Research Articles (School of Pharmacy)

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Comparison between model global AWaRe-based quality indicators and quality indicators developed to assess the appropriateness of antibiotic prescribing in primary healthcare in South Africa
(Frontiers Media SA, 2026) Chigome, Audrey K.; Cook, Aislinn; Heath, Annie; Djukic, Filip; Johnson, Yasmina
Background/objectives – Bacterial antimicrobial resistance represents a significant global public health challenge. Researchers from City St Georges, University of London, UK, developed global model sets of quality indicators, based on WHO AWaRe guidance, to improve future primary healthcare (PHC) prescribing. These were subsequently adapted to the PHC context in South Africa as an exemplar for developing countries. The study aimed to compare nationally adapted indicators in South Africa with global model indicators to improve future prescribing. Methods – Comparative analysis of the two sets of quality indicators, developed using the same Research and Development/University of California Los Angeles (RAND/UCLA) Appropriateness Method (RAM). For the 62 overlapping indicators rated in the second round of the RAM for both sets, the median appropriateness and feasibility ratings, and the level of consensus, were compared. The contextual appropriateness, feasibility, and adaptation of the indicators across public PHC facilities in South Africa were assessed to identify factors that could affect implementation. Results – Of the 62 overlapping indicators, only six (9.7%) were rephrased for the South African RAM to reflect local guidance. Fifty nine (95.2%) indicators were rated appropriate for the global RAM while all indicators (100%) were rated appropriate for South Africa. For the global RAM, 23 (37.1%) indicators were rated feasible while 60 (96.8%) indicators were rated feasible for South Africa. Seven (11.3%) indicators were rated both appropriate with agreement and feasible with agreement for the global RAM. Forty six (74.2%) indicators were rated both appropriate with agreement and feasible with agreement by the South African panelists, including seven indicators rated both appropriate and feasible by the global panel. The South African indicators adapted from the global set covered seven categories: respiratory tract infections, lower urinary tract infections, skin and soft tissue infections, diarrhea and enteric fever, bacterial eye infections, and dental infections, as well as general indicators. Conclusions – The South African indicators for public PHCs facilities, adapted from the model global set, show that local adaptation is imperative to reflect differences in national treatment guidelines between countries, prescribing cultures, epidemiology and infectious disease burden. Ongoing barriers include a reliance on paper-based records and poor-quality routine healthcare data.
Implementation evaluation of the COVID-19 vaccination: speed, equity and mortality trends
(AOSIS (pty) Ltd, 2026) Matthew, Ilona; Viljoen, Michelle; Mccartney, Jane
Background: The coronavirus disease (COVID-19) vaccination campaign in South Africa constituted the most significant public health intervention in recent history, occurring against the backdrop of a prevailing quadruple burden of disease. Aim: To evaluate the implementation of the COVID-19 vaccination campaign, focusing on rollout speed and geographic equity and to examine the temporal associations between vaccination coverage and mortality trends. Setting: All South African residents aged 12 years and older who were eligible for COVID-19 vaccination during the study period. Methods: A retrospective, ecological population-based time-series analysis to assess vaccination rollout trends and geographic equity, and to examine the association between vaccination coverage and excess mortality. The Logic Model and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework were applied to interpret implementation performance. Results: The vaccination campaign expanded rapidly in the early phases, but vaccination activity declined significantly over a three-year period (p<0.001). By February 2024, approximately 49.7% of the eligible population had received at least one dose, below the national target of 67%. Coverage was higher in metropolitan than in district municipalities (p<0.05). Statistically significant non-causal temporal associations were observed between vaccination coverage and excess mortality. Conclusion: Early vaccine coverage was achieved, but uptake was insufficient to meet national coverage targets. Geographic disparities suggest potential inequities in access, offering empirical insights to strengthen primary health care integration, equitable service delivery, and data-driven implementation strategies. Contribution: This study supports dual-framework implementation science for evaluating large-scale public health interventions to inform health system strengthening and emergency preparedness.
