Research Articles (School of Public Health)

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Health services and programmatic responses to improving adolescent HIV care in Lusaka, Zambia: A descriptive qualitative study
(AOSIS (pty) Ltd, 2026) Moomba, Kaala; Crowley, Talitha; van Wyk, Brian
Background: Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care. Aim: This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District. Setting: The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents. Methods: A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery. Conclusion: Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia’s progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade. Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.
Irrational medicine use and its associated factors in conflict-affected areas in Mali: a cross-sectional study
(Taylor and Francis Ltd., 2025) Ahmed, Mohamed Ali Ag; Seydou, Alassane; Coulibaly, Issa; Kielmann, Karina; Ravinetto, Raffaella
Background: Rational use of essential medicines is a critical step towards prevention and treatment of many illnesses. However, it represents a significant challenge worldwide, and particularly for under-resourced health systems in conflict-affected areas. Objective: To assess barriers to rational use of essential medicines at primary healthcare level in conflict-affected areas of Mali. Methods: We conducted a cross-sectional study in twenty randomly selected community health centres (CHCs) in four health districts, by applying the World Health Organisation and International Network on Rational Use of Drugs core forms for the rational use of medicines. Seven hundred eighty-nine (789) prescriptions were retrospectively selected and analysed; four hundred forty-three (443) patients were interviewed: and health facility-related indicators were collected prospectively from the 20 CHCs. Results: The average number of medicines per prescription was 3.89 ± 1.83; out of these, 94.0% were prescribed by generic name, and 91.0% belonged to Mali’s National List of Essential Medicines. Overall, 68% of the assessed prescriptions included antibiotics; 58% included injectables; and 75.79% were characterized by polypharmacy, i.e. more than two medicines per prescription. In multivariate analysis, the study area and prescriber’s sex were significantly associated with polypharmacy; prescriber’s seniority and training were associated with antibiotic overprescription; the study area, prescriber’s sex and seniority were associated with overprescription of injectables. Moreover, the average price of prescriptions was high in relation to average local income, likely making these unaffordable for many households. Conclusion: Excessive polypharmacy and overprescription of antibiotics and injectables undermine the performance of the local health system and the achievement of intended therapeutic outcomes. Our findings provide a solid basis for more targeted and multidisciplinary research, to further inform relevant stakeholders on how best to mitigate the impact of conflict on the rational use of medicines.
Contextual constraints and dilemmas influencing health providers' prescription practices in a conflict-affected area: qualitative insights from Mopti, Mali
(Public Library of Science, 2025) Coulibaly, Issa; Diarra, Yacouba; Ahmed, Mohamed Ali Ag; Ravinetto, Raffaella; Doumbia, Seydou O.; Kielmann, Karina
Armed conflicts present complex, multidimensional challenges that severely compromise both access to and the quality of healthcare, including the adequate prescription of essential medicines. This study aimed to identify and understand the factors underlying the irrational prescribing of medicine in areas affected by armed conflict in the Mopti region in Mali. An exploratory qualitative study was conducted using a semi-structured interview guide to collect data from 30 participants, including health professionals from three health districts, representatives of the regional health directorate, members of community health associations, and staff from non-governmental organisations (NGOs) working in health sector. Interviews were recorded, transcribed, and subjected to thematic content analysis, using NVIVO 14 (2023 version) to support coding and data retrieval. Study participants reported a range of health system- and patient-related factors contributing to irrational prescribing practices in these conflict-affected areas. Health systems factors included: an imbalance between workload and the availability of qualified staff; limited access to professional training and training resources; poor adherence to prescription guidelines and procedures -often a consequence of contextual constraints; and coercion from armed terrorist groups. Administrative and political challenges were also highlighted, including weak monitoring and supervision mechanisms within the local health system; a lack of oversight by health and regulatory authorities in blockaded areas; the development of an informal pharmaceutical sector to compensate for deficiencies in the formal system; and overprescription of medicines linked to insurance schemes. Patient-related factors included delayed care-seeking linked to regional insecurity and contributing to increased morbidity and worsened health outcomes. Our results show that the multiple contextual factors influencing prescribing of medicines are deeply interlinked. Efforts to improve the quality of prescribing in conflict zones must recognise that practices often deemed ‘irrational’ are shaped by complex contextual constraints. A coordinated and comprehensive approach involving all health systems stakeholders is required.
