Research Articles (School of Public Health)

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Interest in long-acting injectable antiretroviral therapy (ART) among adults living with HIV newly starting or restarting ART in Cape Town, South Africa
(Routledge, 2026) Knight, Lucia; Phillips, Tamsin K.; Zondo, Mpumelelo
Long-acting injectable antiretroviral therapy (LAI ART) has proven effective in maintaining viral suppression among people living with HIV but recommendations to switch to LAI ART are limited to individuals stable and virologically suppressed on oral ART. Understanding LAI perceptions among diverse populations living with HIV is essential. In a cross-sectional survey at two peri-urban clinics in Cape Town, adults starting or restarting treatment rated their hypothetical interest in LAI ART on a quantitative Likert-scale (1= not at all interested to 5 = very interested) and provided open-ended explanations. Among 329 participants (61% women; median age 39 years), 74% were very interested, 15% were unsure or somewhat interested (response 3 or 4) and 11% were not very or not at all interested (response 1 or 2). In thematic analysis of open-ended responses, participants commonly viewed LAI ART as a way to avoid daily pills, reduce adherence-related stress, and maintain privacy, noting that injections offered convenience and discretion. Concerns centred on fear of injections, potential side effects, and desire to hear others’ experiences before deciding. The substantial interest observed suggests, once accessible, LAI ART as a treatment option in this population could move us closer to individual- and population-level HIV treatment goals.
Can a code of professional ethics influence the supply of substandard and falsified medicines? Insights from Ethiopia
(Routledge, 2026) Mengesha, Akalework; Dingwall, Robert; Gibson, Linda; Bastiaens, Hilde; Ravinetto, Raffaella
Substandard and falsified (SF) medicines are serious global health problems. Their highprevalence is a threat to public health in resource-limited settings. It is assumed thatprofessionals will uphold specific standards of behaviour to protect the public interestand maintain trust. This study assesses whether a professional ethical code can serve asan effective way to prevent and respond to SF medicines by enhancing ethicalbehaviours in practice. The study adopted a cross-sectional qualitative design employinginterviews and observation. Participants were selected through purposive, convenience,and snowball sampling techniques and included pharmacists, physicians, wholesalers,pharmacy owners, regulatory staff, and members of the local community. The data areanalysed within a framework from the Actor-Network Theory. The influence of theprofessional ethical code is entangled in a complex network of practices involvingvarious actors who adapt their behaviours to meet local needs and demands. Itseffectiveness depends on supportive institutions, and on economic and educationalinfrastructure. Embedding ethics as an enforceable component of a systems rather thana symbolic marker for professional identity may reduce the spread of SF medicines andstrengthen the trust, accountability and legitimacy in pharmaceutical practice.
Urban South African adolescents’ perspectives on healthy and unhealthy foods and the drivers of their food choices in their school food environment: a pilot study
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Khan, Alice Scaria; Dillman-Carpentier, Francesca; Swart, Elizabeth Catherina
Background: Childhood obesity is on the rise in South Africa and adolescents spend a substantial amount of time in the school food environment (SFE), which plays a role in shaping their food choices and provides a critical setting to improve diets. Objective: To investigate South African adolescent school-going learners’ knowledge and understanding of healthy and unhealthy foods and the drivers of their food choices in their (SFE). Design: Qualitative participatory research methods including workshops, photovoice and focus group discussions (FGDs). Setting: Two urban public high schools, one non-metropolitan and one metropolitan, in two separate provinces (Eastern Cape and Gauteng) in South Africa. Participants: Adolescents 14–18 years (n = 42). Results: Unhealthy ultra-processed foods (UPFs) were found to be rampant in the SFE, and healthy foods were scarce, limiting learners’ choices. Taste preference was a major driver of adolescent food choices as were satiety, value for money, affordability, convenience, visual appeal and seeming “cool or “rich” by purchasing branded franchise fast foods. Learners had some general nutrition knowledge, but this did not translate into healthy food choices. Banning unhealthy foods in the SFE and providing affordable and satiating healthy foods were proposed as solutions. Conclusions: UPFs such as packaged foods and fast food were considered tasty but unhealthy, yet were preferred. Interventions are needed to promote healthy diets by changing the SFE, and eventually adolescent food choices. This will require government regulation banning the sale of unhealthy food and beverages (F&Bs) in the SFE and subsidising healthy satiating foods to change dietary behaviour.