Bioengineered Zn2TiO4 nanomaterial and its effective electrochemical, antibacterial and photocatalytic responses
(Nature Research, 2026) Ahmed Rami; Fall, Adama; Masibi, Kgotla K
Bioengineering of bimetallic oxides is a significant requirement for both social and environmental applications. In this work, bimetal oxide nanomaterials, Zinc orthotitanate Zn2TiO4 was produced using a green process which utilizes natural extract of Hibiscus sabdariffa. More accurately, natural extract/phyto-compounds of Hibiscus sabdariffa was validated as an effective chelating agent at room temperature and atmospheric pressure. A variety of techniques were applied to analyse their physicochemical properties and verify the production of the Zn2TiO4 nanoparticles. The XRD analysis illustrated the crystalline structure of the Zn2TiO4 nanocomposites. The SEM analysis showed the morphology of the compounds Zn2TiO4 to be highly porous. The EDS analysis validated the presence of elements such as Ti, and Zn while FTIR analysis indicated the existence of multiple functional groups, including O–H, C–H, C=O, Ti–O, and Zn–O bonds in the compound. The PL peaks identified at 240 and 450 nm are attributed to the charge transfer characteristics present in the surface state of the resulting product. The single phase crystals of the bio-engineered Zn2TiO4 were found to be within the nanoscale while exhibiting a significantly elevated photocatalytic efficacy in decomposing Methylene Blue reaching a threshold of about 94.1% efficacy at about 120 min. From the electrochemistry viewpoint, the bioengineered Zn2TiO4 nanomaterial demonstrated enhanced redox activity and stability, exhibiting 94.2% current retention after 20 cycles. Cyclic voltammetry (CV) studies confirmed a diffusion-controlled process, while electrochemical impedance spectroscopy (EIS) revealed a 10-fold reduction in charge transfer resistance ®ct), from 5.48 to 0.53 KΩ. This significant acceleration in electron transfer kinetics is corroborated by a nearly 2-fold increase in interfacial admittance (Yo), indicating an expanded electroactive surface area. These results demonstrate the applicability and potential for Zn2TiO4 nanomaterial in advanced electrochemical applications. From the antibacterial perspective, Zn₂TiO₄ nanomaterial showed limited activity in the agar-disc diffusion assay, with no meaningful inhibition against most tested Gram-positive and Gram-negative strains and only a marginal response against K. pneumoniae. These results suggest that any antibacterial potential of the Zn₂TiO₄ nanomaterial may likely to be strongly dependent on assay format, nanoparticle dispersion, contact conditions, and possible light-driven ROS generation.
Measuring the composition and availability of human resources for health by sex in 204 countries and territories, 1990–2023, and workforce gaps for universal health coverage: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier Ltd, 2026) Okonji, Osaretin Christabel; Knight, Megan; Bienhoff, Kelly
Background Understanding the size, gender composition, and cadre mix of the health workforce and how it has evolved across time and locations can inform policies for planning, recruitment, training, and retention of human resources for health (HRH), and improvement of access to the health-care workforce among populations. Using comparable and standardised data sources, we aim to describe the composition and density of health workers by sex among 20 cadres for 204 countries and territories over 1990–2023 and quantify workforce shortfalls relative to universal health coverage (UHC) attainment. Methods We used 1816 country-years of data from population-based surveys, 82 from censuses, 3888 from administrative sources, and 96 from scientific literature. We harmonised reported occupation in all sources with the International Standard Classification of Occupations 2008. We produced estimates for 20 cadres and the total health workforce disaggregated by sex using spatiotemporal Gaussian process regression, a standardised method in the Global Burden of Diseases, Injuries, and Risk Factors study. Finally, stochastic frontier meta-regression was used to estimate the minimum density of doctors, nurses and midwives, dentists, and pharmacists required to reach a score of 80 out of 100 on the UHC effective coverage index. Findings In 2023, there were 122·1 million (95% uncertainty interval 115·4–130·5) health workers across 20 cadres, an increase of 81·2 million (72·0–90·5) or 198·5% (161·9–245·6) relative to 1990. Of that total, there were 15·1 million (13·1–18·2) doctors, 33·2 million (30·8–36·3) nurses, 2·4 million (2·0–2·9) midwives, and 7·6 million (6·7–8·6) community health workers (CHWs). 68·9% (66·9–70·6) of all health workers in 2023 were female, and female health workers accounted for 71·4% (64·5–77·4) of net HRH workforce growth. Less than half of doctors were female (43·9%, 34·5–53·2) and most nurses (80·7%, 76·2–83·1), midwives (96·0%, 83·9–98·5), and CHWs (89·5%, 83·6–93·7) were female. Substantial differences in HRH density remained into 2023: sub-Saharan Africa had the lowest HRH densities across cadres, with the exception of CHWs, while high-income countries had the highest HRH densities. To reach 80 out of 100 on the UHC index, an additional 7·1 million (6·6–7·5) doctors, 23·9 million (21·8–26·1) nurses and midwives, 1·8 million (1·6–1·9) dentists, and 1·6 million (1·4–1·9) pharmacists are required globally. Interpretation The global health workforce has expanded substantially since 1990, largely due to women entering the formal health workforce. However, this expansion has been uneven across regions and persistent shortfalls remain in doctors, nurses and midwives, dentists, and pharmacists relative to moderate UHC attainment. Addressing these gaps will require expansion of training capacity, retention and remuneration policies for early-career workers, and gender-responsive workforce arrangements. Funding Gates Foundation.
