Research Articles (School of Public Health)

Permanent URI for this collectionhttps://hdl.handle.net/10566/11

Browse

Now showing 1 - 20 of 1016

Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the global burden of disease study 2023
(Elsevier, 2026) Vongpradith, Avina; Adebiyi, Babatope. Oluwadamitare; Dominguez, Regina-Mae Villanueva
Background Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. Methods We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution.
“It’s not easy, but we need to support them so they don’t get tired on the way”: provider perspectives on delivering HIV services for people returning to HIV care in Cape Town, South Africa
(BioMed Central Ltd, 2026) Phillips, Tamsin Kate; Wolpe, Hannah; Gwiji, Nasiphi; Clouse, Kate; Chi, Benjamin H; Maman, Suzanne; Myer, Landon; Knight, Lucia
Background: People living with HIV who interrupt treatment often face challenges when re-engaging in care and remain at risk for future interruptions. Understanding the provider perspective on the healthcare context in which re-engagement occurs is essential for designing effective and scalable support interventions. We aimed to characterize the implementation context for re-engaging in HIV care in Cape Town, South Africa, with a view to inform the design of future interventions in this setting. Methods: We conducted semi-structured in-depth interviews with nurses (n = 5), counsellors (n = 3) and administrative clerks (n = 3) at two public-sector health facilities. Data collection and thematic analysis were guided by the inner setting of the Consolidated Framework for Implementation Research (CFIR), including structural characteristics, organizational culture, relational dynamics, and communication. Results: We identified compounding and interconnected challenges within the CFIR inner setting. Limited staffing and fragmented clinic organization contributed to delays and frustration for both clients of HIV services and providers, reinforcing negative client-provider interactions. Despite valuing person-centred care, providers struggled to uphold these principles amid high workloads and systemic pressures relating to physical, information system, and human resource infrastructure limitations. Additionally, a cross-cutting theme was the challenge of inter-facility transfers, driven by geographic mobility and stigmatizing clinic interactions. Difficulties in linking client information across clinics intersected with the structural and relational barriers, adding another layer of complexity to providing supportive care for people returning to HIV services. Conclusions: Providers in this context were empathetic but layered inner setting barriers made it challenging to provide person-centred care. Addressing these challenges requires interventions that not only accommodate the changing life circumstances of people living with HIV but crucially facility- and system-level changes to support the providers and their working environments, which together will foster strong reciprocal client-provider relationships.
Global and regional progress towards reduced burden of oral conditions between 2019 and 2023: a systematic analysis for the global burden of disease study 2023
(Elsevier Ltd, 2026) Adebiyi, Babatope Oluwadamilare; Adedokun, Kamoru Ademola; Bernabe, Eduardo
Background WHO's Global Oral Health Action Plan (GOHAP) targets include a 10% relative reduction in the combined prevalence of main oral conditions by 2030. The first GOHAP evaluation was planned for 2023, with subsequent evaluations scheduled for 2026 and 2030. The aim of this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 was to evaluate global and regional progress (2019–23) towards this target and related complementary indicators. Methods Using modelled estimates from epidemiological surveys and registries in 204 countries and territories, we estimated the age-standardised prevalence of untreated caries in deciduous and permanent teeth, severe periodontitis, edentulism, other oral disorders and orofacial clefts, and the age-standardised incidence of lip and oral cavity cancer. Progress towards GOHAP targets was measured by comparing the percentage change from 2019 to 2023 in the above indicators against the stated GOHAP target of a 10% relative reduction. Findings Globally, the age-standardised prevalence of main oral conditions declined (−1·55% [95% uncertainty interval −2·32 to −0·82]) between 2019 and 2023, but global cases increased by 3·07% (2·32 to 3·75), from 3·62 billion (3·35 to 3·95) to 3·73 billion (3·45 to 4·06). Among complementary indicators, reductions in age-standardised prevalence were observed for untreated caries in permanent teeth (−1·99% [−2·49 to −1·40]) whereas the age-standardised incidence of lip and oral cavity cancer increased (8·35% [0·13 to 16·32]), as did the age-standardised prevalence of orofacial clefts (2·25% [0·77 to 3·83]). Progress was heterogeneous across GBD super-regions, with south Asia having the largest reductions in the age-standardised prevalence of main oral conditions (−3·34% [−4·95 to −1·80]) and untreated caries in deciduous teeth (−9·09% [−17·62 to −0·08]). Sub-Saharan Africa showed the largest increase in prevalent cases of main oral conditions (9·51% [8·09–10·94]) and age-standardised incidence of lip and oral cavity cancer (14·86% [1·19–32·45]). The high-income super-region had an increase in the age-standardised prevalence of main oral conditions (1·24% [0·56–1·96]) and untreated caries in deciduous teeth (9·21% [6·60–11·89]).
Reliability and validity of early adolescent mental health scale: an analysis of cross-sectional and longitudinal data of the global early adolescent study
(Elsevier B.V., 2026) Kinoshita, Rinko; Yu, Chunyan; Ahmed, Saifuddin
Objective: Assessment of mental health problems among young adolescents remains challenging because of a scarcity of suitable measurement tools. A 6-item questionnaire, the Early Adolescent Mental Health Scale (EAMHS), was designed to measure the mental health of young adolescents in urban, low-resource settings and was used in the Global Early Adolescent Study (GEAS). This study aims to assess the reliability and validity of the EAMHS. Method: Through a secondary data analysis of cross-sectional and longitudinal datasets from the GEAS, we first refined the underlying constructs of the EAMHS using exploratory factor analysis and assessed its internal reliability. We then took a set of measurement invariance tests to verify the cross-group, cross-cultural, and cross–time-point validity of the refined scale. