Research Articles (School of Public Health)

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Drivers of food choice in three urban communities in South Africa
(Taylor and Francis Ltd, 2026) Sayed, Nazeeia; Swart, Elizabeth Catherina
Background: With South Africa’s high burden of disease, increasing attention has been given to improving food environments to facilitate healthier food access. An understanding of the main drivers of food choice and barriers in consuming healthier foods can assist in the formulation of nudge strategies to improve the quality of diets consumed. Objectives: To explore the drivers of food choice among adults in three urban communities in South Africa. Design: Qualitative descriptive phenomenological study using focus-group discussions. Setting: Three urban sites in the Eastern Cape, KwaZulu Natal, and Western Cape provinces in South Africa. Subjects: Adults (male and female, 21 to 59 years of age).Outcome measures: Self-administered sociodemographic questionnaire and focus-group discussions. Findings: Nine focus groups with 68 participants were completed. Financial considerations, household/family factors, and shop/food retail factors were the key drivers of food choice identified. Health considerations were present, but not prevalent. Enablers of healthy food consumption included: cost, recognised health/nutrition benefits, and good taste. Barriers were unavailability, unknown preparation, beliefs, and disliked taste. Conclusions: This study found that financial considerations, household/family factors, and the retail food environment were key influences on food choice in three urban South African communities. The research contributes to qualitative evidence on consumer perspectives in urban contexts. Recommendations include exploring retail interventions and pricing strategies to improve access to healthy foods. The study limitations include limited transferability beyond the study sites, but findings remain valuable for guiding future research and public health nutrition policy.
“We have to amplify what we saw at EBOVAC” – assessing participant perceptions, attitudes, and acceptability of an ancillary care policy in an Ebola vaccine trial in the Democratic Republic of the Congo: A mixed methods study
(Public Library of Science, 2025) Ravinetto, Raffaella; Lemey, Gwen; Larivière, Ynke
In a vaccine trial conducted between 2019 and 2022 in Boende, a remote, resource-constrained area of the Democratic Republic of the Congo, our research team developed an ancillary care (AC) policy to provide adequate care and follow-up for concomitant adverse events (AE), whether study-related or not. The trial aimed to assess the safety and immunogenicity of an Ebola vaccine regimen among approximately 700 healthcare providers and frontliners to strengthen outbreak preparedness in this Ebola-endemic region, where access to healthcare is severely limited by poverty, weak infrastructure, and an overstretched health system. A mixed-methods approach was used to assess participants’ acceptability of the AC policy. First, participants with AE completed a questionnaire (1-–5 scale; 6 questions on AC policy support, 4 on the consequences of no support, and an open comment field). Second, a telephone survey (1-–3 scale; 3 questions evaluating the AC policy, 1 on unsupported AE and an open comment field) was conducted with participants, both with and without AE. Descriptive statistics were used for quantitative data analysis, while open comments were coded qualitatively. Third, semi-structured interviews were conducted with participants who experienced a (serious) AE and either benefited from or did not benefit from the policy. Participants were selected using purposive and convenience sampling, and thematic analysis was performed.
Transforming South Africa’s school nutrition programme for educational success: A review on challenges and prospects
(SAGE Publications Ltd, 2025) Huni, Chamunorwa; Mazenda, Adrino; Monedi, Aboleleng
Introduction: South Africa’s National School Nutrition Programme (NSNP) was created in 1994 to reduce poverty and unemployment and improve children’s learning. It aims to aid disadvantaged children and strengthen poor communities, especially in rural areas. Objectives: The study examined challenges in implementing Total Quality Management (TQM) in the South African National School Nutrition Programme. Methods: A qualitative case study design was used based on document analysis extracted through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The documents were analysed using thematic analysis. Results: Key TQM challenges affecting the implementation of the NSNP include Customer focus—lack of funding from the Department of Basic Education to accommodate increased enrolment; Employee involvement—role ambiguity due to lack of communication, and at times, the roles of the NSNP players are not clearly defined; Process-centric approaches—lack of school-level infrastructure to store and cook for students, Continuous improvement and training—lack of education curriculum on nutrition education and Relationship management—lack of coordination of the stakeholders on funding, political landscape, nutrition policies, community involvement, programme adaptability. Conclusion: Effective monitoring systems should be established to guarantee that students receive the necessary quality and quantity of food. These systems should also oversee food supply, storage, preparation, and hygiene. Additionally, the current targeting system, the quintile system, requires evaluation. This should involve assessing the school’s location, available resources, and individual students’ social context.
