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

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Screening for diabetic retinopathy at a health centre in South Africa : a cross-sectional study
(AOSIS, 2025-01) Zulu, Ntokozo; Piotie, Patrick Ngassa; Webb, Elizabeth M.; Maphenduka, Wezi G.; Cook, Steve; Rheeder, Paul; patrick.ngassapiotie@up.ac.za
BACKGROUND : In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss. AIM : To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals. SETTING : Laudium Community Health Centre (CHC), a PHC facility in Tshwane. METHODS : We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected. RESULTS : A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management. CONCLUSION : The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency. CONTRIBUTION : The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.
Analytical treatment interruption among women with HIV in southern Africa who received VRC01 or placebo in the Antibody Mediated Prevention Study : ATI stakeholder engagement, implementation and early clinical data
(Wiley, 2025-06) Karuna, Shelly; Laher, Fatima; Dadabhai, Sufia; Yu, Pei-Chun; Grove, Doug; Orrell, Catherine; Makhema, Joseph; Hosseinipour, Mina C.; Mathew, Carrie-Anne; Brumskine, William; Mgodi, Nyaradzo; Andrew, Philip; Gama, Lucio; Karg, Carissa; Broder, Gail; Baepanye, Kagisho; Lucas, Jonathan; Andrasik, Michele; Takuva, Simbarashe G.; Villaran, Manuel; Takalani, Azwidihwi; Tressler, Randall; Soto-Torres, Lydia; Woodward Davis, Amanda S.; Dhai, Ames; Sanne, Ian M.; Cohen, Myron S.; Corey, Lawrence; Gray, Glenda; DeCamp, Allan C.; Bar, Katharine J.
INTRODUCTION : Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly neutralizing antibodies (bnAbs) may modulate immune responses to HIV. We evaluate whether early ART with or without anti-HIV-1 bnAb VRC01, present at HIV acquisition, is associated with later ART-free control in African women and we assess potential associations with observed control. METHODS : Stakeholder engagement informed analytical treatment interruption (ATI) study design and implementation. Participants who received placebo or VRC01 and acquired HIV in the Antibody Mediated Prevention efficacy trial were assessed for ATI eligibility, including HIV acquisition within 8 weeks of receiving VRC01 or placebo, followed by early ART initiation and ≥1 year of viral suppression. Participation facilitators and barriers were assessed. From May 2021 to February 2024, participants enrolled, stopped ART and received frequent viral load and CD4+ T-cell count monitoring for safety and assessment of meeting ART reinitiation criteria. RESULTS : Thirteen women enrolled from southern Africa. No ATI-related serious adverse events (AEs), HIV transmissions, pregnancies or ≥Grade 2 AEs were observed. Eight sexually transmitted infections were diagnosed in seven women during ATI. Two participants had tenofovir levels consistent with use during ATI; 2/11 (18%) who completed ATI without antiretroviral use exhibited ART-free control for ≥32 weeks. The median time to confirmed VL≥200 was 5.4 weeks (range 2.7−112). The most common ART reinitiation criterion met was virologic (n = 7). VRC01 receipt proximate to HIV acquisition was not associated with control. Controllers versus non-controllers did not differ by early post-acquisition viral load kinetics, acquired virus characteristics, or time from estimated acquisition to closest infusion or to ART initiation. CONCLUSIONS : In a safe, well-tolerated ATI, 18% of 11 African women exhibited post-intervention control. Design and implementation lessons inform future ATIs in Africa. Analyses of peri-acquisition and post-ATI host and viral characteristics can inform the development of interventions for HIV cure, prevention and treatment. CLINICAL TRIAL REGISTRATION : NCT04860323
Suspect screening of bisphenol A (BPA) structural analogues and functional alternatives in human milk from Canada and South Africa
(Springer Nature, 2025-07) Chi, Zhi Hao; Liu, Lan; Zheng, Jingyun; Tian, Lei; Chevrier, Jonathan; Bornman, Maria S. (Riana); Obida, Muvhulawa; Goodyer, Cindy Gates; Hales, Barbara F.; Bayen, Stephane
