Research Articles (School of Public Health)

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What does it take to operationalise gender transformative approaches across different African contexts?
(Women's Health and Action Research Centre, 2025) Amde, Woldekidan; George, Asha; Jacobs, Tanya; Mjijelwa, Vuyolwethu; Schaay, Nichola
Africa is the second largest and second most populous continent in the world. Governed by 54 recognised sovereign states, its people celebrate multiple traditions and speak countless dialects and languages apart from those inherited by varied colonial legacies. Despite historical and ongoing debts, it has one of the fastest growing global economies and vast natural resources. Its full potential, however, is not realized due in part to the lack of progress and regression on gender equality and sexual and reproductive health and rights. The inertia and, in some contexts, the pushback on gender equality and sexual and reproductive health and rights are alarming and unprecedented.1 Thirty years after Beijing, sub-Saharan African women experience the highest rates of intimate partner or sexual violence. Of the 20 countries with the highest rates of child marriage, 15 are in Africa (WHO).4,5 There is also a pushback in terms of sexual rights across the continent, whether in terms of contestations regarding female genital cutting in the Gambia or Kenya, or further restrictions, including increased criminalisation, of those who are not exclusively heterosexual in Ghana, Kenya, Namibia, Niger, Tanzania, and Uganda.
Shaping the African research agenda for gender transformative approaches to sexual and reproductive health and rights: A scoping review taking stock to re-align and move forward
(Women's Health and Action Research Centre, 2025) George, Asha; Amde, Woldekidan; Jacobs, Tanya
Given the imminent threats to gender equality, it is critical to take stock of what is documented in terms of gender transformative approaches supporting sexual and reproductive health and rights across the African continent. This scoping review found 52 articles published between 2012-2022 from PubMed and Scopus. We describe the geographic distribution, terms, the conceptual frameworks and social theories used, program areas, target populations and intervention approaches, as well as study designs and outcomes found. While a substantial body of evidence on gender and sexual and reproductive health and rights across Africa is building, it remains skewed geographically, programmatically, and analytically. More rigorous research is needed about the dynamics of shifting gender power relations undertaken in partnership with social movements and practitioners who can ensure more ownership and accountability for gender justice in sexual and reproductive health and rights in Africa over the long term.
Inadequate last-mile pharmaceutical waste management is a neglected threat to environmental and public health: a call to action
(BMJ Publishing Group, 2025) Ravinetto, Raffaella; Coetzee, Renier; Bradley, Hazel
In 2024, the WHO’s Division on Access to Medicines and Health Products issued a call to action for sustainability in the pharmaceutical sector. The initiative, ‘Greener Pharmaceuticals’ Regulatory Highway’, underscored the need to reduce the environmental footprint of medical products. It explicitly called on the regulatory community to adopt initiatives towards ‘innovative approaches in the manufacturing, distribution, and usage of medical products. This timely initiative aligns with the growing recognition of interconnectedness between climate change, pollution— including ‘pharmaceutical pollution’—and public health. However, the need to decrease greenhouse gas emissions should not overshadow other relevant areas for action in the pharmaceutical sector. Here, we focus on the negative environmental impact of the inappropriate elimination of pharmaceutical waste generated at the last mile in healthcare
Is global health security worth 0.01% of our gross domestic product?
(PLOS, 2025) Ravinetto, Raffaella; Ooms, Gorik; Assefa, Yibeltal
Within days of starting his second term as President of the United States of America (US), Donald Trump ended most US contributions to global health. Global responses to HIV, tuberculosis (TB) and malaria are not the only programmes affected, but were particularly dependent on US support. The US withdrawal from global health could result in 3 million additional HIV deaths and 10 million additional HIV infections; 107.000 additional malaria deaths and 15 million additional malaria infections; and 2 million of additional TB deaths, all in 2025. These decisions will negatively affect public health in the US and other countries that did not benefit from US aid. HIV, TB and malaria are global health security threats that require international collective action. Undermining such collective action makes the world less safe for everyone.