Global, regional, and national burden of road injuries 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier Ltd, 2026) Wiysonge, Charles Shey; Okonji, Osaretin Christabel; van der Lubbe, Stephanie C C; Moberg, Madeline E
Background Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021–30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). Findings In 2023, there were 50·9 million (95% UI 46·1–56·1) road injury incident cases, 1·34 million (1·04–1·58) deaths, and 75·3 million (59·8–89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10–39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9–39·7) and mortality decreased by 32·3% (6·1–49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7–56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1–7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9–947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Interpretation Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Funding Gates Foundation.
Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the global burden of disease study 2023
(Elsevier Ltd, 2026) Okonji, Osaretin Christabel; Ledesma, Jorge R; Zhang, Meixin; Liew, Mei Fong; Dominguez, Regina-Mae Villanueva
Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets.
A call to action for pharmacogenomics stewardship in South Africa
(Frontiers Media SA, 2026) Keuler, Nicole L.; Hurrell, Tracey; Hurrell, Tracey; Coetzee, Renier; Jordaan, Beatrice; Breedt, Werner; Schellack, Natalie
Pharmacogenomics (PGx) can personalize medication therapy in South Africa’s (SA) diverse populativon but faces context-specific barriers: inadequate SA-specific allele variant data, infrastructure limitations, education and training gaps, and economic constraints. This call to action proposes SA’s first PGx stewardship framework to guide rational PGx testing integration. Three critical pillars are as follows (1) targeted research to build an open-access PGx variant database informed by SA data; (2) phased implementation starting with high-risk medicines in tertiary hospitals; and (3) nationally accredited PGx curricula for health professionals. All pillars are grounded in culturally responsive ethical, legal and social frameworks addressing SA’s sociohistorical context. We advocate for interprofessional collaboration to position SA as a leader in equitable PGx implementation, aligning with National Health Insurance priorities to reduce adverse drug reaction (ADR) related hospitalizations by 30% within 5 years.
Use of proton pump inhibitors in children in a tertiary hospital in Belgium
(Springer Science and Business Media Deutschland GmbH, 2026) Tommelein, Eline; Viljoen, Michelle; Keuler, Nicole
Proton pump inhibitors (PPIs) are frequently prescribed in paediatrics, yet increasing evidence suggests that their use is often inconsistent with clinical guidelines and may be associated with significant safety concerns. We conducted a retrospective study using the dispensing database of a tertiary care hospital in Brussels, Belgium. All PPI dispensed to children under 18 years of age between January 1, 2022 and January 31, 2024 were extracted. Subsequent administrations of the PPIs were linked with clinical data from electronic medical files. Appropriateness of use was assessed using regulatory labelling and the Dutch paediatric pharmacotherapy reference, Kinderformularium. Data were stratified by age category. The main outcomes included indication, dose appropriateness, treatment duration, and deprescribing practices. A total of 658 children received at least one PPI. PPIs were used across all paediatric age groups (0–18 years), most commonly prescribed by paediatricians (59.5%) and emergency physicians (12.9%). The median duration of treatment was 3 days (IQR: 2–7), being similar across age groups. Only 7.6% of children received PPIs for an officially approved indication. The majority (94.4%) of prescriptions were for off-label indications or lacked documentation of any indication. Dosing appropriateness varied by age and indication. Among children receiving PPIs for on-label indications (n = 50), less than half were prescribed a correct dose. In the off-label group (n = 608), dosing was frequently excessive, especially in younger age groups. As age increased, dose appropriateness improved. When PPIs were discontinued, either during hospitalization or at discharge, cessation was abrupt, with no evidence of tapering strategies. Three percent of children were prescribed a continuation of PPI treatment after discharge. Conclusion: These findings highlight significant gaps in guideline adherence and underscore the need for improved prescribing and deprescribing practices in paediatric care.