Beyond the diagnosis: exploring illness identity in HIV and its impact on health outcomes
(Springer, 2026) Sematlane, Neo Phyllis; Knight, Lucia C.; Campbell, Linda; Masquillier, Caroline; Wouters, Edwin
This study utilizes the illness identity framework to investigate the incorporation of HIV into a sense of self and how varying degrees of integration influence key patient-reported outcomes. Using baseline data from the SINAKO Cluster Randomised Controlled Trial, we analysed responses from 316 adults living with HIV (PLHIV) attending 12 healthcare facilities in the Cape metropole, South Africa. Respondents completed assessments on four illness identity dimensions (rejection, acceptance, engulfment, and enrichment) alongside measures for depression and anxiety symptoms, stigma, medication adherence, and self-management. Regression analyses with robust standard errors assessed associations between illness identity and patient-reported outcomes, controlling for gender, age, and illness duration. Longer illness duration was associated with acceptance and enrichment. There was no evidence of an association between gender or education level and illness identity, while age showed a weak positive association with acceptance. Higher engulfment scores correlated with greater depression and anxiety symptoms, increased stigma, and poorer treatment adherence and self-management. Higher enrichment scores were associated with better self-management and lower stigma. Higher rejection scores were associated with heightened negative self-image. Acceptance did not show unique associations with any outcome. This study highlights the vital role of illness integration in shaping health outcomes among PLHIV in resource-limited, high-prevalence settings. Strategies that rapidly identify those in an engulfment state early in the illness trajectory and foster adaptive illness integration, specifically enrichment, could improve outcomes for PLHIV.
Career trajectories of master of public health graduates from South African universities
(BioMed Central Ltd, 2026) Dlungwane, Thembelihle; Christofides, Nicola; Dlungwane, Thembelihle; Matlala, Sogo France; Mokgatle, Mathildah Mpata; Opare, Abraham; Patrick, Sean Mark; Schaay, Nikki
Background: The Covid-19 pandemic highlighted the need for public health professionals to be embedded in country health systems. The Master of Public Health (MPH), offered widely, is accepted as the entry degree for public health practice in low- and middle-Income countries (LMICs). The aim of the study was to address the knowledge gaps on the career trajectories of MPH graduates from South African universities. Methods: A research team from the eight South African universities that graduated MPH students between 2012 and 2016 obtained lists of alumni and invited them to participate in an on-line survey. The self-administered questionnaire elicited the demographic characteristics of MPH graduates, their educational and work background, the impact of the MPH on their subsequent work and their perspectives on the roles of MPH graduates. Results: The overall 37% response rate varied by institution. Respondents were mid-career professionals, in their mid-30s with on average, nine years work life. A sizeable proportion came from sub-Saharan Africa and they returned to their home or a neighbouring country to work. Most had been managers or patient-facing health professionals, and the MPH was the route to shift into public health roles. After MPH completion, 91% were employed in government (40%), non-governmental organisations (32%) or academic/research institutions (21%) in technical, managerial or academic roles. The MPH was a stepping stone for career advancement, and 55% of study participants changed their employers post qualification. They envisaged that MPH graduates could assume leadership positions and effectively contribute across both technical and managerial domains, including during public health emergencies. Conclusion: The MPH degree was pivotal to graduates taking on public health roles in their home countries. In view of public health workforce shortages, the study findings contribute to planning for a competent cadre to tackle pressing public health problems and their social determinants and support robust health systems development in Africa.