Knowledge translation of climate change research into public health action: a scoping review
(Frontiers Media SA, 2025) Mulopo, Chanelle; Schmidt, Bey-Marrie; Onkoba, Nyamongo
Background: There are gaps in translating climate change research into public health action at the global level. Knowledge translation refers to the methods used to bridge the gap between knowledge and action. Given the significant impacts of climate change on health, it is essential to integrate climate research into health decision-making processes. This integration ensures that evidence effectively informs policies and practices at all levels, leading to more timely, equitable, and impactful public health responses. Objective: This scoping review examines key approaches and identifies gaps in knowledge translation methods for integrating climate change research into public health decision-making. Methods: A systematic search of the literature was conducted in PubMed, CINAHL, and Scopus using a predefined search string to identify studies on climate change and health published between January 1, 2003, and March 1, 2024, with no geographic restrictions. Retrieved articles were screened and data extracted using Covidence software. Thematic analysis was performed in ATLAS.TI employing Braun and Clark’s six-step method. The identified knowledge translation approaches were categorized according to the Cochrane Knowledge Translation Framework. Findings: Our findings highlight five primary knowledge translation approaches: (1) monitoring the coverage of climate change and health across media, scientific literature, and government responses; (2) engaging citizens of all ages in participatory activities to address local climate challenges and co-develop policy solutions; (3) integrating knowledge generation, synthesis, and dissemination for effective communication; (4) emphasizing advocacy and education to foster collaborations and gain support from decision-makers; and (5) leveraging health impact assessment tools to guide decision-making related to climate change and health. Nonetheless, we did not find any primary studies on climate change research and knowledge translation in Low- and Middle-Income Countries (LMICs). Conclusion: There is a need for primary studies on the knowledge translation of climate change research, especially in relation to adaptation, into meaningful public health actions that can inform decision-making and contribute to building climate-resilient health systems in LMICs.
Being an alternative caregiver: caring for children who have experienced trauma
(Routledge, 2025) Conibear, Erica; Schmidt, Bey-Marrié; Mulopo, Chanelle
Alternative caregivers play a vital role in South Africa’s alternative care system, providing care to maltreated children removed from their primary families. This qualitative descriptive exploratory study explored the experiences of 15 alternative caregivers of children who have experienced interpersonal trauma. Four themes emerged: (1) navigating the pervasive impact of trauma, (2) adopting a unique parenting approach, (3) experiencing secondary trauma, and (4) establishing your own “village” support. Findings highlight the need for caregivers to develop essential skills and access support to meet children’s complex needs and manage secondary trauma, particularly within an under-capacitated child welfare system.
Sailing global health initiative ships into stormy seas: navigating the introduction of the global financing facility in Mozambique
(Taylor and Francis Ltd., 2025) Kinney, Mary; George, Asha; Chivangue, Andes
Background: Mozambique joined the Global Financing Facility (GFF), a financing mechanism to accelerate progress for women, children, and adolescents’ health, with a history of donor dependence, distrust in public finances, and social inequities. Few independent studies have assessed the GFF. Objectives: To understand how a global mechanism, such as the GFF, was introduced and utilized in Mozambique. Methods: This qualitative study explored the aid coordination dynamics between 2015 and2020 linked to the development of the Investment Case (IC) and Project Appraisal Document(PAD), key national GFF planning documents, based on data from 25 documents and 14qualitative interviews thematically analyzed. Results: The GFF was not fully understood by stakeholders and initially gained traction in the name of strengthening the health system, ironically amidst prevailing distrust of government systems. Some viewed the IC as consultatively developed, aiding the Ministry of Health in prioritizing issues and convening donors, while others remained sceptical about its impact. The PAD was viewed as a less consultative process, though it engaged the government and partners in setting disbursement-linked indicators (DLIs) to incentivize health system improvements. However, some stakeholders viewed them as unfeasible, while others were excluded by technical discourse. The perceived transparency issues around DLIs fuelled scepticism. Conclusion: Although the GFF policy processes provided a technically alluring basis for addressing Mozambique’s health disparities, respondents revealed nuanced perspectives about how IC and PAD were formulated and followed. Aid coordination reflects various interdependencies, power dynamics, and uncertainties that require active relationship management and long-term institution building.
Examining the psychometric properties of the patient health questionnaire-9 and generalized anxiety disorder-7 among young urban South African women
(Elsevier B.V., 2025) Nyati, Lukhanyo H; Hart, Claire; Elizabeth Draper, Catherine Elizabeth
Background: Valid, reliable, and easy-to-administer scales are crucial for identifying mental health conditions, especially in LMICs where such scales tend not to be validated. This study aims to address this gap by investigating the psychometric properties and factorial structure of the PHQ-9 and GAD-7 in a sample of young women in Soweto, South Africa. Methods: The PHQ-9 and GAD-7 were administered to 6028 women aged 18–28 years old. Cronbach's alpha, Mokken scale analysis, and Confirmatory Factor Analysis were used to provide support for the internal consistency and construct validity of these scales. Results: Both scales demonstrated good internal consistency (α = 0.81 for PHQ-9 and α = 0.84 for GAD-7). Internal consistency reliability was further supported by positive inter-item correlations and item-by-scale correlations for all items on both measures. CFA of the PHQ-9 and GAD-7 showed a reasonable fit for the 1-factor model and 2-factor models (depression and anxiety with somatic and cognitive subtypes). Limitations: This study was limited to young African women in urban Soweto who were proficient in English, which may affect generalizability. Differences in language or cultural context may impact the accuracy and applicability of these scales to other African populations. Conclusion: The PHQ-9 and GAD-7 are valid and reliable for identifying psychological distress in the studied population. Despite showing good psychometric properties, further diagnostic assessment is needed to confirm clinical diagnoses. The scales are useful for identifying those at risk but not a substitute for comprehensive diagnostic evaluations. © 2024 The Authors
“… I tried to commit suicide…”: Understanding the intersections between mental health, HIV and teenage pregnancy
(Public Library of Science, 2026) Tabana, Hanani; Satumba, Takunda; Cooper, Diane; Lembani, Martina
Background Adolescent girls in South Africa face a range of interconnected health challenges, including high rates of unplanned pregnancy and HIV infection, which are compounded by systemic inequities in accessing sufficient health care. These vulnerabilities can significantly affect their mental health and overall well-being. This paper describes adolescent girls’ lived experiences when accessing health care services and how these experiences might be associated with mental health, HIV, and teenage pregnancy in the Western Cape province, South Africa. Methods This qualitative study employed narrative and semi-structured interviews to explore the sexual and reproductive health and mental health well-being of adolescent girls aged 15–19. Participants included adolescent girls in various categories: pregnant, postpartum, living with HIV/AIDS or not, recruited from three youth-friendly primary healthcare facilities using purposive and snowballing sampling methods. A total of 17 adolescents, four healthcare providers, and four parents were interviewed, and a focus group was held, involving six sub-district healthcare program managers. Results The factors contributing to mental health among the adolescents were broadly categorised under five themes: 1) Navigating the impact of unintended pregnancy, 2) Negotiating the home environment and other relationships, 3) Barriers around access to services at the facility level, 4) Community healthcare services, and 5) Improving mental health services. Conclusion This study explored factors that contribute to or hinder the mental well-being of adolescent girls and the barriers to accessing mental health services. Designing tailored approaches to the identified factors and systemic challenges that counter mental distress for this age group can significantly mitigate the impact on their mental health.
Ending preventable stillbirths and improving bereavement care: a global scorecard
(John Wiley and Sons Inc, 2026) Kinney, Mary; Leisher, Susannah Hopkins; Wojcieszek, Aleena M
Background: The Lancet Ending Preventable Stillbirths series issued a global Call to Action to reduce stillbirths and improve bereavement care. To monitor progress, we developed a global scorecard to track performance on key indicators. Objectives: To introduce the scorecard and demonstrate its utility with a worked example by comparing global and regional performance in 2022 versus 2018. Methods: Descriptive analysis of performance across 20 nominated indicators spanning mortality targets, universal health coverage targets and milestones for ending preventable stillbirths. Data were extracted from global tracking processes undertaken by United Nations agencies and foundations. Data were summarised globally and by region, with performance against indicators coded as below expectation, in progress, on track, or fully achieved. Results: Seven of the 20 indicators had no available data to assess performance, including those related to stillbirth rate equity, subnational stillbirth rates, national reproductive health plans, the quality of antenatal and intrapartum care, and national processes for stigma reduction. As yet, there is no global consensus on respectful care after a perinatal death. Data were sparse for all indicators in Oceania, Europe and North America, and Latin America and the Caribbean. For most regions and most of the 13 other indicators with available data or estimates, progress was often modest or lacking. Central and South Asia and East and South-East Asia were ‘on track’ for more indicators than other regions, and there was substantial progress on three indicators in Sub-Saharan Africa. However, for the 10 highest-burden countries, progress remained below expectations. Progress was highest for indicators assessing the existence of plans, and worst for indicators assessing implementation. Conclusions: The Global Scorecard for Ending Preventable Stillbirths can be used to provide advocates, policymakers, and practitioners with a detailed status check on data availability and progress in ending preventable stillbirths and improving care after stillbirth.
Assessment of food safety in public psychiatric hospitals in the Eastern Cape province, South Africa
(Taylor and Francis Ltd., 2026) Getyeza, Asanda; Swart, Rina; Theron, Marieke
Objective: To evaluate the state of food safety practices, staff knowledge, and adherence to food safety regulations in food service units across four public hospitals in the Eastern Cape province, South Africa. Design: A cross-sectional mixed-methods study was conducted using purposive sampling. Data collection included self-administered questionnaires, semi-structured interviews, observations, and food safety audits conducted in accordance with national regulatory standards. Setting: Four public hospitals in the Eastern Cape province, South Africa. Participants: Ninety-one permanent healthcare employees in the public sector, including food handlers, foodservice managers, nurses, assistant directors of support services, and quality assurance officers. Outcome measures: The principal areas of investigation included compliance with Regulation 638, adequacy and frequency of staff training, the standards of infrastructure and resources, and perceptions of management support for implementing food safety. Results: Quantitative findings revealed that 84% of food handlers expressed a commitment to serving safe and nutritious meals, and 72% reported familiarity with food safety regulations. However, only 62% demonstrated adequate knowledge of hygiene principles, and just 45% understood the importance of maintaining appropriate food temperature control. No formal food safety training was reported between 2013 and 2018. Qualitative insights indicated that suboptimal handwashing was attributed to insufficient supervisory oversight and weak internal control mechanisms. All four hospital food service units had operated without a Certificate of Acceptability since 1994. Despite positive attitudes, institutional, systematic, and regulatory non-compliance reflects systemic governance weaknesses. Conclusions: Despite food handlers’ awareness of basic safety principles, persistent gaps in food safety training, inadequate infrastructure, and regulatory non-compliance undermine safe meal delivery in public hospital settings. These systematic deficiencies, rooted in weak institutional oversight, poor enforcement of regulations, and insufficient investment in foodservice governance, pose risks to patient health and institutional credibility. Strengthening food safety in public hospitals requires a coordinated policy response, including infrastructure upgrades, accredited staff training, and enforcement of Regulation 638. Integrating food safety within broader health system accountability frameworks is vital for nutrition-sensitive care in hospital settings.
‘I just want the pain to go away’: religious coping and sexual trauma recovery in South African, marginalised contexts
(Routledge, 2026) Morgan, Leona; Nadar, Sarojini; Keygnaert, Ines
There is increased recognition of the need to engage with psychosocial diversity in thepsychotherapeutic treatment of sexual violence. Using a decolonial feminist communitypsychology lens, this paper explores how religious practices shape the traumaexperiences of adult survivors of childhood sexual abuse in the Cape Flats region ofSouth Africa. Drawing on data from qualitative semi-structured interviews andintegrative trauma-informed care sessions with thirteen women who experiencedchildhood sexual abuse, this research explores how religion influences adult survivors’efforts to process childhood sexual abuse and seek healing. Characterised by structuralinequities, intergenerational trauma and limited mental health services resulting fromapartheid, the Cape Flats provides a context in which religion plays a paradoxical rolein study participants’ lives. Insights from reflexive inductive thematic analysis suggestthat religion may provide supportive meaning, but also perpetuates trauma suppressionthrough spiritual bypassing and premature forgiveness. This dynamic occurs wherecultural and religious norms discourage trauma disclosure and institutionalised faithpractices lack specialised trauma care. Integrative trauma-informed care sessions enableparticipants to engage with their trauma authentically, while cultivating an empoweringconnection to their faith. These findings highlight the necessity for trauma recoveryapproaches that address the intersections of structural inequity, gender and spirituality.
