Research Articles (School of Public Health)

Permanent URI for this collection

https://hdl.handle.net/10566/11

Browse

Now showing 1 - 20 of 876

Healing bodies, healing communities: a community-based qualitative study of adult survivors of childhood sexual trauma in South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Morgan, Leona; Nadar, Sarojini; Keygnaert, Ines
Highlights: Body-based care models respond better to long-term, intergenerational and somatic aspects of sexual trauma in survivors being historically excluded from mental health care. Co-creation of care pathways ensures culturally sensitive approaches that are responsive to lived experiences of marginalized survivors of childhood sexual trauma. What are the main findings? Relational safety and somatic engagement were foundational to trauma recovery, enabling survivors to process trauma at their own pace and integrate dissociative experiences through embodied therapeutic praxis. Recovery was relational and continuous, with participants reporting increased peace, authenticity and social connection despite structural barriers, highlighting the effectiveness of culturally grounded, non-pathologizing care. What is the implication of the main finding? Integrative Trauma-Informed Care (ITIC) offers a culturally sensitive, adaptable framework that can be tailored to diverse communities and age groups, emphasizing embodied, intergenerational and relational healing. Decolonial and feminist approaches to mental health care can bridge epistemic gaps in ITIC praxes by centering survivors’ lived, embodied experiences, promoting sustainable and inclusive therapeutic models globally. Background: While sexual trauma is inherently an embodied experience, research on psychological interventions that is cognisant of geographic and socio-political community contexts within which embodied, therapeutic interventions occur remains limited. Decolonial, African and feminist community psychologies have noted this epistemic–ethical gap. Objectives: This paper explores the co-development of trauma-informed care pathways for adult survivors of childhood sexual trauma (CST) in under-resourced communities in Cape Town, South Africa. The study aimed to integrate intergenerational community knowledge, embodied therapeutic practices and collaborative approaches into locally relevant models of care. Methods: Drawing on feminist mental health frameworks, this qualitative study engaged 13 adult female survivors who identify as “coloured”. Embodiment was central in guiding the deconstructive therapeutic praxis, informing both the co-development of care pathways and the conceptualization of integrative trauma-informed care (ITIC) beyond pathologizing, deficit-based narratives. The cultivation of trust and the situated lived realities of survivors were foregrounded to illustrate the relational dimensions of trauma recovery. Results: Establishing relational safety emerged as the foundation for therapeutic engagement, supported by non-directive therapeutic probing. Grounding practices, affective regulation and embodied awareness enabled participants to process trauma at their own pace. Somatic engagement allowed the integration of dissociative experiences while strengthening relational resilience. Recovery was a continuous process, with participants reporting increased peace, authenticity and capacity for social connection despite structural barriers to community support. Conclusions: The development of care pathways was embedded within the research process itself, offering an approach that is culturally sensitive and responsive to survivors’ lived experiences. ITIC accounted for temporal, intergenerational and embodied trauma and should be adaptable across age and community-specific needs. The ITIC approach offers a transferable framework for co-developing de-pathologizing, culturally responsive interventions that can be adapted across diverse global contexts to support sustainable trauma integration.
Women’s experiences of communication and supportive care during labour: a qualitative study in rural KwaZulu-Natal, South Africa
(BioMed Central Ltd, 2025) Doherty, Tanya; Luthuli, Silondile; Horwood, Christiane
Background: Quality maternal care is crucial to improve outcomes for both mothers and newborns. Many initiatives to improve maternal care concentrate on improving clinical practice. However, women’s experiences of care are also important determinants of health outcomes. Establishing strong interpersonal relationships between health workers and women is essential for delivering high-quality person-centered care, with health workers who empathize with women, respect their needs and concerns, and communicate effectively. Aligned with the World Health Organization standards of care framework, this study aimed to explore women’s experiences of care during labour and childbirth, focusing on communication, respectful, and supportive care. Methods: A qualitative exploratory study was conducted with postpartum women in rural district hospitals in KwaZulu-Natal. Purposive sampling was used to recruit women from communities within the hospitals’ catchment areas. Data were collected through focus group discussions (FGDs) conducted in the local language of participants. Five FGDs were conducted between January and April 2023. Inductive thematic analysis using NVivo v12 was employed to analyze the data. Findings: A few women described positive experiences of care, but most women reported suboptimal care characterized by poor communication, lack of privacy, and disrespectful treatment. Participants described experiences of verbal and physical abuse, being called demeaning names, facing invasive procedures without providing consent, and inadequate emotional support, such as their concerns being systematically ignored and birth companions being denied entry to labour wards. Some women responded to these challenges through various coping mechanisms including staying quiet to avoid confrontation, following instructions rigidly, seeking advice from other women in the labour ward, and in some cases standing up for themselves. Some women described persistent anger and distress as a result of their experiences. Conclusion: The findings of the study highlight persistent gaps in effective communication and supportive care for women during labour and childbirth. Possible interventions could be aimed at improving communication skills of health workers as well as fostering a culture of empathy and respect for women in their care. In addition, empowering women through antenatal education and implementing birth companion policies could further improve women’s experiences during labour and childbirth.