A human in the loop evaluation of generative artificial intelligence for translating medicine instructions into low resourced South African languages
(Springer Nature, 2026) Greyling, Cosette; Joubert, Jacques; Kapp, Erika; Ebrahim, Naushaad; Maart, Rudy; Tucker, William D; Mhlongo, Nandi; Dhlamini, Mbali Sunrise; Peck, Amiena; Parker, Mariam
Background: South Africa is home to a rich tapestry of cultural and linguistic diversity, with 11 official spoken languages and South African Sign Language recognised as the twelfth. While this plurality reflects the nation’s vibrant social fabric, it poses challenges for equitable healthcare delivery and pharmacy practice. The predominance of English as the primary language used on medication labels, patient information leaflets and in healthcare communication can create language barriers. This can limit patient understanding and potentially compromise safe and effective medicine use for non-English-speaking populations. This study examines the development and implementation of a generative Artificial Intelligence translation workflow. Developed with OpenAI’s ChatGPT Builder and configured by the research team, the translation application has the potential to translate medicine instructions at pharmacy dispensaries into four major South African languages. Method: Two scoring rounds evaluated the accuracy of translated medicine information. In round one, Section two of a South African Health Products Regulatory Authority-approved Patient Information Leaflet was translated into Afrikaans, isiXhosa, isiZulu, and siSwati using a customised General-purpose Technology. Linguists assessed outputs with a structured scoring tool measuring accuracy, fluency, and cultural appropriateness. After model refinement, round two repeated evaluation on a comparable selection from a new Section two South African Health Products Regulatory Authority-approved Patient Information Leaflet to reduce bias from prior feedback. Results: Across two evaluation rounds, translation accuracy improved for siSwati and isiZulu, with substantial reductions in critical error rates (siSwati: RR = 0.57; 95% CI 0.38–0.86; isiZulu: RR = 0.58; 95% CI 0.43–0.79). These findings indicate a 40–45% improvement in translation precision following model refinement. In contrast, isiXhosa demonstrated a marked deterioration (RR = 10.34; 95% CI 7.34–14.57), while Afrikaans remained unchanged due to an absence of critical errors. Overall, the iterative retrieval-augmented and human-in-the-loop design improved translation quality for selected languages but revealed language-specific disparities in model performance. Conclusion: A human‑in‑the‑loop, retrieval‑augmented approach can strengthen General-purpose Technology‑based medicine translations. Future work will build human‑verified datasets to improve accuracy and reliability across South African languages.
Deprescribing proton pump inhibitors: addressing prolonged and unnecessary use in paediatric hospitalised children
(Medpharm Publications, 2026) Oosthuizen, Mieke; Viljoen, Michelle; Keuler, Nicole
Background: Proton pump inhibitors (PPIs) are approved for shorth-term (≤ 12 weeks) use in children older than one month. Long-term PPI therapy has been associated with increased risk of gastrointestinal and respiratory infections, fractures and micronutrient deficiencies. This study will be the first to describe paediatric PPI use in hospitalised paediatric patients in South Africa in relation to Hospital Level Paediatric Standard Treatment Guidelines (STG)-recommendations of PPI therapy. Methods: A retrospective cross-sectional study was conducted across two tertiary public hospitals in South Africa (01 February 2023–31 January 2024). Data from medical records of paediatric hospitalised patients (< 18 years) who received a PPI prescription within the study period were evaluated. Data analysed included demographic data, in-hospital and discharge PPI prescription particulars. Descriptive statistics were used to present the analysed data. Results: Among 400 patients, only 28% of prescriptions aligned with STG-recommended indications, while 48% of prescriptions were prescribed for non-recommended indications. The median duration of PPI therapy was 31 days and only 7% of prescriptions complied with STG-recommended durations. Long-term use (> 12 weeks) occurred in 17.5% of patients. Deprescribing strategies of PPI prescriptions was employed in 23.8% of cases, predominantly intravenous (IV)-to-oral de-escalation. Conclusion: The findings highlight STG prescribing deviations and infrequent attempts of PPI deprescribing. Structured PPI prescription review processes, clear STG recommendations and proactive deprescribing strategies are required to promote rational PPI use.