Retention in care of people on antiretroviral therapy who inject drugs in South Africa
(AOSIS (pty) Ltd, 2025) Mngomezulu, Phumzile C; van Wyk, Brian E; Roomaney, Rifqah A
Background: Retention of people who inject drugs (PWID) on antiretroviral therapy (ART) is critical for viral suppression. However, PWID, a key population, traditionally have poor retention in care (RiC). Objectives: To determine the prevalence of and factors associated with RiC at 6 months, following ART initiation in three South African districts. Method: Data of 333 PWID (adults 18+ years), who commenced ART between July 2022 and March 2023, were retrieved from TIER.Net electronic database. Results: RiC after 6 months on ART was 40% (n = 132). Bivariate analysis showed higher retention among those on Opioid Substitution Therapy (OST) with treatment support compared to those without support (95% vs 39%; P < 0.001); and lower RiC among those with unstable housing compared to those with stable housing (12% vs 75%; P < 0.001). In the survival analysis, PWID with unstable housing had a 5-fold increased risk of poor RiC (adjusted hazard ratio [AHR] = 4.94; 95% confidence interval [95% CI]: 2.35–10.35), while those in OST had a 75% decreased risk of poor RiC (AHR = 0.25; 95% CI: 0.10–0.60). Conclusion: PWID face significant challenges in remaining engaged in ART care, particularly those experiencing unstable housing. OST uptake can facilitate improved RiC and health outcomes, highlighting the need for expanded harm reduction strategies. Addressing unstable housing remains urgent to strengthen HIV treatment outcomes for PWID in South Africa.
Tool for assessing food industry commitments and practices to address the double burden of malnutrition: a delphi study
(BioMed Central Ltd, 2026) Mchiza, Zandile; Klinger, Carmen; Okanmelu, Elochukwu Christopher
Background: Many low- and middle-income countries face a double burden of malnutrition, i.e., a co-occurrence of undernutrition with overweight, obesity, or other diet-related noncommunicable diseases. In an increasingly connected global food system, multinational and domestic food industry actors – through their commercial practices and corporate political activity – both contribute to the double burden of malnutrition and hold potential to address it. Systematic monitoring of relevant industry commitments and practices may help to hold industry accountable and foster constructive engagement. The Business Impact Assessment - Obesity and population-level nutrition (BIA-Obesity) tool has been developed to assess and benchmark food companies’ commitments and practices related to obesity and support for healthy diets at a national level. Methods: To enable the application of BIA-Obesity for countries facing a double burden of malnutrition, this study aimed to identify and select relevant best practice indicators for assessing food company commitments and practices regarding the double burden of malnutrition, with a focus on indicators not currently captured by the BIA-Obesity tool. A three-round Delphi study was conducted between April and October 2024, involving an international panel of experts. Results: From 52 invited experts, 30 contributed to our expert panel (response rate 58%). Based on a systematic review, 16 best practice indicators addressing the double burden of malnutrition were proposed. Consensus (i.e., group agreement of 75% or higher) for inclusion was reached for 8 indicators covering the production, distribution and marketing of (i) breastmilk substitutes and (ii) complementary foods, (iii) breastfeeding support and (iv) parental leave for employees, (v) food fortification, (vi) use of traditional foods, (vii) use of discounts and donations, and (viii) healthy diets at work. One additional indicator on corporate strategy was included as an overarching indicator. Conclusions: Food industry action may complement other efforts to address the double burden of malnutrition, such as public policies and investments. Tools like the extended BIA-Obesity framework can be used for a systematic monitoring of relevant industry commitments and practices and may help to disseminate and establish favourable industry practices as part of broader efforts to address the double burden of malnutrition in low- and middle-income countries. Clinical trial number: Not applicable
Adherence to methotrexate safety guidelines in rheumatoid arthritis: real-world evidence from South Africa’s public health system
(John Wiley and Sons Inc, 2025) Akunne, Onyinye; Coetzee, Renier; Johnson, Yasmina; Van Heerden, Yasmine; Keuler, Nicole; Wehmeyer, Alex
