • Spike-specific CD4⁺ T-cell responses increased after vaccination in PLWH. • CD8⁺ T-cell responses remained low compared to controls. • Findings support tailored vaccination strategies for advanced HIV.
DN-PMF as a sensitivity test for conventional PMF (C-PMF) source apportionment in three cities in South Africa, 2017–2018
Howlett-Downing, Chantelle Margaret; Boman, Johan; Molnar, Peter; Wichmann, Janine (Taylor and Francis, 2026)
Source apportionment through factorization is a common method for identifying sources of air pollution. Both PCA and DN-PMF have assumptions, strengths, and limitations. Assigning sources to factors is inherently subjective and can introduce bias. PCA for the number of sources, C-PMF and DN-PMF is performed on data from three cities which were sampled at the same time, 16 April 2017 to 18 April 2018. The DN-PMF was able to give seasonal information to support the source apportionment. Results of the PCA included 6 factors for Thohoyandou and Pretoria and 7 factors for Cape Town. At the two large city sites, the C-PMF presented a dominant coal emissions source (29% and 35.6%) yearly and a strong biomass source during winter (24% and 17%). The dominant yearly source shifted to vehicular emissions with the DN-PMF model in Pretoria and Cape Town (41% and 12%) and coal burning at Thohoyandou (33%). By considering the mixing layer and meteorological conditions the factors shifted while keeping the dominant Cl-Pb and Cu-Zn tracer combinations. HIGHLIGHTS DN-PMF is a valid sensitivity test for C-PMF by reducing subjective bias during the assigning of sources to factors.
Building community capacity in diabetes care : perspectives of community health workers
Heyns, Tanya; Muvhungu, Mukhethwa A.; Mathete, Sehlale; Filmalter, Cecilia Jacoba; Piotie, Patrick Ngassa (AOSIS, 2025-09-16)
BACKGROUND : Diabetes is a global public health concern. Approximately, 79% of people living with diabetes reside in low- and middle-income countries. Community healthcare workers (CHWs) provide basic care to communities, including people living with diabetes in South Africa; however, their contribution still needs to be explored. AIM : To explore the perceptions of CHWs regarding their roles in diabetes care. SETTING : This study was conducted at primary healthcare clinics in the Tshwane District, located in the northern part of Gauteng province in South Africa, where CHWs form part of ward-based outreach teams. METHODS : Using a descriptive qualitative research design, four focus group interviews were conducted with 32 CHWs with 5 or more years of experience and involved in providing care to people living with diabetes. The Dynamic reading, Engaged code book development, Participatory coding, Inclusive reviewing and summarizing of categories, Collaborative analysis, Translating (DEPICT) approach for collaborative qualitative data analysis was used. RESULTS : The participants indicated that their roles focused on health education, specifically related to diet, lifestyle changes, medication, involving family and self-care, support and monitoring. CONCLUSION : CHWs play an important role in the screening, continuous monitoring and referral of people living with diabetes. It is important that training and support for CHWs are aligned and informed by evidence and the needs of the communities they serve. CONTRIBUTION : The results may assist in the development of appropriate competencies, to inform programs and in-service training topics and regulate the practices of CHWs.
Availability and access to long-term inpatient rehab centers in north Tshwane, Gauteng
Komane-Mnguni, Rorisang G.; Mkhize, Nonhlanhla M.; Mfolo, Tshepiso; Madiba, Thomas Khomotjo (AOSIS, 2025-11-21)
BACKGROUND : Substance abuse is increasing in South Africa with research indicating a lack of access to public drug rehabilitation centres in all provinces of the country. The insights of recovering substance abusers in terms of access to centres remain a gap in the north of Tshwane. AIM : The study explored the recovering substance abusers' views or perspectives on the accessibility of long-term inpatient substance abuse rehabilitation centres. SETTING: South African National Council on Alcoholism and Drug Dependence (SANCA) centers in Soshanguve and Hammanskraal. METHODS : The qualitative study involved recovering substance abusers undergoing treatment at two outpatient substance rehabilitation centres in the north of Tshwane. The participants were interviewed using a semi-structured questionnaire which explored their views and perceptions and experiences on the accessibility to rehabilitation centres. RESULTS : Saturation was reached at 13 male participants between 29 years and 35 years of age. The interviews were transcribed and translated, and five distinct themes were identified. The themes identified were: rehabilitation is mindset-related; long waiting times translated into continuous substance abuse; peer pressure; no jobs or skills to keep busy; and a lack of trust within the community. Four of the themes were attributed to enabling factors for their substance abuse. CONCLUSION : Long waiting times, few rehabilitation centres, stigma, the lack of jobs and skills were identified as barriers to access rehabilitation centres. CONTRIBUTION : The study contributes to the body of literature exploring access problems in rehabilitation centres from the perspective of recovering drug addicts. It provides insights into risk factors that exacerbate the scourge of substance abuse in the north of Tshwane.
The global burden of Cholesteatoma : a systematic review and meta-analysis
Melariri, Herbert; Balakrishna, Yusentha; Mukhtar, Abdiwahab; Joseph, Elizabeth; Labuschagne, Simone; Hapunda-Chibanga, Racheal; Finestone, Sara; Bosman, Allison; Ukaegbe, Onyinyechi; Werkineh, Haben Birhane; Merven, Marc; Seguya, Amina; Melariri, Blessing; Mokoh, Lillian; Els, Timothy; Tharratt, Daniel; Murtaza, Amir; Moosajee, Mohamed; Harris, Tashneem; Onotai, Lucky; Amir, Ida; Melariri, Paula (Wiley, 2026-01)
OBJECTIVE : This systematic review and meta-analysis sought to estimate the global and World Health Organization (WHO) regional prevalence and burden of cholesteatoma. DATA SOURCES : PubMed, APA PsycINFO, the Cochrane Library, Embase, and WHO International Clinical Trials Registry Platform (ICTRP) from 2010 to 2025. REVIEW METHODS : Teams of independent reviewers assessed each study for inclusion. Studies reporting primary data on cholesteatoma prevalence, recurrence, or its impact were included. The primary outcome was the global prevalence, whereas secondary outcomes were regional prevalence and recidivism rates, treatment, and complications. A random-effects meta-analysis was used to pool data, and study quality and publication bias were assessed. This study was registered with PROSPERO (CRD42024533132). RESULTS : Forty-six eligible studies were included in the meta-analysis. The pooled global prevalence of cholesteatoma was estimated at 4.02 per 1000 persons (95% CI 1.79-7.10). By the WHO regions, the pooled prevalence of cholesteatoma in the Western Pacific Region, European Region, South East Asian Region, Region of the Americas, and African Region was estimated at 5.73 per 1000 persons (95% CI 1.00-13.87), 2.32 per 1000 persons (95% CI 2.23-2.42), 3.30 per 1000 persons (95% CI 2.65-4.11), 0.06 per 1000 persons (95% CI 0.00-0.00), and 7.32 per 1000 persons (95% CI 2.77-13.96), respectively. The prevalence of hearing loss in cholesteatoma was estimated at 75.68 per 100 cases (95% CI 59.02-89.24). CONCLUSION : This meta-analysis is the first to systematically quantify global and regional cholesteatoma prevalence, complications, and treatment approaches, highlighting regional disparities and informing public health strategies and policy globally.
Two decades of tracking femicide in South Africa : an analysis of four national surveys from 1999 to 2020/2021
Abrahams, Naeemah; Chirwa, Esnat; Mhlongo, Shibe; Dekel, Bianca; Ketelo, Asiphe; Lombard, Carl; Shai, Nwabisa; Ramsoomar, Leane; Mathews, Shanaaz; Labuschagne, Gérard; Matzopoulos, Richard; Prinsloo, Megan; Martin, Lorna J.; Jewkesa , Rachel (Taylor & Francis Group, 2025-12)
The absence of reliable administrative data from many countries means that there is little global surveillance of femicide. We conducted femicide surveillance with four dedicated national retrospective mortuary-based surveys to understand its magnitude among women 14 years and older in South Africa from 1999 to 2020/21, including the first year of COVID-19. The surveys included data from police on the investigation to ascertain who perpetrated the femicide (i.e. an intimate partner or someone else). We found overall femicides declined between 1999 and 2009, but the rate of decline slowed in subsequent years. Intimate partner femicide increased during the first year of COVID-19, unlike non-intimate partner femicide. Firearm-related femicides also increased in parallel with the increased availability of firearms in the country during the same period. The data show that South Africa remains one of the countries with the highest recorded rate of intimate partner femicide globally (5.5/100,000 female population), almost five times the global average. We have shown that femicide is prevent-able, but the conditions of the COVID-19 response likely increased the risk for women in abusive relations. We have also shown the value of dedicated surveys in the absence of reliable information systems.
Systematic scoping review on HIV services for males in Sub-Saharan Africa : access, barriers, and research gaps
Manjengwa, Patience G.; Yah, Clarence S.; Musakwa, Nozipho; Musekiwa, Alfred (Taylor and Francis, 2026)
BACKGROUND : Access to HIV services among men and boys in Sub-Saharan Africa is a significant public health challenge, exacerbated by cultural norms surrounding masculinity. This scoping review systematically investigates disparities in the provision and utilisation of these services in Sub-Saharan Africa. METHODS : The review followed the Arksey and O'Malley framework, employing a five-step process with any disputes resolved through discussion. A comprehensive search across various databases was conducted for studies published from January 2010 to October 2023. Methodological quality was assessed using PRISMA-ScR and the Mixed Method Appraisal Tool, while NVivo supported thematic content analysis. EndNote and Rayyan software facilitated reference management and study screening. RESULTS : Out of 1 489 studies retrieved, 30 met the inclusion criteria, primarily qualitative (70%) and quantitative (16.7%). Most studies originated from South Africa (n = 10) and Uganda (n = 5). HIV testing services accounted for 36.7% of the studies, followed by treatment services (26.7%) and prevention services (20%). Facilitators of access included community health services and male catch-up plans. Barriers to accessing HIV services included stigma, masculinity norms, and fear of HIV-positive results, with low-risk perception also frequently noted. Male engagement strategies emerged as key to improving service delivery and utilisation. CONCLUSIONS : The findings revealed a moderate body of literature on HIV services for men in Sub-Saharan Africa, with research concentrated in South Africa and Uganda. Stigma, masculinity norms, and fear of HIV-positive results remain significant barriers, while community health services and male catch-up plans facilitate access. Implementing male engagement strategies and addressing these barriers is essential for improving service delivery, informing policy, and prioritising future research in underrepresented regions.
Impact of climatic factors on malaria in Senegal based on the surveillance system between 2015 and 2022
Talla, Cheikh; Diarra, Maryam; Diouf, Ibrahima; Thiam, Mareme S.; Gaye, Aboubacry; Barry, Mamadou A.; Igumbor, Ehimario Uche; Merle, Corinne Simone; Audu, Rosemary; Loucoubar, Cheikh (Frontiers Media, 2025-09-18)
INTRODUCTION : Malaria remains a major public health concern, particularly in sub-Saharan Africa, where climatic factors strongly influence its transmission dynamics. However, the delayed effects of these factors on malaria incidence remain poorly understood. METHODS : This study examines the relationship between meteorological variables (temperature, rainfall, and humidity) and malaria incidence in Senegal from 2015 to 2022, using a distributed lag non-linear model (DLNM). Daily malaria case data were obtained from the Senegal syndromic sentinel surveillance network (4S network), while daily climatic data were sourced from the Senegalese meteorology agency and NASA POWER DATA Access. RESULTS : The results reveal significant associations between climatic factors and malaria cases. High maximum temperatures were associated with increased malaria risk at lag periods of 2–6 days, whereas extreme rainfall initially reduced mosquito breeding but contributed to increased malaria cases after 10–15 days. Similarly, relative humidity displayed non-linear, time-dependent effects on malaria incidence, underscoring the importance of considering lag effects in climate-health modelling. DISCUSSION : These findings highlight the necessity of integrating climate variability into malaria control strategies. Adaptive interventions, such as predictive modelling and early warning systems, could enhance response efficiency by enabling proactive vector control and healthcare resource allocation. Future research should explore additional factors, such as socio-economic and behavioural influences, to refine prediction models and optimise malaria prevention efforts in the context of climate change.
Attempted femicide : a mixed methods approach to deriving an operational definition for the Fedisa Modikologo Study, South Africa
Jewkes, Rachel; Mhlongo, Shibe; Chirwa, Esnat; Ramsoomar, Leane; Willan, Samantha; Woollett, Nataly; Christofides, Nicola; Seepamore, Boitumelo; Govindasamy, Darshini; Nothling, Jani; Mbowane, Venice; Phakoe, Maureen; Pass, Desire; Zembe, Amanda; Paile, Charntel; Washington, Laura; Shai, Nwabisa; Machisa, Mercilene; Mahlangu, Pinky; Carries, Stanley; Abrahams, Naeemah (Springer, 2026-02)
PURPOSE : Women often do not recognize when they experience attempted femicide, so another way of measuring it is needed for research. We examined narrative accounts of femicide attempts, and analysed data to determine whether we could systematically expand the definition of attempted femicide, for the purposes of research. METHODS : We recruited a non-probability sample of 3742 women into the Fedisa ModikologoStudy. They were 18–45 years and had experienced severe intimate partner violence in the previous year. They completed an interview with two closed and one open question about attempted femicide experiences. RESULTS : Strangulation, suffocation, stabbing, bludgeoning, gun shots, fire, mocked suicides and accidents were all used in attempted femicides, which 32.4% (1211/3742) of women said they had experienced. These were significantly more common among this sub-group of women. Gunshot injuries and loss of consciousness due to strangulation were the most strongly associated with a recognized femicide attempt, however other injuries were also associated. Assuming unrecognized femicide attempts were broadly similar, we conducted an analysis with recognized femicide attempts as a putative gold standard, and examined change in the sensitivity, specificity and ROC AUC of including different elements in the attempted femicide definition. After incrementally adding elements, we optimized the model with a sensitivity to 85.0%, specificity of 52.7% and ROC AUC of 67.1. CONCLUSIONS : Our findings point to a working definition of attempted femicide as having a recognized femicide attempt, or injuries leading to loss of consciousness, acts of strangulation, suffocation, gunshots, burns, or stabbing to the neck, torso or genitals.
Improving health professionals’ capacity to respond to the climate crisis in Africa : outcomes of the Africa climate and health responder course
Magalhães , Danielly de P.; Sorensen, Cecilia; Hamacher , Nicola; Campbell, Haley; Weinstein, Hannah N.W.; Owili, Patrick O.; Ario, Alex R.; Nja, Glory M.E.; Michael, Charles A.; Alimi, Yewande Alimi; Hien, Hervé; Amde, Woldekidan; Thiam , Sokhna; Pagiwa, Vincent; D’Andrea, Shawn M.; Gichuki, Caroline M.; Offei, Marian; Atela, Joanes; Patrick, Sean Mark; Struminger , Bruce; Kaseje, Margaret (Frontiers Media, 2025-10-15)
INTRODUCTION : The fragile health systems in Africa worsen climate-related health impacts, making capacity building essential to strengthen adaptation and resilience. The Africa Climate and Health Responders Course was developed to address the urgent need for climate and health education among African health professionals. Organized by the Global Consortium on Climate and Health Education (GCCHE) in collaboration with ASPHA, Africa CDC, WHO AFRO, Project ECHO, and other regional partners, the course aimed to enhance awareness, communication skills, and preparedness in responding to climate-related health challenges. METHODS : Delivered online via Zoom with over 11 sessions (September 17–October 22, 2024), the course featured expert lectures, case studies, and live discussions. Simultaneous interpretation in English, French, and Portuguese ensured broad accessibility. Participants who attended at least 70% of live sessions and passed the final exam received a certificate. A longitudinal survey was applied to understand the course impact. RESULTS : The course attracted 7,572 registrants, with 89% from Africa. While 3,500 participants attended at least one session, only 1,657 participated (1,607 from Africa) attended 70% or more of the sessions and completed the final survey. Participants held positions in government (31%), Non-Governmental Organizations (NGOs) (27%), academia (24%), private sector (11%), and others (7%). Their main professional backgrounds were public health (33.2%), medicine (16.3%), and environmental health (13.2%). The majority of participants (66%, n = 1,100) had never received prior training in climate and health; among them, 36% (n = 392) were students and 64% (n = 708) were not students. DISCUSSION : The course significantly improved participants’ self-reported confidence and perceived preparedness, with increases in: climate-health awareness (+22%); confidence in risk communication (+40%); preparedness for adaptation and resilience (+36-37%), and professional responsibility in climate-health action (+21%). These findings highlight not only the feasibility and effectiveness of virtual training in this context, but also the opportunity for scaling such initiatives to build a climate-resilient health workforce across Africa. Skilled professionals are key to fostering multi-stakeholder collaboration, integrating climate-health education, and engaging communities—efforts that require sustained investment in capacity building to institutionalize competencies and strengthen public health systems and policies over the long term.
Perceptions of South Africa's master of public health graduates on the degree's contribution to their leadership at work and in society
Zweigenthal , Virginia; Christofides, Nicola; Dlungwane, Thembelihle; Matlala, Sogo France; Mokgatle, Mathildah Mpata; Opare, Abraham; Patrick, Sean Mark; Schaay , Nikki; Shung-King , Maylene; Tshitangano, Takalani; Rispel, Laetitia (Frontiers Media, 2025-10-08)
INTRODUCTION : Integrating public health functions into national health systems is essential to enhance population health. The Master of Public Health (MPH) degree is an important foundation for public health practice in low-and middle-income countries such as South Africa. However, insufficient evidence on individual motivations for undertaking the MPH and the perceptions of graduates on the utility of the degree at work and in society and its contribution to their leadership skills informed this study. METHODS : A consortium of academics from eight South African universities developed a self-administered questionnaire to measure inter alia the socio-demographic characteristics, motivations, career paths, perceptions of the utility of the degree, and its contribution to their professional and personal development. The study population comprised the 2012–2016 cohort of MPH graduates from eight universities. Following informed consent, eligible graduates completed an online survey via REDCap. The data were analyzed using Stata. RESULTS : A total of 221 graduates completed the survey. The mean age of respondents was 35 years, and the majority were from South Africa (53.2%) or other African countries (43.2%). The majority (91.1%) completed the MPH to improve their skills or to promote their personal development for senior management and leadership roles. Approximately 75% used identified leadership skills at work, but only half these skills were obtained from the MPH. Over 80% of respondents positively impacted on their workplace and in society, using skills mostly derived from the MPH in all domains. DISCUSSION : This cohort of MPH graduates exercised leadership in different settings, but many stated that these skills were not obtained from the MPH programs. The COVID-19 pandemic underscored the need for public health leaders skilled in communication, collaboration, and crisis management, amidst considerations of social justice and equity. Hence, leadership skills need to be intentionally included in MPH programs in South Africa.

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