Global, regional, and national burden of Chagas disease, 1990–2023: a systematic analysis for the global burden of disease study 2023
(Elsevier Ltd, 2026) Cousin, Ewerton; Okonji,Osarenti. Christabel; Nascimento, Bruno Ramos
Background: Chagas disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, primarily transmitted by infected bugs, but also through contaminated food, transfusions, congenital transmission, and organ transplantation. Chagas disease has acute and chronic phases; the chronic phase can occur decades after infection, leading to complications such as heart failure, arrhythmias, and megaviscera. Accurate mortality and morbidity estimates are hindered by under-reporting and misclassification. Comprehensive and updated estimates are needed to improve global assessments of Chagas disease burden. We aim to provide a comprehensive description of global and regional burden of Chagas disease and its trends from 1990 to 2023. Methods: In this systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we produced estimates of Chagas disease deaths, years of life lost (YLLs), prevalence, incidence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 204 countries and territories from 1990 to 2023 by age and sex. The GBD 2023 estimates supersede previous estimates for all years. For mortality estimates, we fit a cause of death ensemble model to vital registration data. For non-fatal estimates in endemic locations, we did a systematic review of seroprevalence data, defining a confirmed case as a confirmed diagnosis of T cruzi infection by two different positive tests (or a single ELISA or immunochromatographic test). After adjustment for the population at risk, we used a Bayesian compartmental model (DisMod-MR) to produce estimates. For non-endemic locations, we estimated prevalence on the basis of migration patterns and estimated prevalence from endemic countries. Prevalence of acute and chronic sequelae and corresponding disability weights were used to calculate YLDs. Findings: We estimated 10·5 million (95% uncertainty interval 9·4–11·7) Chagas disease prevalent cases in 2023 globally, a 16·1% (12·6–19·2) decrease compared with 1990.
Knowledge, attitudes, and self-reported practices of South African pharmacists regarding pediatric pharmaceutical care
(Pediatric Pharmacy Advocacy Group, Inc., 2025) Van Heerden, Yasmine
OBJECTIVE Evidence on South African pharmacists’ pediatric knowledge is limited. This study explored the knowledge, attitudes, and self-reported practices of South African pharmacists regarding pediatric pharmaceutical care. METHODS A descriptive cross-sectional online survey was conducted among registered South African pharmacists. The survey, which was developed by the researcher based on previous studies, consisted of 4 sections: demographics, knowledge, attitudes, and self-reported practices. Contact information of pharmacists was obtained from The South African Pharmacy Council. Pharmacists were invited to participate via email, and a reminder email was sent after 2 weeks. The study was closed 3 days thereafter. Quantitative data were analyzed using descriptive and inferential statistics (significance set at p < 0.05), and qualitative responses underwent thematic analysis. RESULTS A total of 436 surveys were fully completed (response rate of 2.4%). The median knowledge score of pharmacists was 9 out of 12 (IQR, 8–10). Participants performed well (90% correct) in questions on basic pediatric medicine, but more poorly in questions on pediatric dose calculations (66% correct), formulation challenges (67% correct), and pharmacokinetics (55% correct). There was no significant correlation between knowledge scores and years of practice, sector of practice, highest qualification, or training in pediatrics. There was a statistically significant correlation between participant knowledge and attitude scores (p = 0.003). CONCLUSION The study sample possesses knowledge of basic pediatric principles; however, gaps in knowledge remain. Participants expressed a lack of perceived preparedness for pediatric care following undergraduate training, underscoring the need for further research and educational reform
Clinically relevant metallic nanoparticles in tuberculosis diagnosis and therapy
(John Wiley and Sons Inc, 2025) Akinnawo, Christianah Aarinola; Dube, Admire
Globally a significant burden of tuberculosis (TB) is faced, which is difficult to eradicate due to patients' non-adherence, and drug-resistant strains that are spreading at an alarming rate. Novel approaches are required to improve diagnosis and treatment. Metallic nanoparticles (MNPs) have demonstrated potential as sensor probes and in combination therapy, which combines MNPs with antimycobacterial drugs to develop new treatment and theranostic approaches. To strengthen the theoretical foundation toward the clinical application of TB nanomedicine, this review focuses on the properties and effectiveness of therapeutically relevant MNPs. It also elaborates on their antimycobacterial mechanisms. This review aims to analyze the body of literature on the topic, pinpoint important empirical findings, and identify knowledge gaps that can provide a basis for future research endeavors and translation of the technologies. Current data suggest that MNPs are potential systems for efficient diagnosis and treatment although additional pre-clinical and clinical research is needed to bring these technologies to the clinic.