‘The not talking is actually what kills you’– young South African women’s communication barriers about sexual health
(Routledge, 2026) Hartley, Felicity; Trappler, Jill; Gill, Katherine; Bekker, Linda-Gail; MacKenny, Virginia; Knight, Lucia; Passmore, Jo-Ann
Conversations about sex and sexual health are often stigmatised and shaped by socio-cultural influences. For young women, lack of adequate communication can influence access to information, knowledge and behaviour and therefore increase vulnerability to negative outcomes such as sexually transmitted infections (STIs) and unintended pregnancy. This qualitative study investigated the barriers young women face when seeking dialogue about sex, their sexual health and relationships. Seven isiXhosa-speaking young women (aged 21–25) participated in a six-session art-based engagement, creating large-format paintings reflecting their sexual health experiences. Data collection included in-depth interviews and a focus group discussion, which were transcribed, translated and thematically analysed. Findings revealed that communication about sex and sexual health was hindered by the attitudes of family, partners, communities and health care providers. The need to please and retain partners also restricted young women’s ability to express their sexual health needs and desires. Young women felt that with age and maturity they gained confidence, agency and capacity to navigate difficult conversations. Empowering tools and strategies to improve communication could enhance young women’s agency, enabling them to overcome barriers for communication and actively seek sexual health information and services.
Availability of essential medicines in 14 remaining health facilities in Gaza
(Elsevier B.V., 2025) Aljadeeah, Saleh; Satheesh, Gautam; Hafez, Sali; Naguib, Mina; Neilson, Amy; Alaloul, Asil; Ooms, Gorik; Shellah, Duha; Abu Shammala, Bissan Ismail; Ravinetto, Raffaella
Multiple human rights and UN officials have raised grave concerns over violations of international law in the Gaza Strip (or Gaza) that have amounted to extermination and genocide. The Israeli military blockade and violence are causing severe medicine shortages. Between May 21 and July 9, 2025, we measured the availability of 25 essential medicines across 14 functioning facilities in Gaza (six in northern Gaza and eight in southern Gaza), comprising three public hospitals, five humanitarian and relief centres, and six private pharmacies. Only functional facilities were included. Data were collected remotely following the WHO/Health Action International (HAI) methodology, which we adapted for conflict settings on the basis of preprint research conducted in northern Syria. Availability was defined as the proportion of facilities stocking each medicine on the day of data collection; more details are available in the appendix (pp 1–2). Availability was considered very low if it was less than 30%, low if it was 30–49%, somewhat high if it was 50–80%, and high if it was more than 80%.
“If there is no data, how do we improve?” Exploring health workers’ perspective on stillbirth recording in the Ashanti Region of Ghana
(BioMed Central Ltd, 2026) Mensah Abrampah, Nana A; Okwaraji, Yemisrach B; Oteng, Kenneth Fosu; Asiedu, Ernest Konadu; Larsen-Reindorf, Rita; Blencowe, Hannah; Jackson, Debra
Background: Health workers play a critical role in documenting the estimated 2 million stillbirths that occur annually. From the moment a stillbirth occurs, a health worker is responsible for recording the birth outcome. The reliability of stillbirth data for informing global and national-level strategies on stillbirths depends on the information recorded by the health worker at the point of care. This study aimed to gain insights into the health worker practices and challenges related to stillbirth recording and reporting. Methods: The qualitative study explored three objectives using an a priori framework: 1) experiences, perceptions, and attitudes; 2) barriers; and 3) support mechanisms available to health workers for stillbirth recording and reporting. Semi-structured interviews were conducted with 28 health workers, including midwives, medical officers, physician assistants, and health information officers. The study was conducted across four secondary and four primary care facilities in the Ashanti Region of Ghana. All health facilities are government owned. Thematic analysis was performed. Results: Under experiences, perceptions, and attitudes, inconsistent definitions were used to describe stillbirths. Health workers described stillbirths using various gestational age thresholds, including 24-,28-,36-, and 38-weeks. Some health workers did not reference gestational age when describing stillbirths. Pre-service education shaped knowledge on stillbirths and its recording, with limited opportunities for in-service training. The motivation to record stillbirths was influenced by both intrinsic, driven by the moral imperative to do what is right, and extrinsic factors, influenced by district-level standards. Misclassifications and omissions of stillbirths occurred due to a higher workload, a large volume of forms requiring completion, limited knowledge and experience, and a deliberate effort to minimize facility mortality rates, especially in cases of macerated stillbirths. For barriers to stillbirth recording, midwives reported that blame was evident at three levels: blame from the broader health system, blame within the organizational facility-level, and individual-level blame. The failure to implement audit recommendations was identified as a bottleneck perpetuating negative attitudes toward collecting stillbirth data. The engagement of clinical staff in audit reviews and training was identified as support available to health workers. Conclusion: We need to understand the health worker experiences, perceptions, and attitudes that underpin stillbirth data to reduce the stillbirth burden. The study suggests several recommendations, including socializing the national stillbirth definition, and reviewing audit protocols.