BACKGROUND : Plastic-related contaminants, such as bisphenols, can enter the maternal body and be transferred to breast milk. While common bisphenols such as bisphenol A, S, F and AF have been detected in previous studies, there is limited knowledge about the occurrence of other structurally similar compounds in human milk with potential endocrine-disrupting properties. OBJECTIVE : In this study, we investigated structural analogues and functional alternatives of bisphenol A (BPA) in 594 human milk samples collected from Canada (Montreal) and South Africa (Vhembe and Pretoria) using LC-Q-TOF-MS through suspect screening. METHODS : Suspect screening was performed using data collected from the milk samples using a customized database library (204 compounds). A retrospective semi-quantitative approach was then applied to estimate the levels of TGSA, D-8 and D-90 in human milk. RESULTS : This work revealed the presence of eleven compounds, including four compounds commonly used in thermal labels, four ultraviolet filters, and three synthetic antioxidants or metabolites. Retrospective semi-quantification of D-8, D-90 and TGSA revealed levels of up to 1.24, 1.98, and 0.72 ng/mL in milk, respectively. IMPACT STATEMENT : Several structural analogues and functional alternatives of bisphenol A were identified in human milk through non-targeted screening. Two other phenolic compounds (Irganox 1010 and BHT-COOH) were identified in human milk for the first time. This study highlights the importance of novel strategies in human milk biomonitoring to identify emerging contaminants to which breastfeeding infants are exposed.
Molecular characterization of hepatitis B virus in people living with HIV in rural and peri-urban communities in Botswana
(MDPI, 2024-07-14) Phinius, Bonolo B.; Choga , Wonderful T.; Anderson , Motswedi; Mokomane , Margaret; Gobe , Irene; Ratsoma, Tsholofelo; Phakedi , Basetsana; Mpebe , Gorata; Bhebhe , Lynnette; Gaolathe , Tendani; Mosepele, Mosepele; Makhema , Joseph; Shapiro , Roger; Lockman , Shahin; Musonda, Rosemary; Moyo, Sikhulile; Gaseitsiwe, Simani
BACKGROUND : Hepatitis B virus (HBV) sequencing data are important for monitoring HBV evolution. We aimed to molecularly characterize HBV sequences from participants with HBV surface antigen-positive (HBsAg+) serology and occult hepatitis B infection (OBI+). METHODS : We utilized archived plasma samples from people living with human immunodeficiency virus (PLWH) in Botswana. HBV DNA was sequenced, genotyped and analyzed for mutations. We compared mutations from study sequences to those from previously generated HBV sequences in Botswana. The impact of OBI-associated mutations on protein function was assessed using the Protein Variation Effect Analyzer. RESULTS : Sequencing success was higher in HBsAg+ than in OBI+ samples [86/128 (67.2%) vs. 21/71 (29.2%)]. Overall, 93.5% (100/107) of sequences were genotype A1, 2.8% (3/107) were D3 and 3.7% (4/107) were E. We identified 13 escape mutations in 18/90 (20%) sequences with HBsAg coverage, with K122R having the highest frequency. The mutational profile of current sequences differed from previous Botswana HBV sequences, suggesting possible mutational changes over time. Mutations deemed to have an impact on protein function were tpQ6H, surfaceV194A and preCW28L. CONCLUSIONS : We characterized HBV sequences from PLWH in Botswana. Escape mutations were prevalent and were not associated with OBI. Longitudinal HBV studies are needed to investigate HBV natural evolution.
Facilitators and barriers to antiretroviral therapy adherence among adolescents and young adults in Sub-Saharan Africa : a scoping review
(MDPI, 2025-06) Moyo, Enos; Moyo, Perseverance; Mangwana, Hadrian; Murewanhema, Grant; Dzinamarira, Tafadzwa
BACKGROUND : Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). METHODS : We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. RESULTS : We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. CONCLUSIONS : Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices.