Cholera in Africa: a climate change crisis
(Springer Science and Business Media B.V., 2025) Bekele, Bezawit Kassahun; Uwishema, Olivier; Bisetegn, Lydia Daniel; Moubarak, Antonia; Charline, Mugeniwayesu; Sibomana, Pacifique; Onyeaka, Chinyere Vivian Patrick
Background: Cholera, an acute diarrheal infection caused by Vibrio cholerae, remains a significant public health concern globally, with 1.4-4.0 million cases and 21,000-143,000 deaths annually. While the disease is endemic in 47 less-developed countries across Africa and Asia, the African continent has been particularly affected, with 19 of 29 countries reporting cases in 2023 being from Africa. Aim: To explore the trend of cholera outbreaks in Africa and analyze how climate change has contributed to the spread of the disease in the continent. Methods: A review of current cholera outbreaks in Africa, with particular focus on Sudan and Ethiopia as case studies, examining the relationship between climatic factors and cholera transmission. Results: Recent outbreaks in Sudan (declared September 26, 2023) resulted in 5,414 suspected cases and 170 deaths (case fatality rate 3.1%) across nine states as of December 5, 2023. In Ethiopia’s Somali region, 772 confirmed cases and 23 deaths were reported within two weeks, with approximately 80% of cases affecting children. Climate factors significantly influence cholera transmission: a 1 °C temperature rise doubled cholera cases in Zanzibar. Both drought conditions, which increase Vibrio cholerae concentration in groundwater, and heavy rainfall periods, which lead to flooding and breakdown of sanitary conditions, contribute to outbreak risks. Conclusions: Climate change impacts cholera transmission through rainfall patterns, temperature variations, and extreme weather events. Management recommendations include implementing accurate weather surveillance systems, strategic vaccination programs, flood-proof water supply infrastructure, and community engagement protocols. These interventions should be integrated while considering the growing influence of climate change on disease patterns.
Evaluating the perceived implementation and impact of the chronic dispensing unit in the Western Cape
(Frontiers Media SA, 2026) Matthew Ilona; Viljoen Michelle; McCartney Jane; Bheekie Angeni
Introduction: The research explores the perceived implementation and impact of the Chronic Dispensing Unit (CDU) within a South African primary healthcare system, with a focus on chronic disease management, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Research) frameworks. Equitable access to healthcare and medicine is still a challenge; it demands long-term care and ongoing medical interventions. Introduced in 2005, the CDU in the Western Cape was designed to overcome the challenges in access by centralizing dispensing and distribution of chronic medicines. Two decades after its implementation, its contribution is underexplored. This research evaluated the long-term performance and sustainability of the CDU using implementation frameworks. Method: A qualitative design was used, using virtual semi-structured interviews with purposively selected participants (n = 8) involved in the implementation and maintenance of the CDU. Interviews were analyzed thematically. A deductive-inductive strategy was applied, guided by the RE-AIM and CFIR frameworks. Results: The CDU demonstrated substantial Reach and Effectiveness. It has refined operational processes and reduced patient waiting times. Challenges with data integration and the non-collection of medicine limit the CDU’s ability to inform clinical outcomes and long-term sustainability. Conclusions: The CDU is still an effective, well-integrated system that supports chronic disease management but is constrained by disconnected data systems. This study evaluated a large-scale health intervention that facilitated data-driven decision-making to monitor, evaluate, and report on evidence-based programmes addressing barriers to sustainment. Integrating two frameworks provided an assessment of a patient-centerd intervention, granting insights into equity in access to medicine, to strengthen primary healthcare systems.