Mapping government financing for antimicrobial resistance responses in East and Southern Africa: implications for sustainability and domestic ownership: a narrative review
(KeAi Communications Co, 2025) Mano, Oscar; Munyonho, Ferris Tatenda; Masiku, Silizani
Background: Antimicrobial resistance (AMR) poses a significant and growing public health challenge in East and Southern Africa. Despite formal commitments to the National Action Plans, domestic financing for AMR remains critically limited, with most countries continuing to depend heavily on external donor funding. Objective: This narrative review examines the current extent to which domestic fiscal commitments align with national AMR policy goals across the two regions. Methods: Government websites for ministries of health and finance, donor platforms, and three academic databases (Scopus, JSTOR, Google Scholar) were searched for eligible articles. National budget statements and media reports were also reviewed where available. Three researchers independently screened titles and summaries, followed by full-text reviews to confirm eligibility. Results: The findings reveal that while several countries have developed National Action Plans, very few have allocated domestic funding to implement them. Only Malawi, Nigeria and Uganda reported modest domestic contributions, while in other countries such as Zambia, Ethiopia, and South Africa, AMR programs remain largely donor-financed or lack dedicated budget lines altogether. Veterinary and laboratory sectors are particularly underfunded, with minimal integration into broader AMR strategies. While this review has several limitations including restricted access to current, comprehensive national budget data and a reliance on secondary sources such as donor and World Health Organization reports, which may introduce bias, the patterns identified in this review still offer valuable insight into regional funding dynamics and can inform future policy and research efforts. Conclusion: We conclude that without dedicated domestic financing and accountability mechanisms, AMR efforts in the region may face significant sustainability challenges observed in other health responses such as human immunodeficiency virus. Strengthening AMR governance requires clear budgetary commitments, sustainable co-financing models, and policy instruments to reduce dependency on external support.
Interventions to reduce HIV-related stigma among older people living with HIV in sub- Saharan Africa: a scoping review
(Routledge, 2025) Knight, Lucia; Wolpe, Hannah M.; Tollaa, Tsidiso
HIV-related stigma remains a major barrier to testing, treatment, and quality of life, especially for the growing population of older people living with HIV (OPLWH, aged 50+). Such stigma intersects with age-related and other stigmas, compounding health vulnerabilities. Research on this issue remains limited, particularly in sub-Saharan Africa (SSA). This review thus sought to explore stigma-reduction interventions for OPLWH in SSA to inform future efforts. Guided by Joanna Briggs Institute and PRISMA-ScR standards, studies published between 2004 and 2024 including OPLWH in SSA and reporting stigma-reduction interventions were reviewed. A search of seven databases produced 709 articles, with 21 manually sought manually. Eight studies were included, five of which were from Kenya. Five were qualitative, and only one quantitative study included follow-up data. Three explicitly targeted stigma, and one intersectional stigma. Various features (e.g., education) were targeted, mostly at individual or interpersonal levels. Few operated at higher levels and age reporting was inconsistent. There is an evident lack of stigma-reduction interventions for OPLWH in SSA. Future efforts should consider age-related dynamics and intersecting stigmas. Social support (formal and informal) showed particular promise, alongside economic and nutrition-based strategies. Broader, higher-level efforts addressing social and institutional drivers of stigma are also needed.
Reflection or correction? A qualitative study of health manager’s experience of clinical audit activities in rural maternity units in Kwazulu Natal, South Africa
(Taylor & Francis, 2025) Doherty, Tanya; Horwood, Christiane; Filippi, Veronique
Clinical audit aims to improve maternal and newborn care by systematically reviewing clinical practices, identifying gaps, implementing corrective actions, and monitoring progress. Audit can improve outcomes but effective implementation requires strong teamwork, communication and trust. To explore how health professionals experience audit, individual semi-structured interviews were conducted with maternity managers in 11 rural health facilities in KwaZulu-Natal, South Africa, between November 2022 and February 2023. Participants included medical managers (5) and nursing managers (11). Analysis used inductive thematic analysis supported by Nvivo v15. Managers described the maternity team working together to systematically assess care across a range of clinical areas, suggesting that reflective practice was embedded in their work. Audit activities included auditing of clinical case records, caesarean sections, and perinatal and maternal deaths. However, managers reported that clinical audit was time consuming and required high level technical and facilitation skills. Feedback was often described as didactic, emphasising teaching rather than reflection and learning, and frequently involved elements of identifying and blaming individuals. It is important that maternity managers have skills to provide feedback in a safe, blame-free environment. Inappropriate or judgemental feedback could lead to a blame culture and negatively affect communication, teamwork and collaboration across the maternity team.
Attitudes, beliefs, and predictors of gestational weight gain and postpartum weight retention in South Africa: a mixed methods analysis
(Springer, 2025) Cintron, Chelsie; Madlala, Hlengiwe Pretty; Battle, Ameerah; Reid, Tishara; Pellowski, Jennifer A.; Knight, Lucia C.; Myer, Landon; Bengtson, Angela M.