Global health development aid initiatives and the quality of medical laboratory services in sub-Saharan : a narrative review
(Elsevier, 2025) Musuka, Hazel; Mano, Oscar; Iradukunda, Patrick Gad; Pierre, Gashema; Munyonho, Ferris Tatenda; Moyo, Enos; Dzinamarira, Tafadzwa
BACKGROUND : Medical laboratory diagnostic services play a critical role in the diagnosis, treatment, and management of diseases, forming the cornerstone of effective healthcare systems. Despite the crucial role of laboratory services, the quality and accessibility of medical laboratory services in sub-Saharan (SSA) face significant challenges. Global health development aid has been pivotal in supporting SSA laboratory services. This study aimed to examine global health development aid initiatives that have successfully enhanced the quality of medical laboratory services and the challenges and barriers to effectively improving medical laboratory services through global health development aid in SSA. METHODS : We used a narrative review study design. We searched PubMed, Web of Science and Scopus for articles published in the last 15 years. These three databases are generally considered premier databases for peer-reviewed articles in global health, public health, health systems, and biomedical sciences. The inclusion criteria for this review included research studies, reports, and grey literature. Only articles published in English from 2010 onward were considered. The analysis followed a qualitative approach, emphasizing thematic synthesis and critical interpretation. RESULTS : Forty articles were included in this study. Of these, 18 were primary research studies, 11 were reports, 7 were commentaries, and 4 were reviews. Five sub-themes from the successful global health development aid initiative themes were capacity building and training programs, infrastructure development, partnership models, policy advocacy and regulatory support, quality control and standardization of laboratory services. The sub-themes from the challenges and barrier theme were insufficient funding and resource allocation, human resource constraints, inadequate infrastructure and equipment, and political and institutional barriers. This review revealed that several factors, including financial sustainability, human resource capacity, institutional support, resilience, and effective monitoring systems, shape the sustainability of improvements in medical laboratory services in SSA. CONCLUSION : Achieving long-term sustainability requires strategies that ensure financial self-sufficiency, foster a skilled and stable workforce, and integrate laboratory services into national health frameworks.
Insights into malaria vectors-plant interaction in a dryland ecosystem
(Nature Research, 2024-09-04) Kinya , Fiona; Milugo, Trizah K.; Mutero , Clifford M.; Wondji, Charles S.; Torto, Baldwyn; Tchouassi, David P.
Improved understanding of mosquito–plant feeding interactions can reveal insights into the ecological dynamics of pathogen transmission. In wild malaria vectors Anopheles gambiae s.l. and An. funestus group surveyed in selected dryland ecosystems of Kenya, we found a low level of plant feeding (2.8%) using biochemical cold anthrone test but uncovered 14-fold (41%) higher rate via DNA barcoding targeting the chloroplast rbcL gene. Plasmodium falciparum positivity was associated with either reduced or increased total sugar levels and varied by mosquito species. Gut analysis revealed the mosquitoes to frequently feed on acacia plants (~ 89%) (mainly Vachellia tortilis) in the family Fabaceae. Chemical analysis revealed 1-octen-3-ol (29.9%) as the dominant mosquito attractant, and the sugars glucose, sucrose, fructose, talose and inositol enriched in the vegetative parts, of acacia plants. Nutritional analysis of An. longipalpis C with high plant feeding rates detected fewer sugars (glucose, talose, fructose) compared to acacia plants. These results demonstrate (i) the sensitivity of DNA barcoding to detect plant feeding in malaria vectors, (ii) Plasmodium infection status affects energetic reserves of wild anopheline vectors and (iii) nutrient content and olfactory cues likely represent potent correlates of acacia preferred as a host plant by diverse malaria vectors. The results have relevance in the development of odor-bait control strategies including attractive targeted sugar-baits.
Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda
(Nature Research, 2024-07-10) Niyoyita , Jean Claude; Ndayisenga , Jerome; Omolo , Jared; Niyompano , Hosee; Bimenyimana, Pierre Celestin; Dzinamarira, Tafadzwa; Nsekuye , Olivier; Chavez , Isabella; Hakizayezu, Francois
More than one million neonatal deaths occur every year worldwide, of which 99% take place in low-income countries. In Rwanda, nearly 71% of neonatal deaths are preventable and among these, 10% are due to neonatal sepsis. Nevertheless, limited information exists on neonatal sepsis and its associated factors in Rwanda. The objectives of the study were to find prevalence and factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Ngoma District, Rwanda. We used a retrospective cross-sectional study design reviewing a subset of neonatal, maternal and laboratory records from Kibungo Hospital in 2017. Data were reviewed and collected from March to May, 2018. Logistic regression and odds ratios were calculated to identify the factors associated with neonatal sepsis at 95% CI, p < 0.05. Of the 972 total neonates’ medical records from 2017, we randomly selected 422 of which 12.8% (n = 54) had neonatal sepsis. When blood cultures were positive, 62% grew Klebsiella pneumoniae. Among neonates with sepsis, 38 (70%) recovered while 16 (30%) died. Neonatal sepsis was strongly associated with neonatal age less than or equal to three days (aOR: 2.769, 95% CI 1.312–5.843; p = 0.008); and gestational age less than 37 weeks (aOR: 4.149; CI 1.1878–9.167; p ≤ 0.001). Increased use of blood cultures including sensitivity testing, routine surface cultures of the neonatology and maternity wards facilities, and systematic ward cleaning are all important approaches to prevent and treat neonatal infections in additional to regular neonatal sepsis evaluations.
Accuracy of self‑collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections in females : an updated systematic review and meta‑analysis
(Nature Research, 2024-05-07) Jaya, Ziningi Nobuhle; Mapanga, Witness; Dlangalala, Thobeka Nomzamo; Thembane, Nokukhanya; Kgarosi, Kabelo; Dzinamarira, Tafadzwa; Mashamba‑Thompson, Tivani Phosa; u21848522@tuks.ac.za
The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), human papillomavirus (HPV), Mycoplasma genitalium (MG), Neisseria gonorrhoea (NG), Treponema pallidum and Trichomonas vaginalis (TV) in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.
Using machine learning models to plan HIV services : emerging opportunities in design, implementation and evaluation
(South African Medical Association, 2024-06) Dzinamarira, Tafadzwa; Mbunge, E.; Chingombe, I.; Cuadros, D.F.; Moyo, E.; Chitungo, I.; Murewanhema, G.; Muchemwa, B.; Rwibasira, G.; Mugurungi, O.; Herrera, H.; Musuka, G.; u19395419@up.ac.za
HIV/AIDS remains one of the world’s most significant public health and economic challenges, with approximately 36 million people currently living with the disease. Considerable progress has been made to reduce the impact of HIV/AIDS in the past years through successful multiple HIV/AIDS prevention and treatment interventions. However, barriers such as lack of engagement, limited availability of early HIV-infection detection tools, high rates of HIV/sexually transmitted infections (STIs), barriers to access antiretroviral therapy, lack of innovative resource optimisation and distribution strategies, and poor prevention services for vulnerable populations still exist and substantially affect the attainment of the UNAIDS 95-95-95 targets. A rapid review was conducted from 24 October 2022 to 5 November 2022. Literature searches were conducted in different prominent and reputable electronic database repositories including PubMed, Google Scholar, Science Direct, Scopus, Web of Science, IEEE Xplore, and Springer. The study used various search keywords to search for relevant publications. From a list of collected publications, researchers used inclusion and exclusion criteria to screen and select relevant papers for inclusion in this review. This study unpacks emerging opportunities that can be explored by applying machine learning techniques to further knowledge and understanding about HIV service design, prediction, implementation, and evaluation. Therefore, there is a need to explore innovative and more effective analytic strategies including machine learning approaches to understand and improve HIV service design, planning, implementation, and evaluation to strengthen HIV/AIDS prevention, treatment, and awareness strategies.
Trends and factors associated with adverse pregnancy outcomes in Zimbabwe, 2005-2015
(South African Medical Association, 2024-06) Chibura, T.; Twabi, H.S.; Maluleke, Kuhlula; Musekiwa, Alfred; kuhlula.maluleke@up.ac.za
BACKGROUND : Adverse pregnancy outcomes, including abortions, miscarriages and stillbirths, are common in developing countries such as Zimbabwe. OBJECTIVE : To determine the trends and factors associated with adverse pregnancy outcomes. METHODS : This article is a secondary data analysis of three repeated cross-sectional Zimbabwe Demographic and Health Surveys to assess adverse pregnancy outcomes among women of reproductive age (15 - 49 years old) who fell pregnant during the study period. Bivariate and multivariable logistic regression models were applied to the 2015 dataset to determine factors associated with adverse pregnancy outcomes. RESULTS : There was an overall increase in reported adverse pregnancy outcomes (stillbirths, miscarriages and abortions) from 2005 to 2015. The percentage of women who experienced adverse pregnancy outcomes among those who fell pregnant in the 5 years preceding each survey rose from 13.4% in 2005 to 13.8% in 2010, followed by a sharp increase to 16.3% in 2015. The multivariable model, belonging to the 35 - 49-year age group, was associated with almost a twofold increased odds of experiencing an adverse pregnancy outcome (adjusted odds ratio (aOR) 2.11, 95% confidence interval (CI) 1.35 - 3.31, p=0.001). Women currently married/in a union (aOR 4.69, 95% CI 2.64 - 8.34, p<0.001) or formerly married/in a union (aOR 3.56, 95% CI 1.89 - 6.69, p=0.001) had higher odds of experiencing an adverse pregnancy outcome. Not belonging to any religion or being a traditionalist or Muslim decreased the odds of experiencing an adverse pregnancy outcome (aOR 0.58, 95% CI 0.42 - 0.80, p=0.001). Women from Harare (aOR 1.56, 95% CI 1.05 - 2.32, p=0.027), Mashonaland West (aOR 1.59, 95% CI 1.08 - 2.36, p=0.027) and Mashonaland Central (aOR 1.76, 95% CI 1.15 - 2.69, p=0.009) provinces had higher odds of experiencing adverse pregnancy outcomes than those from Bulawayo Province. Women who gave birth for the first time at ≥25 years of age (aOR 3.08, 95% CI 2.27 - 4.16, p<0.001) had higher odds of experiencing adverse pregnancy outcomes. Women who delivered 2 - 4 children (aOR 0.75, 95% CI 0.59 - 0.95, p=0.018) or ≥5 children (aOR 0.51, 95% CI 0.36 - 0.72, p<0.001) were less likely to experience adverse pregnancy outcomes. CONCLUSION : Trends showed an increase in the proportion of women experiencing adverse pregnancy outcomes in Zimbabwe from 2005 to 2015. Advanced maternal age, marriage, lack of religion and living in Harare, Mashonaland Central or Mashonaland West were associated with adverse pregnancy outcomes. There is a need to reduce these outcomes through integration of social issues into maternal health programmes, as well as ensuring accessibility and availability of comprehensive reproductive health services that target high-risk groups such as women aged 35 - 49 years.
Trends and distribution patterns of infant mortality and maternal HIV positivity in South Africa : a decade review (2007-2016)
(South African Medical Association, 2024-06) Makhele, M.; Ledibane, Neo R.T.; Ramatsoma, Hlologelo; Musekiwa, Alfred
BACKGROUND : The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs. OBJECTIVES : To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA. METHODS : This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey – ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman’s rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0. RESULTS : A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman’s rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001). CONCLUSIONS : The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.
The prevalence of malaria in the five districts of Limpopo Province, South Africa, 2015-2017
(South African Medical Association, 2024-05) Lamola, Mashudu Teresa; Musekiwa, Alfred; De Voux, A.; Reddy, Carl; Morifi, M.; Mutevedzi, P.C.
BACKGROUND : In South Africa (SA), malaria is endemic in three of nine provinces - KwaZulu-Natal, Mpumalanga and Limpopo. During 2010 - 2014, SA reported that ~47.6% of all malaria cases were imported. Contemporary estimates for the prevalence of malaria in the five districts of Limpopo Province are limited, with unknown proportions of imported malaria cases. We estimated the prevalence of malaria, and the proportion of imported malaria cases in the five districts of Limpopo, from January 2015 to December 2017. OBJECTIVE : To measure the prevalence of malaria in Limpopo Province, the proportion of malaria cases that are imported and to determine factors associated with malaria from January 2015 to December 2017. METHODS : We retrospectively reviewed data routinely collected through the Malaria Information System and Laboratory Information System of the National Health Laboratory Services, and assessed associations with age, sex and district, using a multivariable logistic regression model. RESULTS : From 2015 to 2017, a total of 43 199 malaria cases were reported, of which 3.5% (n=1 532) were imported. The prevalence of malaria in Limpopo Province was the highest in 2017, at 331.0 per 100 000 population. The highest malaria prevalence district was Vhembe, with 647.9 in 2015, 220.3 in 2016 and 659.4 in 2017 per 100 000 population. However, Waterberg had the highest proportion of imported malaria cases 28.5% (437/1 532). In adjusted analyses, ages 15 - 49 years (adjusted odds ratio (aOR) 1.58, 95% confidence interval (CI) 1.48 - 1.68, p<0.001) and <1 year (aOR 1.55, 95% CI 1.37 - 0.74, p<0.001) were at higher odds of having malaria compared with ages >65 years. CONCLUSION : These findings highlight the significant burden of imported malaria in Limpopo Province. There is a need for strengthened surveillance and control programmes in neighboring countries (such as Mozambique, Zimbabwe and Botswana) to reduce the importation and spread of malaria in this region.
Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe : evidence from the 2019 National Multiple Indicator Cluster Survey
(South African Medical Association, 2024-07) Musuka, G.; Murewanhema, G.; Herrera, H.; Mbunge, E.; Birri-Makota, R.; Dzinamarira, Tafadzwa; Cuadros, D.; Chingombe, I.; Moyo, E.; Mpofu, A.; Mapingure, M.
Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.
Prevalence and factors associated with adverse pregnancy outcomes in South Africa : evidence from the 2016 demographic and health survey
(South African Medical Association, 2024-06) Mpolokeng, L.; Musekiwa, Alfred; u13248422@tuks.co.za
BACKGROUND : Adverse pregnancy outcomes are an important indicator of the overall health of a population and the socioeconomic development of a country. OBJECTIVES : To determine the prevalence and factors associated with adverse pregnancy outcomes among women of reproductive age in South Africa, and to recommend strategies to reduce the burden of these outcomes. METHODS : We conducted a secondary data analysis on women of reproductive age using data from the nationally representative, population- based, cross-sectional 2016 South Africa Demographic and Health Survey (SADHS). We described the sociodemographic characteristics of the study participants and determined the prevalence and factors associated with adverse pregnancy outcomes using the multivariable logistic regression model. We adjusted all our analyses for complex survey sampling using survey weights. RESULTS : There were 8 514 women of reproductive age, of whom 41.2% had fallen pregnant during the 5-year period preceding the survey. The majority (70.9%) were of age 20 - 34 years, 78% had secondary education, 61.6% were unemployed, 65% were from urban areas, and more than 40% of these women were currently living with a man, while 51.5% reported that they had never been in a union. The prevalence of adverse pregnancy outcomes was 14.6% (95% CI 13.2 - 16.1%). The odds of experiencing adverse pregnancy outcomes were significantly higher for those aged 35 - 49 years (adjusted odds ratio (aOR) 7.41, 95% CI 3.46 - 15.85) or 20 - 34 years (aOR 2.07, 95% CI 1.02 - 4.18), compared with those aged 15 - 19 years. Women who were currently in a union/living with a man (aOR 1.85, 95% CI 1.41 - 2.43) or formerly in a union/living with a man (aOR 2.66, 95% CI 1.64 - 4.29), compared with those who had never been in a union, had higher odds of adverse pregnancy outcomes. Contrarily, adverse pregnancy outcomes were lower with each additional child delivered or ever born (aOR 0.66, 95% CI 0.58 - 0.75). CONCLUSIONS : We report a high prevalence of adverse pregnancy outcomes among women of reproductive age in South Africa. We recommend addressing factors such as maternal age and currently/formerly living with a man within interventions to reduce the burden of adverse pregnancy outcomes in South Africa.