Born too soon: accelerating change to 2030 and beyond
(BioMed Central Ltd, 2025) Kinney, Mary; Lawn, Joy; Khosla, Rajat
Progress needed Preterm birth rates have “flatlined” for a decade with major loss of human capital, hindering progress for many Sustainable Development Goals. Progress on the reduction of maternal, newborn and child mortality needs to accelerate by between 3 and 11-fold to reach national and global targets by 2030. Priorities Actions are required on two tracks: (1) prevention of preterm birth, including better management for women in preterm labour, and (2) provision of high-quality care to vulnerable newborns, including those born into fragile and conflict-affected settings. Together these tracks have potential for high impact in terms of millions of lives saved, and socioeconomic returns on investment. We can and must do more to provide quality and respectful reproductive, antenatal and birth care for all adolescent girls and women, everywhere, and close unacceptable survival gaps for small and sick newborns. New focus is essential on threats beyond the health sector, notably conflict and the climate crisis. Pivots The cost of inaction is too high in every country. Four pivots are central to accelerating action: invest, implement, integrate, and innovate. More specifically these pivots include investments in systems including more skilled human resources; implementation of high-impact interventions with data used for quality improvement and accountability; innovations including new health technologies and also systems and social innovations; plus, integration with levels of the health sector and across sectors and the life-course, with families at the centre. Everyone has a role to play. Increasing speed now, and sustaining progress, requires multi-level leadership including from grassroots movements led by parents and affected people through to heads of state. Some countries provide examples of such change: The United States of America in data identified inequalities by state and ethnicity for preterm birth. Importantly noting drops in donor aid, India has made ambitious investment in the health sector and beyond, and United Republic of Tanzania in multi-level leadership. Changing gears requires the ambition and energy witnessed a generation ago for HIV/AIDS. We have the ability now to ensure that every baby born too soon – and their mothers – can survive and thrive. Our next generation depends on us acting now for more healthy starts and hopeful futures.
The health system’s response strategies to the effects of climate change extreme weather events in Malawi: “a policy analysis”
(BioMed Central Ltd, 2025) Chimatiro, Chancy Skenard; Mianda, Solange; Lembani, Martina
Introduction: The effects of climate change and extreme weather events on the health system are becoming unbearable globally. We conducted a health policy analysis to understand the health system’s response strategies to the effects of climate change extreme weather events in Malawi and identified implementation response challenges for improvement. Methods: The policy triangle model was used to analyze health system policies. A list of policies was obtained from the Department of Policy, Planning, and Development at the Ministry of Health. We retrieved the policies from the Ministry of Health Website, and hard copies were obtained for those not published online. A data extraction form was created to capture all climate change-related issues, which were grouped according to the policy triangle model, including context, content, process, and actors. We further identified implementation challenges to climate change. Results: In total, we obtained 32 health policy documents from the Department of Planning at the Ministry of Health that were screened for climate change-related issues. Out of these, only three had climate change-related themes and strategies. Guided by the policy triangle framework, we present our findings under five themes: policy context, policy contents, policy process, actors, and the implementation gaps. Contextually, the policies were aligned with both local and international goals. The contents of the analyzed policies have climate change thematic areas and strategies not specific to health system improvement. The process involved situation analysis and consultations with both national and international stakeholders. The actors involved included government ministries, local councils, development partners, community leaders, and global organizations. Some of the implementation challenges include a lack of health system-specific climate change strategies and guidelines, a lack of clear funding mechanisms, limited consideration of local knowledge, and a lack of capacity building strategies among health workers. Conclusion: The health system in Malawi is moving in the right direction to minimize the effects of climate change extreme weather events on health. The availability of climate change thematic areas, objectives, and strategies in the analyzed health policies shows that some efforts are being made to address the effects climate change extreme weather events in the country. We recommend developing climate change-specific health policies with clear strategies and financing mechanisms.