What is Known and Objective?: Methotrexate (MTX) is the cornerstone therapy for rheumatoid arthritis (RA) but is associated with potential haematologic and hepatic toxicities. In South Africa, treatment guidelines emphasise regular laboratory monitoring and folic acid supplementation to enhance treatment safety and reduce adverse effects. This study evaluates the implementation of these safety measures in a resource-constrained public health setting. Methods: A retrospective review of electronic health records was conducted for adult RA patients (≥ 18 years) who had been prescribed oral MTX for at least six months in the Western Cape Province between January and December 2022. Data collected included patient demographics, MTX and folic acid prescriptions, laboratory test results (white cell count [WCC], platelet count [PLT] and alanine aminotransferase [ALT]) and comedications. Laboratory abnormalities were classified according to the WHO reference ranges. Correlation analysis assessed associations between MTX/folic acid doses and laboratory values. Results and Discussion: Among 820 patients included in the study (82.1% female, mean age 55 ± 13 years), 94.9% were prescribed folic acid at the initiation of MTX and 96.2% at their most recent visit. Monitoring adherence improved over time: At MTX initiation, 71.8% had baseline WCC/PLT and 72.2% had ALT records; within 6 months of the last visit, over 88% had follow-up laboratory results. Most patients had normal laboratory results at follow-up (WCC: 85.9%; PLT: 73.8%; ALT: 90.4%). Spearman’s correlation analysis did not identify significant associations between MTX/folic acid dose and laboratory values, likely reflecting narrow dose ranges and limited subgroup size. These findings highlight the success of safety monitoring practices and the coprescription of folic acid in reducing the risks associated with MTX. What is New and the Conclusion?: This study demonstrates that MTX safety monitoring and folic acid supplementation are well integrated into public RA care in South Africa, with a low incidence of laboratory abnormalities. Our exploratory correlation analysis did not identify significant associations between MTX/folic acid dose and laboratory values; however, this likely reflects narrow dose ranges and limited subgroup data rather than the absence of effect. These findings highlight the success of current safety practices while underscoring the need for larger, prospective studies to better characterise dose–toxicity relationships.
Risk factors associated with hearing loss in neonates: A retrospective cross-sectional study from Qatar
(HBKU Press, 2025) Andreas, Jarreth Noël; Amde, Woldekidan Kifle; Roomaney, Rifqah Abeeda
Background: Hearing loss (HL) affects approximately 3 in every 1,000 infants worldwide. However, current Early Hearing Detection and Intervention (EHDI) guidelines may not fully account for region-specific neonatal risk factors. In the Middle East, conditions such as gestational diabetes mellitus (GDM), pre-eclampsia, and consanguinity are highly prevalent but remain underexplored in HL research. This study investigates the association between these and other neonatal risk factors and HL outcomes in newborns in Qatar. Methods: A retrospective cross-sectional review of electronic health records was conducted for 5,098 neonates born between March 2019 and March 2022 at a tertiary hospital in Qatar. After exclusions, 4,126 neonates were analyzed. Maternal and neonatal risk factors, along with newborn hearing screening outcomes, were assessed using Fisher’s exact test, Chi-square test, and logistic regression analysis. Results: Overall, 6% of neonates failed the hearing screening (n = 248). The most common risk factors were GDM (34.5%), hyperbilirubinemia (21.0%), and gentamicin exposure (9.6%). However, GDM showed no significant association with failed screening. The strongest association was found with Down syndrome (odds ratio [OR] = 14.215; 95% confidence interval [CI]: 4.286–47.151; p < 0.001), followed by cleft lip/palate (OR = 4.371; 95% CI: 1.384–13.801; p < 0.012), and high-risk categorization (OR = 1.973; 95% CI: 1.266–3.076;p < 0.003). Conclusion: Contrary to expectations, GDM and hyperbilirubinemia were not associated with an increased risk of HL. In contrast, Down syndrome and cleft lip/palate showed significant associations with HL risk. These findings highlight the importance of incorporating regionally relevant risk factors—such as genetic syndromes and craniofacial anomalies—into local Early Hearing Detection and Intervention (EHDI) frameworks. Contextualizing hearing screening within the Gulf region may enhance early detection and optimize care pathways.