Health system strategies and responses to the effects of climate change in sub-Saharan Africa: a scoping review
(Public Library of Science, 2026) Chimatiro, Chancy Skenard; Mianda, Solange; Hajison, Precious; Lembani, Martina
Background Climate change is now regarded as a global health challenge of the 21st century, posing a negative health risk to the population. Sub-Saharan Africa is disproportionately affected more than any other region worldwide. Mapping strategies and responses in Sub-Saharan Africa to address the impact of climate change on health systems is a starting point for understanding evidence-based decision-making and informing best practices. Methods We conducted a scoping review to identify health systems strategies and responses to the effects of climate change in Sub-Saharan Africa. Electronic database searches were conducted on African Index Medicus, PubMed, CINAHL, and Scopus. Covidence software was used to remove duplicates, blind study selection, and data extraction. We included peer-reviewed articles (original quantitative and qualitative studies, mixed methods studies, reviews, editorials, and commentaries) published between 2011 and 2025. All book chapters and grey literature publications (dissertations, conference proceedings, abstracts, and reports) that primarily focus on climate change strategies and responses without effects on health systems were excluded. The results were analysed using descriptive thematic analysis. Results Out of 11459 articles, 8 studies met our inclusion criteria. Most studies provided strategies and responses centered on service delivery, health workforce, health information, leadership and governance, with few on health financing and medicinal products. No study was identified that had outlined strategies and responses across all of the six World Health Organisation building blocks for the health systems. Implementation challenges identified include inadequate funding, lack of knowledge among health workers on climate change and health, inadequate surveillance and reporting structures, and low prioritization of climate change activities among health workers. Conclusions This scoping review has identified some health system strategies and responses to the effects of climate change within the Sub-Saharan African region. The review has revealed that existing strategies and responses are fragmented and hindered by some implementation challenges. As climate change continues to pose health threats to the global population, urgent and effective interventions are required to minimize its impacts. It is essential to understand the unique vulnerabilities of the health systems, particularly those in the Sub-Saharan African region. The time is now to develop strategies and responses that can improve and strengthen health systems as it protects health of the population from the effects of climate change.
Perceptions of facilitators, barriers and adaptations for provision of obstetric fistula surgery and care: a qualitative descriptive study of service providers in selected hospitals in Busoga sub-region, eastern Uganda
(Frontiers Media SA, 2026) Mukasa, Peter Kivunike; Kinney, Mary; Jackson, Debra
Introduction – Obstetric fistula is a devastating childbirth injury common in low-resource settings, with many women failing to access surgical repair due to health system challenges. However, limited evidence exists on the health system factors shaping the provision of fistula care and surgery. The study aimed to explore facilitators, barriers encountered, and adaptation mechanisms employed by healthcare providers in the provision of fistula surgery and care. Methods – We conducted 20 qualitative interviews in two hospitals providing fistula surgery and care in the Busoga sub-region, a government and a private not for profit hospital between June and December 2024. In-Depth Interviews (n = 12) were conducted with purposively selected healthcare providers and facility administrators. We also conducted Key Informant Interviews (n = 8) with purposively selected national fistula experts/surgeons, policy makers and implementing partners. Data were audio-recorded, transcribed verbatim and analyzed using a deductive thematic analysis, guided by the World Health Organization (WHO) health system blocks framework. Results – Seven themes emerged from the findings including: 1) human resources, 2) equipment and supplies, 3) infrastructure, 4) financial resources, 5) access to services, 6) adaptation mechanisms, and 7) recommendations for improved provision of obstetric surgery and care. Facilitators to provision of fistula surgery and care included government coordination and stewardship, availability of trained specialists during fistula camps, donor-supported equipment and supplies, community mobilization, and financial support to patients. However, significant barriers including inadequate and poorly compensated staffing, high staff turnover, inconsistent supplies and equipment, limited ward space leading to overcrowding, and an overreliance on external donor funding constrained routine service provision. Access barriers included stigma, limited awareness and high transport costs involved in seeking care.
“If I’m not okay, I won’t take the pills”: anticipating the effects of depression and PTSD on prep use among prep naïve pregnant and postpartum persons in South Africa
(Springer, 2026) Knight, Lucia; Stanton, Amelia M.; Gulbicki, Lauren
Background: Poor mental health may influence the uptake and persistence of pre-exposure prophylaxis (PrEP) use to prevent HIV. Because HIV acquisition risk increases during the perinatal period, we explored the anticipated impacts of mental health symptoms on PrEP uptake and continued use during pregnancy and breastfeeding among pregnant and postpartum persons in South Africa. Methods: PrEP-naive pregnant and postpartum people (PPP) with elevated depression and/or post-traumatic stress disorder (PTSD) symptoms completed qualitative interviews between May 2022 and May 2023. Interviews probed the anticipated impacts of these symptoms on the likelihood of starting and continuing PrEP while pregnant or breastfeeding. After transcription and translation, a codebook was developed using inductive and deductive methods. Coded data were analyzed via thematic analysis. Results: Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1 years old and had 2.1 previous pregnancies. Thirteen participants met criteria for probable depression, two for PTSD, and eight for both. Participants articulated a range of mental health symptoms (e.g., persistent negative emotions, anhedonia, fatigue) that might impact PrEP use. Four themes related to the anticipated impact of these symptoms on PrEP uptake and persistence emerged: (1) skipping doses when experiencing negative emotions; (2) delaying pick up from the clinic; (3) specific negative impacts of trauma-related fear, worry/rumination, and associated forgetfulness; and (4) no or minimal anticipated impact of mental health symptoms on PrEP use. A minority anticipated no or minimal impacts on PrEP use. Conclusion: This study suggests that depression and PTSD symptoms may negatively impact PrEP uptake and use during pregnancy and postpartum. Specific strategies that reduce the impacts of negative emotions and associated withdrawal/avoidance behaviors could help PPP with depression and/or PTSD use PrEP during this critical period.
Drought exposure and severe mental distress among adolescent girls and young women in Lesotho: the moderating role of food insecurity
(BioMed Central Ltd, 2026) Somefun, Oluwaseyi Dolapo; Baruwa, Ololade Julius; Gwebu, Hlengiwe
Background: Climate-related shocks such as drought are increasingly recognised as threats to mental health, yet evidence remains limited on how these stressors affect adolescent girls and young women (AGYW) in Lesotho. This study examines the association between drought exposure and severe mental distress among AGYW in Lesotho and assesses whether household food insecurity moderates this relationship. Methods: We analysed nationally representative cross-sectional data from 7,101 AGYW aged 13–24 years drawn from the 2018 Lesotho Violence Against Children and Youth Survey. Severe mental distress was measured using the Kessler-6 scale. Drought exposure was defined using district-level Integrated Food Security Phase Classification data. Multivariable logistic regression models assessed independent associations, and interaction terms were used to examine moderation by food insecurity. Predicted probabilities were estimated to illustrate combined effects. Results: Drought exposure was associated with increased odds of severe mental distress (adjusted odds ratio [aOR] = 1.47; 95% CI: 1.01–2.15; p = 0.045). Food insecurity independently increased the odds of distress (aOR = 1.47; 95% CI: 1.06–2.05; p = 0.022). In the interaction model, the association between drought vulnerability and severe mental distress differed by food insecurity status (interaction aOR = 2.21; 95% CI: 1.15–4.27; p = 0.018). AGYW experiencing both drought and food insecurity had the highest predicted probability of severe mental distress. Conclusions: The association between drought vulnerability and severe mental distress among AGYW in Lesotho was stronger in food-insecure households. Integrated climate adaptation, food security, and mental health interventions may help protect vulnerable AGYW in drought prone settings such as Lesotho.
Systemic challenges in the supply and distribution of medicines in conflict-affected areas of Mali: a qualitative study
(Taylor and Francis Ltd., 2026) Ravinetto, Raffaella; Ag Ahmed, Mohamed Ali; Konta, Mama
Background: The conflicts that have been ongoing for over a decade in different Sahel countries, including Mali, have a negative impact on the supply and distribution of medicines. Objective: This study aims to identify and analyze the key contextual challenges affecting the supply and distribution of medicines in conflict-affected areas in Mali. Methods: This study adopts a qualitative study design. First, we conducted 28 interviews with key stakeholders in the pharmaceutical sector in the Mopti and Bamako areas. Such key stakeholders included health professionals, community association members, health authorities, and humanitarian stakeholders. Second, we conducted a thematic analysis, using NVivo software for retrieving and coding the qualitative data. Results: The key contextual factors affecting the supply and distribution of medicines in the study area have been organized under four interlinked themes: (1) insecurity and instability, disrupting transport routes and supply chains; (2) systemic and market dysfunctions, generating price instability and recurrent shortages; (3) technical and infrastructural weaknesses, compromising adequate storage conditions; and (4) insufficient coordination and collaboration among the different stakeholders, which further destabilizes the already fragile pharmaceutical supply system. Together, these factors have considerably weakened the pharmaceutical supply chain’s capacity to ensure continuous and equitable access to quality-assured medicines. Conclusion: Insecurity, market disruptions, weak infrastructure, and insufficient coordination severely undermine the supply and distribution of essential medicines in the conflict-affected areas of Mali. Restoring equitable access requires a strong coordination across public, private, and humanitarian actors, sustained investment in logistics and information systems, and the strengthening of regulatory oversight during and after the conflict.