Differentiating resistance from formulation failure: isoniazid instability and poor dissolution in crushed multi-drug paediatric preparations
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Samsodien, Halima; Aucamp, Marique; Winkler, Jana
Background: Bedside manipulation of adult anti-tuberculosis tablets for paediatric dosing is common in low-resource settings, yet it can compromise drug stability. This study investigated how grinding and multi-drug co-suspension affect the supramolecular organisation, thermal stability, and dissolution of isoniazid (INH). Methods: INH raw, INH branded tablets (whole and ground), and multi-drug combination mixtures (MCMs) that simulate paediatric multi-drug-resistant tuberculosis (MDR-TB) regimens were assessed. Samples were analysed as solids and aqueous suspensions using hot-stage microscopy (HSM), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), Raman spectroscopy, FTIR-ATR, USP dissolution, and HPLC (LOD 0.0015 mg mL−1; LOQ 0.005 mg mL−1). Results: Grinding and co-mixing lowered melting points and masked typical INH events. Spectroscopy revealed the broadening and shifting of OH/NH and pyridine-ring bands, consistent with the formation of new hydrogen-bonding networks, correlative with supramolecular rearrangements. In multi-drug suspensions, INH fell below the HPLC quantification limit in both pH 1.2 and 6.8 media, despite visible residue, suggesting the formation of non-dissociable supramolecular complexes. Using a validated HPLC assay, no quantifiable INH was detected from the crushed multi-drug suspensions in either pH 1.2 or pH 6.8, whereas intact API/tablets showed measurable release. Conclusions: Co-suspension of INH with companion tuberculosis (TB) drugs disrupts its supramolecular integrity, leading to pre-administration degradation and a loss of quantifiable drug. Dissolution testing showed minimal INH release at pH 1.2 and none at pH 6.8, contrasting with intact tablets/API. These observations highlight that converting an immediate-release tablet into an aqueous suspension fundamentally alters its physicochemical environment and requires rational formulation design to preserve molecular stability, differentiating true resistance from formulation failure.
Can systemic corruption be prevented by legal means? The market for pharmaceuticals in Southern Ethiopia
(Taylor and Francis Ltd., 2025) Mengesha, Akalework; Bastiaens, Hilde; Ravinetto, Raffaella; Gibson, Linda; Dingwall, Robert
Some international and national regulatory and policy actors assume that strengthening domestic laws and tightening enforcement measures will be sufficient to reduce the extra-legal supply of medicines, whether legal, substandard, or falsified, to patients in low- and middle-income countries. This paper uses a qualitative study of the pharmaceutical market in Southern Ethiopia to argue that this assumption is unjustified, given the common lack of institutional capacity and the complexity of supply chains by which medicines reach local markets. Data are drawn from interviews with pharmacists, wholesalers, pharmacy owners, regulators, law enforcement agents, and health professionals, supplemented by participant observation and review of relevant policy and legal documents. These data were analyzed through the frame of Actor-Network Theory, to trace the journey of medicines from producer to consumer. Officially endorsed regulatory and enforcement mechanisms are entangled in an intricate web of practices involving different actors responding to local demands. The extra-legal supply of medicine, particularly if substandard or falsified, is an important global public health concern, but it will only be reduced by measures that place law and regulation within the context of the social, economic, and cultural factors that shape local markets and undermine the integrity of legal supply chains.