Safety, pharmacokinetics, and neutralisation activity of PGDM1400LS, a V2 specific HIV-1 broadly neutralising antibody, infused intravenously or subcutaneously in people without HIV-1 in the USA (HVTN 140/HPTN 101 part A) : a first-in-human, phase 1 randomised trial
(Elsevier, 2025-06) Seaton, Kelly E.; Paez, Carmen A.; Yu, Chenchen; Karuna, Shelly T.; Gamble, Theresa; Miner, Maurine D.; Heptinstall, Jack; Zhang, Lu; Gao, Fei; Yacovone, Margaret; Spiegel, Hans; Dumond, Julie B.; Anderson, Maija; Piwowar-Manning, Estelle; Dye, Bonnie; Tindale, India; Proulx-Burns, Lori; Trahey, Meg; Takuva, Simbarashe G.; Takalani, Azwidihwi; Bailey, Veronique C.; Kalams, Spyros A.; Scott, Hyman; Mkhize, Nonhlanhla N.; Weiner, Joshua A.; Ackerman, Margaret E.; McElrath, M. Juliana; Pensiero, Michael; Barouch, Dan H.; Montefiori, David; Tomaras, Georgia D.; Corey, Lawrence; Cohen, Myron S.; Huang, Yunda; Mahomed, Sharana; Siegel, Marc; Kelley, Colleen F.
BACKGROUND : PGDM1400LS is a human monoclonal antibody targeting the HIV envelope V2 apex with a lysine-serine modification intended to enhance serum and tissue half-lives and is being considered for use in combination monoclonal antibody trials. We sought to test whether PGDM1400LS was safe and had favourable serum concentration, pharmacokinetics, and neutralising ability in healthy adults. METHODS : HVTN 140/HPTN 101 part A is an open-label, dose escalation, first-in-human phase 1 trial of PGDM1400LS given intravenously or subcutaneously to healthy adults aged 18–50 years without HIV-1. The study enrolled participants at four sites in the USA, across five groups, each receiving one dose of PGDM1400-LS intravenously (group 1: 5 mg/kg; group 2: 20 mg/kg; and group 4: 40 mg/kg) or subcutaneously (group 3: 20 mg/kg; and group 5: 40 mg/kg). Participants in group 1 were enrolled sequentially without random assignment. Participants in groups 2 and 3 were block randomised and enrolled simultaneously after group 1 safety review. Groups 4 and 5 followed the same process, contingent on groups 2 and 3 safety review. The primary endpoints were safety and tolerability of PGDM1400LS, serum concentration of PGDM1400LS, and serum neutralising activity after single administration of PGDM1400LS. Serum PGDM1400LS concentrations collected at seven timepoints (day 0, day 3, day 6, day 28, day 56, day 112, and day 168) were assessed via an anti-idiotype binding assay and characterised via non-compartmental pharmacokinetic analysis. Serum neutralisation activity (ID80) was assessed by a TZM-bl assay. The study is registered with ClinicalTrials.gov, NCT05184452. FINDINGS : Between Nov 15, 2021, and March 4, 2022, 15 participants were enrolled into the five study groups (three participants per group) with 6 months of follow-up. Ten of 15 participants were female, 14 of 15 participants were non-Hispanic, and 11 of 15 participants were White, with a median age of 27 years (range 24–47). PGDM1400LS was safe and well tolerated, with mild to moderate solicited symptoms. Serum concentrations showed dose proportionality by administration route, with peak concentrations observed immediately after intravenous infusion (range 95·7–727·4 μg/mL) or on day 6 after subcutaneous infusion (205·6–547·1 μg/mL). The median elimination half-life was 55 days (range 48–59), representing a 2-to-3-times increase versus parental PDGM1400. Estimated subcutaneous (vs intravenous) bioavailability was 50–60%. ID80 titres showed agreement with concentration-predicted ID80 titres, indicating maintenance of neutralisation activity in vivo. INTERPRETATION : PGDM1400LS is a promising candidate for combination monoclonal antibody efficacy trials going forward.