HIV viral re-suppression on second-line ART in Southern Zimbabwe
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) van Wyk, Brian; Musomekwa, Kudakwashe
The national prevalence of HIV among adults in Zimbabwe was 10.4% in 2023, while the HIV prevalence in Bulawayo Metropolitan Province was 11.7%. The country achieved the UNAIDS Fast Track goals of 95-95-95 ahead of the 2030 target, by reporting an ART coverage of 97.0% and a viral suppression rate of 95.0%. As the number of people on ART continues to grow, it is expected that the number of patients failing current first-line non-nucleoside treatment will increase. However, access to second-line treatment regimens remains very limited in resource-poor settings such as Zimbabwe. It is therefore imperative to review treatment success for persons on second-line treatment. A retrospective cohort analysis was conducted using routinely collected clinical and demographic data from 315 participants who had been on a second-line ART regimen in Bulawayo for at least six months between 2015 and 2020. Statistical analyses were conducted to identify risk factors for viral suppression using SPSS version 28. Viral suppression (68.6%) for adults was far below the target of 95%. After accounting for all other variables, baseline CD4 count (>200 c/µL) [AOR = 1.94 (1.05–3.61)], having no history of non-adherence on first-line ART [AOR = 3.88 (1.91–7.85)], drug switch within 12 months of failure [AOR = 4.13 (1.98–8.60)] and retention in care at 5 years [AOR = 6.35 (2.56–15.76)] predicted viral re-suppression. The second-line (rescue) regimen has not achieved the expected success in reversing initial viral non-suppression (due to late presentation and poor adherence), despite enhanced adherence counselling. Timely switching is effective when done within 12 months and coupled with persistent engagement in care. We recommend improved methods, such as enhanced adherence counselling for behaviour change to improve viral re-suppression rates, especially for those on with a history of poor adherence and virologic non-suppression.
Knowledge and perceptions of uterine fibroids: a descriptive cross-sectional survey among women of childbearing age in Kwa-Zulu Natal, South Africa
(Women's Health and Action Research Centre, 2025) Nxumalo, Celenkosini Thembelenkosini; Dlamini, Amanda; Mpofana, Nomakhosi
Uterine fibroids are the leading cause of hysterectomies among women of childbearing age. This study aimed to elicit the knowledge and perceptions of childbearing women towards uterine fibroids. A quantitative, cross-sectional descriptive design was used and data were collected from a sample of 362 women of reproductive age residing in a selected township in KwaZulu-Natal, South Africa. Ethical approval to conduct the study was obtained from the Durban University of Technology’s Institutional Research Ethics Committee (IREC – Ref No. BIREC 014/21). A pre-tested survey was conducted to collect data for this study. SPSS version 27 was used to analyze data and further employed descriptive statistics. Inferential statistics were also conducted to investigate relationships between important variables and respondents who self-reported being diagnosed with uterine fibroids. Most participants, 73.8% (n=267), had no awareness of uterine fibroids. Participants also demonstrated poor knowledge regarding the aetiology and symptoms of the condition. However, nearly half of the participants, 49.2% (n=178), perceived uterine fibroids to be of spiritual origin, citing evil spirits and witchcraft as the cause. The study findings suggest that women in the selected township lack accurate knowledge about uterine fibroids. Despite the limitations related to the use of a convenience sampling approach for data collection and the subsequently low levels of education observed among certain participants, the study findings provide useful baseline information to inform the development of tailored educational interventions for the condition
Political economy of adolescent mental health and well-being globally
(BioMed Central Ltd, 2026) Biermann, Olivia; Shawar, Yusra Ribhi; Shiffman, Jeremy; Brown, Seika L; Bain, Miranda; Shire, Ismahan; Baird, Sarah; Baird, Sarah; Collins, Pamela Y; Requejo, Jennifer H; Mensa-Kwao, Augustina; Tomlinson, Mark; George, Asha; Kumar, Manasi; Aranda, Zeus; Tamambang, Rita; Omigbodun, Olayinka; Peterson, Stefan Swartling; Claeson, Mariam