Responding to extreme stress: resilience and psychological distress in undergraduate nursing students in the Western Cape, South Africa
(AOSIS (pty) Ltd, 2026) Chipps, Jennifer; Cromhout, Amanda; Steenkamp, Ilze; Marie Modeste, Regis R.
Background: Nursing students face significant academic and clinical stressors that can affect their psychological well-being. These challenges are intensified during extraordinary events, such as the coronavirus disease 2019 (COVID-19) pandemic. Objectives: This study investigated psychological distress and resilience among junior (1st year – 2nd year) and senior (3rd year – 4th year) undergraduate nursing students exposed to a major stressor at two universities in the Western Cape, South Africa. Method: A survey was conducted among 589 nursing students during and after COVID-19. Most respondents were female (77.4%) and junior students (75.2%), with a mean age of 22.5 years (± 4.6). Data collection took place at University A (February 2021–March 2021) and University B (November 2021–February 2022). Measures include psychological distress (Kessler-10), resilience (Response to Stressful Experiences Scale) and fear of COVID-19 (Fear of COVID-19 Scale). Results: Overall, students reported mild psychological distress and fear of COVID-19, and high levels of resilience. Senior students experienced significantly higher psychological distress than juniors (p < 0.001), but lower fear of COVID-19 (p = 0.028). Resilience did not differ significantly between groups, with most students demonstrating high resilience. Conclusion: Nursing students showed strong resilience despite the added pandemic-related stressors. Elevated distress among seniors, however, highlights the need for targeted psychological support. Strengthening resilience within nursing education may prepare students to manage future crises and contribute to a sustainable, adaptable nursing workforce. Contribution: This study provides evidence on the psychological well-being of nursing students in South Africa during the COVID-19 pandemic. It emphasises the importance of resilience-building interventions within nursing curricula and institutional support systems to safeguard student health and professional readiness.
Reasons for HIV testing and testing experiences among men testing for HIV in Cape Town, South Africa
(Routledge, 2026) Knight, Lucia; Tolla, Tsidiso; Wouters, Edwin
This study explored factors influencing the experiences of HIV testing among men. The qualitative study was conducted between February and May 2024 in Cape Town, South Africa. Fifteen men, five healthcare workers, four community health workers and six community leaders took part in individual interviews. Men, women, and mixed groups of men and women took part in focus group discussions (n = 6) (5–7 participants per group). Participants were purposively selected. Thematic analysis, guided by the conceptual framework of access to healthcare, was applied. Testing was influenced by (a) healthcare workers initiating HIV testing, which men generally accepted, (b) the availability of male-friendly and men’s clinics, which were limited, but approachable and preferred over general facilities, and (c) men’s engagement in sexual behaviours that increased their exposure to HIV, which motivated testing after self-reflection. While men would access services, they nonetheless experienced emotional distress, including anxiety and fear. However, support services to cope with these emotions were unavailable. The findings highlight the need to integrate psychological support services with HIV testing and treatment and to stimulate and encourage social support to help men manage testing-related anxiety, cope with HIV-positive diagnoses, and improve linkage to care.
Mapping common job demands and job resources for large-scale community health worker programmes in Southern Africa: protocol for a scoping review
(BMJ Publishing Group, 2026) Coley, Rachel S; Shuro, Linda; Coetzee, Renier; Tabana, Hanani
Introduction: High burdens of infectious and non-communicable diseases and human resource shortages strain primary healthcare systems in Southern Africa. Despite the widespread use of community health workers (CHWs) across the region, the existing literature offers no holistic exploration of the characteristics of CHWs’ work. The Job Demands-Resources model provides a framework to enable such a review, positing that two aspects of working conditions—job demands and job resources—are unique to each workplace but have universal impacts on workers’ health, motivation and the achievement of organisational aims. Methods and analysis: The population, concept and context framework will guide the development of a comprehensive search strategy to source reports on CHWs working in large-scale programmes that explore job demands and job resources within at least one Southern African Development Community country. Searches to identify peer-reviewed articles and grey literature will be done in CHW Central, CINAHL, PubMed, Scopus and the WHO Library with citations purposively mined. Eligibility will be limited to reports published in English after the Declaration of Ouagadougou on Primary Health Care in 2008, as this ushered in the modern era of large-scale CHW programmes in Africa. Following publication of this protocol, two reviewers will independently complete screening and full-text review, with the lead author driving data extraction and coding. The results will include organising job demands and job resources into themes, documenting the types of research that articulate these themes and identifying potential knowledge gaps. The review’s methodology and the inclusion of various types of literature will support replicability and comprehensiveness. Ethics and dissemination: Formal ethical approval is not required. Results will take the form of a summative article, and additional publications may be considered if the results warrant more in-depth reporting. The evidence from this review may also inform the creation or improvement of programmes. Trial registration number: INPLASY202580052.