Differentiating resistance from formulation failure: Isoniazid instability and poor dissolution in crushed multi-drug paediatric preparations
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Samsodien, Halima; Aucamp, Marique; Winkler, Jana
Bedside manipulation of adult anti-tuberculosis tablets for paediatric dosing is common in low-resource settings, yet it can compromise drug stability. This study investigated how grinding and multi-drug co-suspension affect the supramolecular organisation, thermal stability, and dissolution of isoniazid (INH). Methods: INH raw, INH branded tablets (whole and ground), and multi-drug combination mixtures (MCMs) that simulate paediatric multi-drug-resistant tuberculosis (MDR-TB) regimens were assessed. Samples were analysed as solids and aqueous suspensions using hot-stage microscopy (HSM), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), Raman spectroscopy, FTIR-ATR, USP dissolution, and HPLC (LOD 0.0015 mg mL−1; LOQ 0.005 mg mL−1). Results: Grinding and co-mixing lowered melting points and masked typical INH events. Spectroscopy revealed the broadening and shifting of OH/NH and pyridine-ring bands, consistent with the formation of new hydrogen-bonding networks, correlative with supramolecular rearrangements. In multi-drug suspensions, INH fell below the HPLC quantification limit in both pH 1.2 and 6.8 media, despite visible residue, suggesting the formation of non-dissociable supramolecular complexes. Using a validated HPLC assay, no quantifiable INH was detected from the crushed multi-drug suspensions in either pH 1.2 or pH 6.8, whereas intact API/tablets showed measurable release. Conclusions: Co-suspension of INH with companion tuberculosis (TB) drugs disrupts its supramolecular integrity, leading to pre-administration degradation and a loss of quantifiable drug. Dissolution testing showed minimal INH release at pH 1.2 and none at pH 6.8, contrasting with intact tablets/API. These observations highlight that converting an immediate-release tablet into an aqueous suspension fundamentally alters its physicochemical environment and requires rational formulation design to preserve molecular stability, differentiating true resistance from formulation failure.
Development of aware-based quality indicators to assess the appropriateness of antibiotic prescribing in primary healthcare in South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Johnson, Yasmina; Coetzee, Renier; Chigome, Audrey K.
Background/Objectives: The overuse and misuse of antibiotics contribute to antimicrobial resistance (AMR) globally. The appropriateness of antibiotic prescribing at the primary healthcare (PHC) level must be urgently addressed to reduce high levels of inappropriate antibiotic prescribing and associated AMR. This study aimed to develop quality indicators, based on the World Health Organization (WHO)’s Access, Watch, Reserve (AWaRe) guidance, to assess the appropriateness and quality regarding antibiotic prescribing in public PHC settings in South Africa. Methods: Potential indicators were identified from indicators developed by City St George’s, University of London (SGUL); a review of AWaRe-based indicators; and the results from point prevalence surveys at PHC clinics in South Africa. The indicators were developed using the RAND/UCLA Appropriateness Method. In Round 1, 12 experts individually rated 78 indicators for clarity and appropriateness. In Round 2, 10 experts rated 89 indicators for appropriateness and feasibility during an interactive online meeting. Results: The final set had 61/89 indicators (68.5%) that were rated both appropriate and feasible with agreement. Dental infections (9/9; 100%) alongside skin and soft tissue infections (11/13; 84.6%) had the highest percentage of indicators that were rated appropriate and feasible with agreement. Lower urinary tract infections (6/11; 54.5%) and general (4/8; 50%) categories had the lowest percentage of indicators rated appropriate and feasible with agreement. Conclusions: The process proved valuable in developing potential indicators for use in future antimicrobial stewardship programmes to improve antibiotic prescribing in public sector PHC facilities in South Africa and beyond.
Value addition to african natural product-based drug discovery initiatives
(American Chemical Society, 2025) Beukes, Denzil; Mayoka, Godfrey; Cheuka, Peter Mubanga
Natural products are vital to drug discovery, yet Africa’s vast biodiversity remains underutilized. This perspective examines barriers limiting Africa’s impact such as weak infrastructure, limited translational capacity, and minimal integration of medicinal chemistry. We advocate for advancing beyond basic extraction to include systematic isolation, pharmacokinetics studies, and semisynthetic derivatization. Emphasis is placed on integrating AI, cheminformatics, and biotransformation, alongside embedding drug discovery training into academic curricula. Strengthening regional networks, fostering interdisciplinary collaborations, and securing Africa-sensitive funding are essential. Strategic implementation of these actions will enable Africa to harness its natural resources for global drug discovery and address local health challenges.

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