Background: The current generation of 1.3 billion adolescents (10–19-year-olds), most of whom live in low- and middle-income countries, face large and growing mental health problems. Collective action that could lead to significant improvement in adolescent mental health and well-being (AMH) remains limited. We analyse the factors shaping the global prioritization of AMH for funding and action and reflect on a way forward. Methods: We triangulate data from interviews with key informants knowledgeable in AMH; focus group discussions with youth representatives who are mental health advocates, some with lived experience of mental ill-health; and document review. We collected the qualitative data from 2021 to 2023, followed by thematic analysis and stakeholder consultations. Results: We identify four themes which shape the global prioritization of AMH. First, prevailing interpersonal and institutional stigma and discrimination directed against adolescents with mental health problems hamper attention to AMH. Second, limited data on the burden of mental health problems and evidence of what works have led to the perception among decision-makers that AMH is an intractable problem. Third, diverse ways of framing AMH are often viewed as a sign of weak alignment rather than as opportunities for coalition-building. Fourth, a wide variety and increasing number of stakeholders are involved in AMH, while the stakeholder landscape remains fragmented, inhibiting coalition-building for AMH. Conclusions: To overcome the barriers that currently impede the prioritization of AMH, we recommend that (1) stakeholders conduct an adolescent-led consultative process to develop an “umbrella framing”, supported by common metrics, (2) advocates use existing global platforms to shape the political priority for AMH, (3) decision-makers, funders and research partners invest in meaningful engagement of adolescents (with lived experience), researchers and implementing partners (4) identify a leadership, governance and accountability structure for a global coalition that could transform AMH and (5) conduct context-specific analyses to inform coalition-building nationally.
Optimizing adolescent HIV care: a review of EMR system quality for clinical monitoring in Zambia
(Frontiers Media SA, 2026) Moomba, Kaala; Van Wyk, Brian
Adolescents living with HIV (ALHIV) in Zambia experience poorer treatment outcomes than adults, with lower viral suppression and higher loss to follow-up rates. Electronic medical record (EMR) systems such as SmartCare aim to strengthen patient monitoring, but their utility is contingent on high data quality. Accurate monitoring of ALHIV treatment outcomes is critical for improving patient care and supporting progress toward UNAIDS 95–95-95 targets. We conducted a retrospective cross-sectional review of EMR data for ALHIV on antiretroviral therapy in selected Lusaka facilities (January–December 2023). Data were extracted from SmartCare and assessed using the WHO Routine Data Quality Assessment framework across three dimensions: completeness, correctness, and consistency. Records from 3,978 ALHIV were analysed. Socio-demographic variables (gender, date of birth, age at ART initiation) and treatment data (ARV regimen) performed strongly, with ≥98% completeness, correctness, and consistency. In contrast, clinical variables showed substantial gaps. Completeness for baseline (n = 1,707) and current (n = 2,149) CD4 counts was 43% and 54%, respectively, though correctness and consistency exceeded 99%. Pregnancy and breastfeeding data among female adolescents (n = 2,177) were particularly poor, with completeness of 4% and 12%. By comparison, history of tuberculosis (100%) and current viral load results (91%) were reliably captured. Whereas SmartCare demonstrated strong reliability for demographic and treatment indicators, notable weaknesses in the completeness of key clinical variables, such as CD4 count and pregnancy/breastfeeding status were observed. These gaps may reflect variability in data entry workflows and system-level factors, including EMR upgrades, highlighting areas for targeted improvement. We recommend targeted training, system redesign to enforce mandatory entry of critical fields, and routine data quality monitoring to ensure EMR systems provide accurate and actionable data. Addressing these gaps would facilitate optimising HIV care and support progress toward achieving the UNAIDS 95–95-95 goals for ALHIV in Zambia.
Enhancing circular economic activities of e-waste pickers in South Africa: using Korten's four generations strategies as framework
(John Wiley and Sons Ltd, 2025) Chitaka, Takunda; Schenck, Catherina; Petersen, Jochen
E-waste pickers play a valuable role in the circular economy and divert waste from landfills. Despite their contributions to the economy, informal e-waste pickers work in very adverse conditions. With a view to improving their livelihoods and working conditions and possibly increasing their integration, Korten's four generations framework is used as theoretical lens. A total of814 surveys were completed across South Africa. The main findings highlight the collecting, dismantling and sorting and pre-processing activities. The main motivation for the individual participants to move beyond collection was monetary: the more processed the goods, the higher the price. Despite exposing themselves to hazardous practices during pre-processing, the majority of respondents were still earning below the minimum wage level. Korten's four generations of strategies are found to provide valuable guidance on how to think and act when supporting e-waste pickers towards increased integration in the waste systems and the circular economy.