Immunization coverage, equity, and access for children with disabilities : a scoping review of challenges, strategies, and lessons learned to reduce the number of zero-dose children
(MDPI, 2025-03) Musuka, Godfrey; Cuadros, Diego F.; Miller, F. DeWolfe; Mukandavire, Zindoga; Dhliwayo, Tapiwa; Iradukunda, Patrick Gad; Mano, Oscar; Dzinamarira, Tafadzwa
BACKGROUND : Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. METHODS : This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. RESULTS : Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. CONCLUSIONS : Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.
Antimicrobial resistance and its impact on food safety determinants along the beef value chain in sub-Saharan Africa-a scoping review
(MDPI, 2025-03) Musuka, Godfrey; Machakwa, Jairus; Mano, Oscar; Iradukunda, Patrick Gad; Gashema, Pierre; Moyo, Enos; Nsengimana, Amon; Manhokwe, Shepherd; Dhliwayo, Tapiwa; Dzinamarira, Tafadzwa
Antimicrobial resistance (AMR) poses a significant threat to human, animal, and public health, particularly in Sub-Saharan Africa (SSA), where the beef sector is vital to food security and livelihoods. We conducted a scoping review to explore the determinants and impacts of AMR within the beef value chain in SSA, highlighting the challenges and progress in mitigating AMR risks in livestock production. This review identifies key factors contributing to AMR, including the overuse and misuse of antimicrobials, inadequate veterinary oversight, and weak regulatory frameworks. These practices are prevalent across various stages of the beef value chain, from farm to slaughterhouse, and are exacerbated by informal markets and insufficient infrastructure. Our findings also highlight the role of environmental factors, such as contamination of feed, water, and manure, in the spread of resistant pathogens. Additionally, gaps in AMR surveillance, education, and enforcement limit effective control measures in the region. While efforts to combat AMR have gained momentum in some countries, including the development of national action plans and surveillance systems, substantial challenges remain. These include poor adherence to antimicrobial guidelines, insufficient veterinary training, and the lack of integration between sectors. There is a need for targeted research to better understand antimicrobial misuse, socio-economic drivers, and the environmental pathways of AMR, as well as the need for stronger regulatory frameworks and cross-border cooperation. Addressing these challenges will be essential to safeguarding food safety, public health, and the sustainability of the beef industry in SSA.
Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province
(South African Medical Association, 2024-06) Mhlanga, S.; Turner, Astrid Chrisilda; Bibbulph, S.J.
BACKGROUND : In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. OBJECTIVES : To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. METHODS : A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. RESULTS : One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. CONCLUSION : OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.
Knowledge of pregnant women regarding prevention of mother-to-child transmission of HIV infection in Gert Sibande District, Mpumalanga Province, South Africa
(South African Medical Association, 2024-06) Manyawu, V.; Musekiwa, Alfred; Moyo-Chilufya, Maureen; Yah, Clarence S.; alfred.musekiwa@up.ac.za
BACKGROUND : Prevention of mother-to-child transmission (PMTCT) of HIV helps in closing the gaps for new HIV infections, thereby contributing to achieving the global targets of an AIDS-free generation. OBJECTIVE : To explore knowledge regarding PMTCT among pregnant women in Gert Sibande District, Mpumalanga Province, South Africa (SA). METHODS : The study was performed in two clinics in Chief Albert Luthuli Municipality, Gert Sibande District. It was a qualitative and descriptive exploratory study involving in-depth, one-on-one interviews with pregnant women regarding their PMTCT knowledge and perspectives. RESULTS : The study findings showed that pregnant women from the two clinics have a good knowledge of PMTCT. However, they were not aware that caesarean section can minimise mother-to-child transmission (MTCT) of HIV infection. CONCLUSION : PMTCT is important in establishing an HIV-free generation. The study revealed that women had a good understanding of MTCT; nevertheless, additional education is necessary, particularly regarding birthing procedures that minimise the risk of MTCT.

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