Project ODIN: advancing environmental genomic surveillance for public health across Sub-Saharan Africa
(Elsevier Ltd, 2026) Calvert-Joshua, Tracey; Levy, Joshua; Smith, Emily
Persistent SARS-CoV-2 transmission, ongoing mpox outbreaks, and the continued spread of endemic diseases such as typhoid fever and cholera underscore the urgent need for global, multiomics surveillance. In this Personal View, we present Project ODIN, a consortium of European and African partners launched in 2023 that aims to meet this challenge by deploying innovative systems for near real-time pathogen detection and actionable public health insights. The project is a collaboration between high-income and low-income countries in northern Europe and subSaharan Africa. Focusing on low-income and middle-income countries, ODIN integrates metagenomics with mobile laboratory systems for comprehensive pathogen monitoring across diverse environments. ODIN emphasises standardised sampling, bioinformatics pipelines, and data-sharing protocols to ensure reliable, interoperable results while addressing infrastructure and resource limitations. By bridging gaps in genomic surveillance, these initiatives seek to strengthen outbreak preparedness, improve pathogen detection, monitor antimicrobial resistance, and provide a holistic approach to One Health challenges. Together, these innovations could advance global surveillance capacity—particularly in under-resourced regions—paving the way for effective disease control and evidence-based policy making.
A qualitative study on community engagement at two clinical trial sites in South Africa
(Springer Nature, 2026) Späth, Carmen; Schmidt, Bey-Marrié
Background: Community engagement (CE) and building collaborative relationships with stakeholders is an ethical imperative for public health research. Understanding the pathways to effective CE through reviewing barriers, facilitators and strategies, can inform the conceptualisation of strategies that foster beneficial collaboration between clinical trial (CT) staff and communities. The aim of this qualitative case study was to identify and describe the factors affecting CE at two infectious disease CT sites in South Africa (SSA), from the perspectives of various CE stakeholders. Methods: We purposively selected two case studies in the Western Cape Province (South Africa), with a total of 17 participants. Case study 1 (TB trial site) had 4 CT staff/community advisory board members (CABs) who were individually interviewed (Zoom), including a senior research officer/principal investigator, a research officer, a CAB coordinator/researcher and a site manager. A further 4 CAB members were part of two in-person group interviews. Case study 2 (HIV trial site) entailed two in-person group interviews and four individual interviews, and participants included a community liaison officer, fieldworkers, CAB members, a clinical research worker and a doctor. Thematic analysis was used to generate themes and findings. Results: From Case study 1 it was evident that staff viewed CE as outreach, with successful activities having been implemented; staff positioned CABs as responsible for CE and its challenges; and there was an overlap between roles of CT staff/CABs (leading to role-confusion). Case study 2 revealed that CABs were allies to CT staff and that the selection of CABs were tied to those individuals who could encourage access to participants and who are respected by communities; staff mentioned that approaching communities in a considerate manner aided effective CE. Moreover, at both sites, it appeared to be necessary to improve CE strategies through trial literacy, collaboration and reduced role-confusion. Conclusion: Approaching communities considerately, building connections among staff/CABs and addressing role-confusion are some factors affecting CE in CT research. CE and relevant roles should be clearly defined. Efforts to support effective CE in CT research depend on approaching communities in respectful and culturally appropriate ways.
Stakeholder engagement in health: whose business is it anyway?
(African Field Epidemiology Network, 2026) Gelderbloem, Sebastian James; Kruger, James; Van Wyk, Brian
Universal Health Coverage (UHC) is the cornerstone of equitable health systems and service delivery. Achieving UHC requires both "whole of government" and "whole of society" approaches that are vital for building resilient health systems that promote physical and mental wellness for all communities. In this paper, we review several theories of stakeholder engagement (SE) and argue that meaningful SE-as opposed to stakeholder management-is essential for fostering early participation and democratic decision-making in the transformation of health systems towards UHC. We recommend several key steps to promote early and inclusive SE that actively solicit input from diverse community members, establish open platforms for dialogue, and leverage the expertise and resources of various sectors. By creating a collaborative environment that includes each individual, whether an educator, policymaker, family member, or business leader, amongst others, we can advance the goals of UHC and build health systems that benefit everyone.
Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis
(BioMed Central Ltd, 2026) Knight, Lucia; Gulbicki, Lauren R.; Fertig, Madison R.
Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via adverse health outcomes for the birthing parent and for their infants, and contribute to emotional and behavioral problems later in childhood. There is little research exploring the anticipated impacts mental health symptoms have on one’s ability to emotionally connect or care for their infant after delivery. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby’s wellbeing, their ability to bond with their baby, and their ability to meet their baby’s needs. After transcription and translation of interviews, a codebook was developed using inductive and deductive methods. Coded data were analyzed using thematic analysis. Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1 years old and had 2.1 previous pregnancies. Three themes emerged from interviews: (1) a strong perceived connection between maternal mental health and baby’s wellbeing; (2) perceived strains on bonding with the baby; and (3) the impact of mental health on the likelihood of completing parenting tasks. These results provide insight on how women expect their mental health symptoms to impact their ability to care for their baby, and also how a sense of resilience can contribute to overcoming anticipated mental health challenges. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.
Dietary practices and nutritional status of older persons: a cross-sectional study of Northern Uganda
(BioMed Central Ltd, 2026) Ocaya, Dennis; Kyeyune, Jemimah Kiboss; Ndagire, Regina
Background: Malnutrition remains a problem in older populations globally. Most older persons do not meet the required dietary intake with the majority consuming mainly carbohydrate-based foods and vegetables. The current study therefore aimed at assessing the dietary practices, nutritional status and associated factors among older persons in Gulu district. Methods: This was a cross-sectional study among older persons aged 60 years and above in Gulu District. The study used a multi-stage sampling procedure. Nutritional status was measured using the Mini Nutrition Assessment – Short Form (MNA-SF). Analysis was done in STATA 16 using modified Poisson regression considering a 5% level of significance. Results: The study enrolled 141 participants with a median age (IQR) of 71(64,79) years. Majority of the respondents, 96(68.1%) were female and 72(51.1%) reported to be widows or widowers. The prevalence of malnutrition was 53.9%. Millet was eaten by 62(45.9%) participants 1-4 times a week while maize and its products were eaten by 56(40.6%) 1-2 times monthly. We found that increasing age (aPR=1.02, p-value=0.021), having primary education (aPR=1.51, p-value=0.046), and staying <5km away from the health facility (aPR=1.60, p-value=0.003) were significantly associated with having malnutrition. Conclusion: Majority of the participants were malnourished. Age, education, and distance from healthcare facility were the factors that influenced nutritional status.
Born too soon: every story counts: lessons in ethical, inclusive storytelling from born too soon
(BioMed Central, 2025) Kinney Mary; Reid Amy; Juma Mercy; Gruending Anna
Storytelling is an effective communication strategy for articulating health needs and service demands, enhancing public understanding of complex and stigmatized health issues, and informing policy reform and innovative public health practices. Specific to pregnancy and childbirth, storytelling has influenced perceptions, reduced fear, empowered women, complemented educational interventions, contributed to legal and policy change and has enhanced understanding of complex issues and cultural norms through personal experiences . The issue of preterm birth remains a global challenge, and personal narratives of preterm birth experience are a critical form of advocacy—amplifying families’ literacy and their voices, highlighting systemic gaps, and reinforcing the call to uphold the rights of babies, mothers, families, and health workers.
Born too soon: priorities to improve the prevention and care of preterm birth
(BioMed Central, 2025) Kinney Mary; Langlois Etienne; Reid Amy; Lawn Joy
For over 50 years there has been a commitment to multilateralism and funding for science and health. Recent shifts around the world jeopardise the ability of all countries to address existing and new health crises, and specifically threaten hard-won progress in reproductive, maternal, newborn, and child health, including for preterm babies who are particularly vulnerable. Preterm birth remains a silent emergency of a global scale. Every 2 seconds, a baby is born too soon [1]. Every 40 seconds, one of those babies dies. An estimated 13.4 million babies were born preterm (before 37 weeks of pregnancy) in 2020 - equivalent to nearly one in ten babies being born preterm worldwide [2].

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