Access to essential medicines for noncommunicable diseases during conflicts: the case cardiovascular diseases, diabetes and epilepsy in Northern Syria
(Public Library of Science, 2025) Aljadeeah, Saleh; Tarrafeta, Belen; Fahed, Samah; Kielmann, Karina; Ravinetto, Raffaella
Access to essential medicines is a critical component of healthcare. Conflicts severely disrupt pharmaceutical supply chains. This study examines the availability and prices of essential noncommunicable diseases (NCDs) medicines in Northern Syria, and explores the underlying factors contributing to medicine shortages and price variability. We applied a mixed-methods approach, combining a cross-sectional quantitative survey based on the World Health Organization/Health Action International (WHO/HAI) methodology with qualitative interviews. Medicine availability and price data were collected from public healthcare facilities and private pharmacies across Northeast and Northwest Syria. Availability was calculated as the percentage of facilities with the medicine in stock and categorized into four levels. Prices were reported using median price ratios. Qualitative data were collected from retailer pharmacists, representatives from non-governmental organizations (NGOs), and personnel working in medicine warehouses and wholesale distribution. Thematic content analysis was employed to analyze the qualitative data. The findings indicate low medicine availability, falling well below WHO targets. The mean availability was 45.5%. Of 28 medicines surveyed, 11 had somewhat high availability (50%–80%), 12 had low availability (30%–49%), and 5 had very low availability (<30%). Epilepsy medicines had the lowest availability, highlighting a particularly neglected area of care. Qualitative report suggested that the observed price variations were largely driven by the geopolitical tension, supply chain disruptions, and the absence of effective regulatory mechanisms. The conflict has caused or exacerbated shortages through the destruction of infrastructure, trade restrictions, and economic instability. Additionally, concerns over the quality of medicines were frequently reported. This study highlights challenges in accessing essential medicines in Northern Syria but also reveals that medicine supply systems, although disrupted, continue to operate through alternative and informal channels. Moving forward, efforts must prioritize coherent, context-sensitive policies that build on existing structures and human resources to rebuild a well-regulated and equitable system.
Early and young child feeding in South Africa: expert assessment of public policy using food-EPI
(Routledge, 2025) Delobelle, Peter; Holliday, Nicole; Klinger, Carmen; Mchiza, Zandile June-Rose; Von Philipsborn, Peter; Geffert, Karin; Alaba, Olufunke
Stunting under the age of two years remains a significant public health problem in South Africa. This study used data from the 2023/24 Food-EPI assessment to benchmark implementation of public nutrition policy related to undernutrition to develop recommendations for priority policy action. The assessment included ratings by an expert panel including academics, civil society, and government representatives (n = 13). Implementation of food fortification was rated as high, and access to water, sanitation, and hygiene in public areas was rated as low. Policies on breastfeeding and restrictions on the marketing of breast milk substitutes need to be updated and/or enforced. Breastfeeding in public and workplaces needs to be supported, the informal sector regulated, and breastfeeding and complementary feeding targets and growth monitoring attended to. The need to address stunting requires a systems approach to tackle undernutrition, as suggested by the UNICEF Nutrition Strategy 2020-2030.