Healthcare-associated bloodstream infections caused by bacterial and fungal contamination of intravenous fluids and medicines in healthcare facilities in low- and middle-income countries: a scoping review
(Elsevier, 2025) Ravinetto, Raffaella; Nyandwaro, Jemima Nyaboke; Hyland, Peter
Introduction: We reviewed culture-confirmed healthcare-associated outbreaks linked to bacterial and fungal contamination of intravenous fluids and medicines (further “infusates”) in low-income countries and lower and upper middle-income countries (LIC, Lower-MIC and Upper-MIC). We assessed the scope, impact, risks, and gaps in knowledge. Methodology: Literature search including PubMed, Web of Science, Worldwide Database for Nosocomial Outbreaks, Global Health, and Google Scholar. National essential medicine lists (NEMLs) of sub-Saharan countries were searched for listing of pediatric infusates. Results: Between 1975 and 2023, 50 articles were retrieved. Median (range) number of patients affected was 12 (3–185); 74.2% (761/1025) of all patients affected were children. All patients presented with bloodstream infections; median case fatality ratio was 21.1% (0.0–87.5%). Upper-MIC, Lower-MIC and LIC accounted for 21, 25 and 4 articles, respectively. Most frequently affected wards were neonatal and adult intensive care units (19 and 6 articles). The 50 articles revealed 59 contaminated infusates: IV fluids (n = 37), including TPN (n = 10, of which 8 were from Upper-MIC), and IV medicines (n = 22), comprising amongst others propofol (n = 4) and Water for Injection (n = 3). The 63 isolates included Enterobacterales (46.0% (29/63) of isolates), non-fermentative Gram-negative bacteria (NFGNB, 47.6% (30/63)), fungi (4.8%, 3/63)) and Bacillus circulans (1.6% (1/63)). Among the Enterobacterales, the genera Serratia, Klebsiella, and Enterobacter represented 82.8% (24/29) of isolates. Burkholderia cepacia was the most frequent NFGNB (53.3% (16/30) isolates). Excluding TPN, 18 IV fluids and 7 IV medicines (representing half (51.0%, (25/49) of these infusates) were incorrectly used as multidose vial. A third (33.9%, 20/59) of infusates in 40.0% (20/50) of articles was intrinsically contaminated. In LIC and LMIC, staff in neonatology units turned to in-ward preparation of infusates because of lack of access to pediatric IV formulations and sizes. Less than a third (31.8%, 18/44) of the NEMLs listed neonatal IV premixtures. Conclusion: Infusate contamination is a serious, underreported risk especially for children in LICs and Lower-MIC. Outstanding issues are access to pediatric infusates and preventing in-ward preparation of IV medicines in LIC and Lower-MIC, and safe preparation and administration of TPN in Upper-MIC.
Assessing patterns of authorship of low- and middle-income countries in global commercial clinical trials in oncology
(BioMed Central Ltd, 2026) Ravinetto, Raffaella; Payedimarri, Anil Babu; Mouhssine, Samir
Poor authorship practices in global health research may be a sign of unequal partnerships. Previous studies have shown that authors from low- and middle-income countries (LMICs) are frequently underrepresented in publications from global research collaborations between LMICs and high-income countries (HICs). To the best of our knowledge, the patterns of authorship from LMICs in international industry-sponsored clinical research on breast, lung and colon cancer have not yet been investigated. Therefore, as a spin-off to broader research on globalization of commercial clinical trials in oncology, we conducted an analysis of authorship in the publications from completed industry-sponsored therapeutic trials in breast, lung and colon cancer (from phase I to IV) that involved LMICs. Only articles published in a peer-reviewed journal in English by March 30, 2024 were included. A total of 302 publications from 173 trials were analysed. 63% (n = 191) of them have at least one author from a middle-income country (MIC); 14% (n = 42) articles have the first author from a MIC; and 13% (n = 39) articles have the last author from a MIC. Conversely, 37% (n = 111) of articles had no author from MIC, including two trials conducted only in MICs. In conclusion, our study found an imbalance in authorship, suggestive of significant inequalities, in collaborative research in industry-sponsored clinical trials for breast, lung and colon cancer. Industry sponsors need to work towards greater equity in authorship when collaborating with researchers in (L)MICs, and oncology researchers and opinion leaders in HICs should actively advocate for greater fairness to their colleagues in (L)MICs.