Public health diplomacy: summary of the methods and outcome of the 1st University of Memphis School of Public Health Diplomacy Summit
(Frontiers Media SA, 2025) Amde, Woldekidan; Joshi, Ashish; Magana, Laura
Public health diplomacy addresses global challenges impacting societies, economies, the environment, and health by integrating foreign policy and development. The University of Memphis School of Public Health hosted a multistakeholder summit to identify strategies and competencies essential for effective public health diplomacy. A 3-day summit included 29 participants from 15 countries, representing the WHO, the World Federation of United Nations, and seven regional public health associations. An iterative human-centered design (HCD) approach and concept mapping were employed to facilitate discussions and generate actionable recommendations. Developed a working definition of Public Health Diplomacy emphasizing cross-disciplinary collaborations, communication, negotiation, and consensus building. Produced a 9-point action plan to establish a global framework, launch capacity-building initiatives, and institutionalize public health diplomacy as a public health discipline.
Tracking viral control in adolescents on antiretroviral therapy in Lusaka, Zambia: a retrospective cohort analysis
(AOSIS (pty) Ltd, 2025) Moomba, Kaala; van Wyk, Brian; Crowley, Talitha
Background: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10–19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15–24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018. Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10–19 years) on ART in Lusaka District, Zambia. Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29. Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/ mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15–19 years) had lower odds of suppression compared to younger adolescents (10–14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI]: 1.32–2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23–8.11) and optimal adherence (AOR = 1.89; CI: 1.03–3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45–0.80). Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents
Policy implementation and recommendations to address the double burden of malnutrition in South Africa: expert assessment using the expanded Healthy Food Environment Policy Index (Food-EPI)
(BioMed Central Ltd, 2025) Mchiza, Zandile June-Rose; Holliday, Nicole; Delobelle, Peter
Background: South Africa faces a double burden of malnutrition (DBM), the coexistence and interaction of multiple forms of malnutrition (undernutrition, micronutrient deficiencies, and overweight/obesity) within individuals and households and across the life course. A healthy food environment is necessary to reduce this DBM. The Healthy Food Environment Policy Index (Food-EPI) can be used to evaluate the implementation of public nutrition and food environment policies in comparison with international best practices. The aim of this study was to assess the extent of implementation of healthy food environment policies in South Africa using an expanded DBM Food-EPI framework, benchmark policies against international best practices, develop priority policy recommendations, and compare implementation progress since the 2016 South African Food-EPI assessment. Methods: From October 2023 to March 2024, a panel of 23 national experts from different tiers of government (Department of Health), academia, and civil society was invited to participate in the Food-EPI assessment. Through two workshops and online feedback, experts evaluated the implementation of food environment policies across 60 indicators, compared these policies to international best practices, and proposed and prioritized a list of policy actions based on perceived implementation gaps. Results: Of the 23 invited experts, 13 participated in the benchmarking workshop in which about 70% of indicators were rated at very low to low levels of implementation. Overall, of the 48 original indicators, the mean level of implementation improved from 2016 to 2024. Of the 12 indicators that addressed the DBM, eight were rated at very low to low levels of implementation. The experts (original panel plus four additional participants) then proposed ten priority actions, mainly across the domains of Food Promotion, Food Prices, Funding, and Platforms for Interaction. Conclusions: Application of the expanded Food-EPI in South Africa showed improvements for the original indicators compared with 2016 and highlights the need for additional policy efforts to improve public nutrition policy and address the DBM.
Global maternal child health initiatives and programs 1974 to 2023
(Springer, 2025) Jackson, Debra
Aim: This review paper aims to review Global MCH initiatives and note trends across the last five decades (1974–2023). Methods: As an organizing framework, MCH initiatives and programs have been classified into five categories: Global Health Conferences, Declarations or Strategies; Global Health Surveys; Global MCH Programs; Global MCH related Data Initiatives or Working/Advisory Groups; and Global MCH Partnerships or Networks. Results: Over 50 Global MCH initiatives and programs have been implemented during this period. The first International Conference on Primary Health Care and the Alma Ata Declaration in 1978 initiated a new era of global public health. International conferences building on Alma Ata with a focus on population health and MCH, along with global surveys to measure the health status of populations across countries and global working groups to analyze these data, emerged over the next decades. Global MCH partnerships also emerged for advocacy and coordination of an increasing number of efforts to improve maternal, newborn, child and adolescent health and well-being—towards achieving the Millennium (2000–2015) and Sustainable (2016–2030) Development Goals. Conclusion: Four trends were noted across these five decades: (1) MCH Mortality decreased but unacceptable inequities persist with COVID-19, ongoing conflicts and climate change threatening these gains. (2) Implementation of primary health care (PHC) as envisioned by Alma Ata in 1974 continues to see a debate about selective versus comprehensive programs. (3) As mortality declined (Survive), the field expanded focus to child well-being (Thrive) and across preconception through adolescents (Transform). (4) Global MCH issues are relevant across high-income (HIC) and low-middle income (LMIC) settings to achieve health and well-being of all women and children everywhere.
Perceived accuracy and utilisation of DHIS2 data for health decision making and advocacy in Kenya: a qualitative study
(Public Library of Science, 2025) Oware, Phoene Mesa; Omondi, Gregory; Adipo, Celestine
Reliable health information systems (HIS) are critical for effective decision-making in the delivery of Primary Health Care and Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (PHC/RMNCAH+N) services. In Kenya, the District Health Information Software 2 (DHIS2) platform serves as the primary HIS for tracking health indicators. This qualitative study explored perceptions of DHIS2 data accuracy and use for decision-making among PHC/RMNCAH+N stakeholders across 15 counties in Kenya. 89 Key Informant Interviews were conducted with PHC/ RMNCAH+N stakeholders, to explore experiences, barriers, and facilitators of DHIS2 data use. Thematic network analysis was employed to identify recurrent themes and generate insights into the utility of DHIS2-generated information. Sociotechnical challenges included limited technical capacity among health staff, inadequate analytical skills, and reliance on a small pool of Health Records Information Officers (HRIOs). However, positive practices emerged, such as the use of DHIS2 dashboards and user-friendly outputs, which were valued for supporting evidence-based decision-making and advocacy, particularly at higher levels of health management. In some counties, visual displays of data, including scorecards and performance trends, facilitated budget advocacy and community engagement. Contextual challenges and constraints, such as use of inconsistent data collection tools across counties post-devolution, human resource shortages, and limited integration of private sector data, contributed to incomplete reporting. These challenges underpinned perceived inaccuracy of DHIS2 data, arguably, hindering the complete reliance on DHIS2 data for planning and decision making. The study highlights the need for targeted investments to improve DHIS2 data accuracy and use through stronger stakeholder coordination, enhanced data synthesis skills, and fostering a culture of data ownership among a wide range of stakeholders in health, including political actors.. Addressing these gaps will contribute to improvement in DHIS2 data quality, enhanced ownership and reliance on DHIS2 data by PHC/RMNCAH+N stakeholders for decision making in Kenya.
Strategies and responses to the effects of climate change on health systems in Sub-Saharan Africa: a scoping review protocol
(Public Library of Science, 2025) Chimatiro, Chancy Skenard; Mianda, Solange; Lembani, Martina
Background Climate change is recognized as the greatest global health threat of the 21st century. Projections suggest that the Sub-Saharan African region will face more consequences of climate change than any other region globally. The health systems within the region have been affected by the negative effects of climate change. Mapping strategies and responses used in the region to address the effects of climate change on health systems in Sub-Saharan Africa could be a starting point for understanding evidence-based decision-making to inform best practices. Methods This scoping review will follow the methodological framework by Arksey & O’Malley. A wide range of databases will be searched to identify articles published on the strategies and responses to the effects of climate change on the health systems in Sub-Saharan Africa. Only peer-reviewed articles (original quantitative and qualitative studies, mixed methods, systematic reviews, editorials, and commentaries) published in English Language between 2010 and 2024 will be reviewed. All Book chapters and the grey literature (dissertations, conference proceedings, abstracts, reports) and publications primarily focusing on climate change strategies and responses without effects on health systems will be excluded. Covidence software will be used during study selection, data extraction, and summary. Deductive thematic analysis will be performed using predetermined themes from the objectives. Dissemination The results of this scoping review will be disseminated at local and international research conferences. Furthermore, the findings will be published in open-access journals targeting different audiences. The findings will also be shared with the Ministry of Health in Malawi for possible policy considerations.
Perceptions of South Africa’s master of public health graduates on the degree’s contribution to their leadership at work and in society
(Frontiers Media SA, 2025) Schaay, Nikki; Tshitangano, Takalani; Zweigenthal, Virginia
Introduction: Integrating public health functions into national health systems is essential to enhance population health. The Master of Public Health (MPH) degree is an important foundation for public health practice in low-and middle-income countries such as South Africa. However, insufficient evidence on individual motivations for undertaking the MPH and the perceptions of graduates on the utility of the degree at work and in society and its contribution to their leadership skills informed this study. Methods: A consortium of academics from eight South African universities developed a self-administered questionnaire to measure inter alia the socio-demographic characteristics, motivations, career paths, perceptions of the utility of the degree, and its contribution to their professional and personal development. The study population comprised the 2012–2016 cohort of MPH graduates from eight universities. Following informed consent, eligible graduates completed an online survey via REDCap. The data were analyzed using Stata. Results: A total of 221 graduates completed the survey. The mean age of respondents was 35 years, and the majority were from South Africa (53.2%) or other African countries (43.2%). The majority (91.1%) completed the MPH to improve their skills or to promote their personal development for senior management and leadership roles. Approximately 75% used identified leadership skills at work, but only half these skills were obtained from the MPH. Over 80% of respondents positively impacted on their workplace and in society, using skills mostly derived from the MPH in all domains. Discussion: This cohort of MPH graduates exercised leadership in different settings, but many stated that these skills were not obtained from the MPH programs. The COVID-19 pandemic underscored the need for public health leaders skilled in communication, collaboration, and crisis management, amidst considerations of social justice and equity. Hence, leadership skills need to be intentionally included in MPH programs in South Africa.
Global prioritised indicators for measuring WHO’s quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus
(BMJ Group, 2025) Jackson, Debra; Day, Louise Tina; Vaz, Lara M E
Objectives The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels. Design Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels. Setting The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur. Participants The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts. Results The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9). Conclusions The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.
A systematic review assessing the association between extreme temperature exposure and cardiovascular health outcomes in Africa
(Academic Press Inc., 2025) Sello, Mamakase G.; Kyeyune, Jemimah; Kgatla, Hellen; Mchiza, Zandile J
The African continent is grappling with a rising prevalence of cardiovascular diseases (CVDs) in conjunction with the growing threat of climate change and its associated extreme temperatures. This systematic review aims to assess the relationship between extreme temperature exposures (heat and cold exposure) and cardiovascular health outcomes in African populations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in compiling this evidence. A comprehensive literature search was performed on PubMed-Medline, Scopus, Web of Science, and Google Scholar as the primary databases to identify relevant studies published from January 1990 to October 2024. Both hot and cold temperature extremes were linked to detrimental cardiovascular outcomes related to stroke. Exposure to sudden drops in minimum temperature exceeding 2.4 °C was linked with a 43 % higher risk of stroke. Elderly women (≥65-years) exposed to cold had the highest mortality rates and were more vulnerable to air pollution interactions during moderate temperatures (20–23 °C). Exposure to high temperatures (>37 °C) was associated with increased rates of heart failure and stroke. Hypertension was identified as a significant risk factor, with 37.6 % of stroke patients having pre-existing hypertension; notably, 86.2 % of these cases were linked to heat exposure. The highest CVD vulnerability was observed among females, older adults, and rural dwellers. The evidence presented in this systematic review suggests that exposure to both extreme cold and heat significantly contributes to the development of cardiovascular diseases. However, further studies are needed to validate and strengthen these findings.
Knowledge translation platforms: Broker, intermediary or more? A scoping review of definitions, functions and characteristics
(BioMed Central Ltd, 2025) Shmidt, Bey-Marrié; Mulopo, Chanelle; Späth, Carmen
Background: Knowledge translation platforms (KTPs), also referred to as intermediaries, play a key role in supporting evidence-informed decision-making. Numerous KTPs exist globally, striving to translate evidence into policy. However, these platforms are described in varying ways, and some KTPs do not explicitly identify themselves as such. This makes identification, recognition and leveraging of KTPs suboptimal. It also hinders opportunities for learning, adapting and scaling of such platforms. Objective: This scoping review aimed to synthesize the literature on the variety of definitions, functions and characteristics of a KTP with a view to harmonize these aspects of KTPs and offer a revised framework of functions. Methods: This review was conducted using recommended methods and reporting guidelines. Searches were performed in PubMed, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using a predetermined search strategy, without date or geographical restrictions. Included studies were analysed and synthesized in ATLAS.ti, following Braun and Clarke’s six steps of thematic analysis. Findings: With one exception, all KTPs did not identify themselves as such in their names. Five common elements emerged across the KTP definitions: (i) a physical or virtual platform (ii) that engages with and convenes different stakeholders (iii) through a set of knowledge translation activities and outputs (iv) to contribute to health decision-making. We identified KTP activities that aligned with the core functions described in the Valmeekanathan et al. (Valmeekanathan et al. in Tert Educ Manag 27:227–256, 2021) framework – namely knowledge exchange, dialogue and capacity – but also additional activities, including engaging funders, planning for sustainability and scalability, providing training grants and initiating innovative knowledge translation processes that integrate knowledge across projects and sectors to maximize impact. Conclusion: This review provides a synthesized definition of KTPs while expanding on the three core functions described in the Valmeekanathan et al. (Valmeekanathan et al. in Tert Educ Manag 27:227–256, 2021) framework. To maximize their impact, sustained investment, stronger institutional support and integration into national policy ecosystems are essential.
Monitoring District Health System performance in South Africa: a proposed dashboard based on key pragmatic indicators
(South African Medical Association, 2025) Schneider, Helen; Barron, Peter; Mahomed, Hassan
Effective monitoring and evaluation (m&e) systems are central to ensuring the performance and accountability of the district health system (dhs). Current systems in south africa are suboptimal and poorly oriented to the decision-making needs of district managers. Drawing on a who measurement framework for the performance of primary healthcare, and as a follow-up to a first article describing the challenges of m&e systems in the dhs, this article proposes a dhs performance monitoring dashboard that is both practical and pragmatic. The dashboard was constructed in an iterative and consultative process, and consists of 20 indicators for quarterly monitoring a set of general criteria underpinning the choice of indicators is spelled out (e.g. The data are readily available and reliable). Indicators that do not have much variability, or are better suited to annual evaluation (e.g. Number of community health workers per 1 000 population) are not included. The dashboard includes the name or description of the indicator, the definition of the indicator, why it is useful, challenges and pitfalls to be considered when analysing the indicator and how it can be used for decision-making. We propose that these indicators be assessed, tracked and monitored on a quarterly basis by relevant managers at the facility sub district and district levels. We emphasise that the purpose of this dashboard is not external compliance, but rather to support district managerial decision-making and accountability.
Developing a strategic action plan for reducing the burden of stroke in Africa: report of the first African Stroke Leaders' Summit
(Frontiers, 2025) Akinyemi, Rufus; Naidoo, Pamela; Olowoyo, Paul
Introduction: Stroke is a leading cause of adult neurologic disability, cognitive decline, and death worldwide, and particularly in Africa. Stroke research in Africa has exposed challenges militating against the translation of research evidence into practice and policy. The evidence-based, context-sensitive multilevel strategies required to surmount these challenges are presented in this report on the first African Stroke Leaders' Summit (ASLS) organized to tackle the burden of stroke in Africa. Methods: The Africa–UK Stroke Partnership (AUKSP) Project had a Steering Committee (SC) and four theme-based Working Groups (WGs): stroke services, stroke training/capacity building, research and stroke advocacy, each with defined terms of reference. These groups generated 20 priorities (five per thematic area) during breakout sessions at the first ASLS which were further refined into four topmost priorities (one per thematic area) at the general consensus session. Results: The topmost priorities included promoting the development of acute stroke services (stroke services), strengthening population-based stroke education focusing on prevention and symptom recognition (stroke training), research on hypertension control to reduce stroke risk (stroke research), and developing national stroke action plans (advocacy). Conclusion: Sustained reduction of stroke burden in Africa requires the adaptation of best practices to the African context, building the capacity of African stroke care professionals and using available resources with political support. Improving stroke literacy in African communities is a complementary strategy to reinforce healthy lifestyle choices and improve screening and detection of hypertension and other modifiable stroke risk factors.
Mpox and the ethics of outbreak management: lessons for future public health crises
(John Wiley and Sons Inc, 2025) Kleinsmidt, Anita; Obasa, Adetayo; Botes, Marietjie
Mpox, first identified in captive monkeys in 1958 and recognized in humans by 1970 in the Democratic Republic of Congo, was historically confined to sporadic zoonotic outbreaks in Central and West Africa. These outbreaks, often driven by rodent‐to‐human transmission in resource‐limited settings, reflect persistent systemic health disparities. In recent years, mpox has also been reported in high‐income countries (including the United States, United Kingdom and Europe), underscoring its global health implications beyond traditionally endemic regions. This article examines the mpox outbreak through the lens of public health ethics, evaluating how core ethical frameworks—justice (encompassing equitable vaccine distribution and addressing health inequities), solidarity and respect for rights (including intellectual property considerations)—shape outbreak management strategies. These strategies are ensuring equitable access to vaccines and therapeutics amid intellectual property barriers, combating stigma and misinformation through transparent risk communication and fostering international solidarity in coordinating responses. The analysis highlights how neglect of these principles exacerbates existing disparities and undermines the effectiveness of interventions. Integrating ethical principles into outbreak responses is critical for building public trust, accountability and community resilience. By distilling lessons from the mpox response, this article contributes to ongoing debates in public health ethics and outbreak preparedness, arguing that ethically grounded approaches are essential for fair and effective management of future public health crises.
Synergistic effects of drought and heat stress on Medicago truncatula: understanding growth response and photosynthetic mechanisms
(Institute of Experimental Botany, ASCR, 2025) Ludid, Ndiko; Maiza, Nourhene; Mnafgui, Wiem
Drought and heat stress significantly threaten forage crop development and photosynthetic activity in the Mediterranean region. This study investigated the physiological responses and photosynthetic activity of two lines TN6.18 and F83005.5 (F83), to single and combined heat and drought stress treatments. Biomass traits, leaf gas exchange, and photosystem activities were evaluated. Our findings indicate a reduction in biomass parameters under heat, drought, and combined stress on both lines, particularly in F83. The stomatal conductance and photosynthetic parameters exhibited differential responses, with F83 reducing its stomatal conductance under drought stress, while TN6.18 was adapted by opening its stomata. Moreover, in TN6.18, combined stress enhanced protection mechanisms in PSI, while F83 showed changes in PSII efficiency. These insights deepen our understanding of plant responses to abiotic stresses and offer strategies for improving tolerance and resilience in changing environmental conditions.
Behind the billions: policies, politics and power of the Global Financing Facility for women’s, children’s, and adolescents’ health
(Taylor and Francis Ltd, 2025) George, Asha; Kinney, Mary; Lawn, Joy
The landscape of global health financing has shiftedprofoundly in recent years – with redirection of donor aid to national security spending, economic shocks from the COVID-19 pandemic, and rising debt burdens – placing immense pressures on low- and middle-income countries (LMICs) to self-finance theirhealth systems . Sudden major donor cuts to global health amplify the need to transform health financing to more sustainable and equitable models that protect vulnerable populations, especially women, children, and adolescents . Many LMICs, and notably those in sub-Saharan Africa, are off track or haveslowed down in progressing towards the Sustainable Development Goals targets for ending preventable maternal, neonatal and child deaths by 2030. This requires urgent action and increased investment. Concurrently, global health initiatives (GHIs), including the Global Financing Facility (GFF), are also beingreimagined to better support countries on their path towards Universal Health Coverage . The GFF launched in 2015 with a compelling mission: to close financing gaps for women’s, children’s, and adolescents’ health through smarter, more sustainable investments . Framed as a ‘country-led’ mechanism that could both mobilize and coordinate domestic and external financing, the GFF promised to move beyond traditional aid models by catalyzing investment cases tailored to each country’s priorities. A decade since its inception, there remains relatively little peer-reviewed research about how the GFF operates in practice, how its promises of country leadership and catalytic financing are realized, and what lessons can be drawn for the future of global health financing .
Dispensing of medicines for asthma and chronic obstructive pulmonary disease through the government health insurance in Syria: a retrospective analysis
(Taylor and Francis Ltd, 2025) Ravinetto Raffaella; Aljadeeah Saleh; Tomas Ana
Asthma and chronic obstructive pulmonary disease (COPD) are common noncommunicable diseases, exacerbated in conflict settings by the heightened environmental exposure to triggers, weakened health systems, and poor access to medicines and healthcare. However, accurate data on medicines dispensing in this context are generally scarce. We examined the patterns and rates of medicines dispensing for asthma and COPD among the beneficiaries of the Syrian governmental health insurance scheme between June 2018 and March 2021. We retrospectively analyzed the outpatient dispensing records for 125,371 adults. Medicines for asthma and COPD were identified using the Anatomical Therapeutic Chemical (ATC) classification system. Dispensing rates were calculated as the number of packages per 1,000 beneficiaries per month, stratified by age, sex, and route of administration. Out of our sample, 15.02% received at least one package of a medicine for asthma or COPD. Oral formulations were the most frequently dispensed (92.67% of patients), particularly oral salbutamol and xanthines. Inhaled medicines, including inhaled corticosteroids (ICS) and ICS long-acting β2-agonists (ICS-LABA) combinations, were markedly under-dispensed (17.08% of patients). Dispensing rates were higher in females and older adults. Seasonal variation showed peaks in autumn and winter, with a notable decline in April 2020, coinciding with the early COVID-19 period. The study highlights substantial gaps in dispensing of medicines for asthma and COPD, with particularly low rates for inhalers, likely reflecting barriers driven by the conflict, economic instability, and sanctions. Robust coordinated action is needed to improve their availability in Syria.
Examining sustained sub-national health system development: experience from the Western Cape province, South Africa, 1994-2016
(Oxford University Press, 2024) Schneider, Helen; Gilson, Lucy; Vallabhjee, Krish
Governance and leadership are recognised as central to health system development in low- and middle-income countries, yet few existing studies consider the influence of multi-level governance systems. South Africa is one of many (quasi-)federal states. Provincial governments have responsibility for managing health care delivery within national policy frameworks and norms. The early post-apartheid period saw country-wide efforts to address the apartheid legacy of health system inequity and inefficiency, but health system transformation subsequently stalled in many provinces. In contrast, the Western Cape provincial health department sustained service delivery reform and strengthened management processes over the period 1994-2016. This department can be considered a ‘pocket of relative bureaucratic effectiveness’ (POE): an organisational entity that, compared to others, is relatively effective in carrying out its functions in pursuit of the public good. This paper considers what factors enabled the development of the Western Cape health system in the period 1994-2016. Two phases of data collection entailed document review, participatory workshops, 43 in-depth interviews with purposively selected key informants from inside and outside the Western Cape, and a structured survey testing initial insights (response rate 42%). Analysis included triangulation across data sets, comparison between the Western Cape and other provincial experience and deeper reflection on these experiences drawing on POE theory and public administration literature. The analysis highlights the Western Cape experience of stable and astute sub-national governance and leadership and the deepening of administrative and technical capacity over time - within a specific provincial historical and political economy context that sustained the separation of political and administrative powers. Multi-level governance systems can create the space for sub-national POEs to emerge in their mediation of wider political economy forces, generating spaces for skilled reform leaders to act in the public interest, support the emergence of distributed leadership and develop robust management processes.
A combined strategies intervention on the world health organization prescribing indicators: a quasi-randomised trial
(AOSIS (pty) Ltd, 2024) Ncube, Nondumiso B.Q.; Mukumbang, Ferdinand C; Laing, Richard; Schneider, Helen; Laing, Richard
Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance. Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. Setting: The study was conducted in public-sector healthcare facilities in Eswatini. Methods: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times. Results: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up. Conclusion: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing. Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.

Browse

Recent Submissions