Gender-affirming care in South Africa: a cross-sectional survey ff transgender and gender-diverse people in the Eastern and Western Cape provinces, South Africa
(South African Medical Association, 2026) Bust, L; Matyila, S A; Welte, O; Xaba, N; Zintwana, Z; George, A; De Jong, M; Kaplan, R
Background: Transgender and gender-diverse (TGD) people face significant discrimination in the South African (SA) health system, limiting their access to HIV services and gender-affirming care, which supports an individual’s gender identity when it does not align with their sex assigned at birth. Despite the critical role of these services for TGD people, access to care remains understudied in SA. Objectives. To describe TGD people and their access to and need for social, legal and medical transition, including psychosocial care, hormone therapy and surgery, as well as HIV services, in the Eastern Cape and Western Cape provinces, South Africa. Methods. A cross-sectional quantitative survey design was utilised, with 150 TGD individuals recruited via convenience sampling in the Western and Eastern Cape provinces. Interviews were conducted using structured questionnaires, with data captured on REDCap. Descriptive analysis was conducted using Stata 18. Results. Of the 150 respondents, 74.0% were people assigned male at birth (AMAB) and 26.0% were people assigned female at birth (AFAB). Reported gender identities showed that 68.5% of AMAB respondents identified as transgender women/female, 56.4% of AFAB respondents identified as transgender men/male and 34.0% of all respondents identified as gender diverse or non-binary. Demographics showed a vulnerable population, with 18.7% with housing insecurity and 66.0% unemployed. While social transition was common (98.7%), access to legal transition (4.0%) was very low, as was access to all forms of medical gender-affirming care, with 44.7% of TGD people accessing psychosocial care, 32.0% accessing hormone therapy and 2.7% surgery. Of the respondents who had not legally transitioned, 71.4% wanted to. Most respondents who had not accessed medical gender-affirming care services expressed a need for psychosocial care (77.1%) and hormone therapy (68.6%). Gender-affirming surgery was more variable, with 33.3% of AFAB respondents wanting bottom surgery compared with top surgery (63.9%), and 49.5% of AMAB respondents wanting bottom surgery compared with top surgery (55.9%). Almost all (99.3%) respondents had had an HIV test in their lifetime, with reported HIV prevalence differing between AMAB (34.2%) and AFAB (7.9%) respondents. PrEP uptake among HIV-negative AMAB respondents was 30.4%, and 5.7% among AFAB respondents, while 78.0% of TGD people living with HIV were on antiretroviral treatment. Conclusion. Findings demonstrate a critical gap between needed and actual access to legal and medical gender-affirming care services. There is an urgent need for the provision of integrated and accessible gender-affirming care and HIV services as part of comprehensive care for TGD populations within inclusive health systems nationally.
Born Too Soon: learning from the past to accelerate action in the next decade
(BioMed Central Ltd, 2025) Kinney, Mary; Gruending, Anna; Lawn, Joy
This paper is a narrative review that takes stock of the progress in addressing preterm birth over the past decade – notably on policies, national plans, innovation, evidence, social mobilisation, and community engagement – to inform future progress on preterm birth. At the global policy level, many countries have strongly supported collective initiatives and resolutions on maternal and newborn health relevant to preterm birth in multilateral fora, most recently through a World Health Assembly resolution calling for a revival amongst the global community on stalled progress for maternal, newborn and child health. Following the adoption of other global plans, like the Every Newborn Action Plan and Strategies for Ending Preventable Maternal Mortality, most countries set corresponding national mortality and coverage targets, and many have national and subnational policies and plans for integrated maternal and newborn health. Adequate financing remains a challenge, and sexual and reproductive health and rights of women and girls are being challenged globally. There have been significant advances in evidence-based interventions for preterm birth prevention and care, reflected in updated World Health Organization guidelines on antenatal, intrapartum and postpartum care, and care for small and sick newborns. The past decade has also seen progress in social mobilisation and community engagement, particularly parent groups and healthcare professional organisations advocating on issues surrounding preterm birth.
Let’s hear it from the facilitators: experiences of peer facilitators in engendering work with adolescent boys and young men in Cape Town, South Africa
(Women's Health and Action Research Centre, 2025) Schaay, Nikki; Jacobs, Tanya; Oware, Phoene; Mjijelwa, Vuyo; Walmisley, Ulla; Nyembezi, Anam; Akintola, Olagoke; George, Asha
Working with men and boys is central to improving sexual and reproductive health and rights and contributes to gender equality and social justice. Focusing on two behaviour change interventions (“One Youth Can” and “SKILLZ Guyz”), embedded within a national HIV programme (“My Journey”), this qualitative, exploratory study explored the contextual and organizational realities faced by peer facilitators in implementing these two interventions and what it would take to integrate a gender-transformative approach into their practice. The research, conducted in South Africa, used three data sources: a curriculum gender analysis, observations of both interventions and capacity strengthening sessions with peer facilitators. The study found that facilitators have to manage an array of contextual challenges. The programmatic context in which they work is dominated by the need to meet quantitative targets, leaving the capacity strengthening and mentoring needs of the facilitators – and their own lived experiences insufficiently addressed. Our research confirms the pivotal role peer facilitators can play in implementing gender-transformative approaches with adolescent boys and men in South Africa, but recommends that their practice be accompanied by sustained capacity strengthening and organisational support to address the unequal systems of gender and intersecting power relations in the contexts in which they work and live.
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.

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