Investigating nutrition information and marketing strategies of packaged food products in the Tanzanian market
(Elsevier B.V., 2026) Khan, Alice S.; Frank, Tamryn; Kaale, Lilian Daniel
Tanzania faces a complex nutrition challenge, with rising rates of malnutrition and nutrition-related non-communicable diseases (NCDs). A significant driver of this trend is the growing availability of ultra-processed packaged foods, which are often high in unhealthy ingredients, poorly labeled, and aggressively marketed. This lack of transparency makes it incredibly difficult for consumers to make healthy choices. This cross-sectional study analysed 5243 packaged foods from 19 purposively selected retail outlets in Dar es Salaam, Arusha, and Zanzibar. Twenty-eight percent of the products assessed lack a nutrition information panel or ingredients list. The vast majority of items, over 82 % were classified as ultra-processed, and over 90 % contained at least one nutrient of concern, such as high levels of fat, sugar, or sodium. The research also highlighted the pervasive use of on-package marketing, which was present on 87 % of products and often targeted children. These findings reveal significant weaknesses in Tanzania's current food regulations. Urgent policy interventions are needed to standardize and improve nutrition labeling, implement clear and easy-to-read front-of-package labels, and restrict marketing practices, especially those aimed at children. Such measures, guided by an evidence-based nutrient profile model, are critical for promoting a healthier food environment.
A primary health care re-engineering approach to enhance PrEP initiation and adherence among high-risk, sexually active adolescents and young adults in KwaZulu-Natal, South Africa
(BioMed Central Ltd, 2025) Mathole, Thubelihle; Nicol, Jeannine Uwimana; Hlongwa, Mbuzeleni
Objective: This study explores the decentralisation of PrEP services through primary health care (PHC) re-engineering structures such as schools, pharmacies, youth zones, community halls, and mobile clinics to improve PrEP uptake and adherence among adolescents and young adults (AYAs) in KwaZulu-Natal, South Africa. Methods: In-depth interviews were conducted from August 2021 to July 2023 with 48 purposively selected participants from a cohort of 2,772 newly diagnosed HIV-negative, sexually active, high-risk individuals. These included 36 adolescent girls and young women aged 15–24 years and adolescent boys and young men aged 15–35 years who initiated PrEP within one month at various service delivery points, including clinics, schools, and community-based services. An additional 12 participants who had not initiated PrEP were also included. Data were analysed thematically using a comprehensive codebook developed to guide the coding process. All transcripts and audio recordings were validated for completeness and accuracy before coding. Findings: The study identifies critical factors that support successful PrEP implementation and expansion among high-risk, sexually active AYAs. The PHC re-engineering programme emerged as a crucial strategy for increasing both PrEP uptake and adherence. Participants expressed a strong preference for decentralised service models, including community-based facilities, outreach teams, and home delivery systems. These models were most appealing to AYAs compared to traditional healthcare facilities. They effectively addressed common barriers such as long waiting times, unfriendly healthcare professionals, overcrowding, stigma, and transportation challenges. Some participants noted that home delivery of PrEP saved both time and money, contributing to better adherence. Conclusion: Decentralised, community-based approaches play a vital role in improving PrEP uptake, adherence, and continuation among AYAs in South Africa.
Co-creating strategies and recommendations to enhance the physical activities of undergraduate students at a South African University: a social ecological approach
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Johannes, Chanté; Roman, Nicolette Vanessa; Onagbiye, Sunday Olawale; Titus, Simone; Leach, Lloyd
Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing individual, social, environmental, and public engagement domains to enhance student PA. Therefore, this study aimed to develop strategies and recommendations to enhance the PA levels of undergraduate university students by using a SEM Approach. A co-creative consensus workshop, held between July and August 2024, was employed. The stakeholder group (n = 25) comprised undergraduate university students, professors and academic doctors specialising in PA and health-related disciplines. Data generated from the workshop were uploaded into Atlas Ti. V8 and thematically analysed. The co-created strategies underscore the importance of a multi-level approach to enhancing PA participation among undergraduate students. A total of 32 strategies were developed, reflecting the interconnected influence of psychosocial factors across the levels of the SEM. These include strategies related to PA (9), mental health (7), motivation (9), and social support (7). By developing context-specific strategies and recommendations that address individual, social, physical, and public engagement levels, the research offers practical, student-centred solutions to enhance PA participation. The co-created strategies hold the potential to foster long-term behavioural change and promote active, healthier lifestyles within the South African university context.

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