Suboptimal gestational weight gain (GWG) is associated with pregnancy complications and postpartum weight retention (PPWR). Little data exists about GWG and PPWR attitudes and beliefs in low-and-middle-income countries (LMICs) to inform interventions. We examined GWG and PPWR attitudes, beliefs, and intentions among pregnant people, with and without HIV, in Cape Town, South Africa. Pregnant persons were enrolled between 2019 and 2022 (N = 400). Study visits were conducted at 24–28 weeks’ and 33–38 weeks’ gestation. Rate of GWG (kg/week) between the second and third trimesters was estimated and reported as below, above, or within the 2009 Institute of Medicine guidelines. Multivariable-multinomial regression estimated predictors of GWG. In-depth interviews among pregnant participants, community leaders and healthcare providers informed GWG attitudes, beliefs, and perceptions. Over 90% of participants experienced suboptimal rates of GWG (35% below and 47% above guidelines) during pregnancy. Living with HIV [OR 0.50, 95% CI (0.26–0.95)] was protective against GWG rate above guidelines compared to those without HIV. Being 25–29 years old was associated with GWG rate below guidelines [OR 0.28 95% CI (0.08–0.95)]. Little concordance occurred between intended and true GWG. Despite GWG category, two-thirds of participants felt it was ‘very important’ to monitor GWG while 44% viewed losing weight gained during pregnancy as “not important”. Barriers to meeting GWG goals included lack of access to healthy foods, exercise opportunities, and education. Given rising obesity in women of reproductive age in LMIC, locally-adapted interventions are needed during pregnancy and postpartum to aide in healthy GWG and improve maternal-child health outcomes.
Measuring respectful maternal and newborn care in Nepal: comparing linked observation and interview data- prospective cohort study
(Public Library of Science, 2025) Kinney, Mary; Basnet, Omkar; Sacks, Emma
Respectful maternal and newborn care is the cornerstone of high-quality care, however, measuring experience of respectful care has challenges since it can be subjective, and dependent on expectations. In this study, we assess the concordance between women's reported experiences of respectful maternal and newborn care and independent observation of their care in Nepal.MethodsThis is a secondary analysis of a prospective cohort study among 22832 pregnant women conducted in three high volume hospitals in the country: Koshi Provincial Hospital (Hospital A), Bharatpur Hospital (Hospital B), and Lumbini Provincial Hospital (Hospital C) for 18 months between April 2017 and October 2018. The study implemented direct observation during and semi-structured interviews at discharge to evaluate the quality of maternal and newborn care in three large public hospitals. For this analysis, three domains for respectful maternal and newborn care were considered: 1) consent and counselling 2) respect and dignity of care, and 3) care provision. The two data sources (observation checklist and semi-structured interview) were plotted to these three domains to identify common indicators. The level of agreement (LOA) between two measurements was compared using Cohen kappa scores (κ) and Bland Altman plots.FindingsDuring the study period, 22832 women had both observation and interview completed. For consent and counseling, 78.8% of women reported being informed about routine care while only 47.3% were observed to have been consented and counseled (k, LOA = 59.1%). For respect and dignity of care, 99.0% of women reported being treated with dignity and respect and 96.4% were observed (k, LOA = 95.4%). For care provision, 37.9% reported that the infant was kept in immediate skin-to-skin contact after delivery while only 3.9% were observed (k, LOA = 61.7%).ConclusionA significant difference existed between observed and self-reported measures of maternal and newborn care. This study highlights the need for a measurement approach that incorporates independent observations alongside self-reported data. There is also a need to further explore concordance between different sources for progress monitoring.
An assessment of compliance with proposed regulations to restrict on-package marketing of packaged foods to improve nutrition in South Africa
(BioMed Central Ltd, 2025) Abdool Karim, Safura; Frank, Tamryn; Khan, Alice Scaria; Tlhako, Morongoa Glenda; Joni, Sikhumbule Kagiso; Swart, Elizabeth Catherina
Background: Ultra-processed products (UPPs), high in sugar, fat and sodium, contribute to increasing burdens of obesity and non-communicable diseases in South Africa (SA). Increased consumption and acceptability of UPPs is driven, in part by aggressive marketing. Front of package labelling laws, particularly warning labels (WLs) coupled with marketing restrictions, have been recommended to improve consumer awareness of unhealthy products, incentivise reformulation and underpin other interventions. The SA government published a draft regulation to introduce WLs and restrict marketing, called R3337. This study aims to analyse on-package marketing and create a baseline to evaluate compliance with the proposed R3337. Methods: This study is an analysis of a dataset of 6768 packaged food products, collected as pictures of products in four major grocery stores in Cape Town, SA between March and July 2019. A codebook was developed based on R337. The codebook was used to identify and assess child-directed marketing (CDM) and health claims on products potentially subject to front-of-package WLs. Food packages and their nutritional information were coded and analyzed to determine whether the product would be required to carry a WL and whether the package included regulated marketing. Results: The majority (80.16%) of products analyzed would require WLs under R3337 due to high levels of sugar, sodium, or saturated fat. CDM was prevalent, with 59.26% of products displaying some form of marketing, primarily animated characters and depictions of children. Health claims were also common, with 83% occurring on WL products. Discussion: Using a WL system in SA could effectively target common forms of on-package marketing of unhealthy products, given the high prevalence of CDM and health claims on products likely to carry WLs. Such interventions may contribute to improving diets and reducing UPP consumption. Some forms of CDM are not regulated under R3337 and we recommend expanding the regulation to include these. This study provides a baseline which should be used for future research to evaluate R3337 when it is implemented.
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.

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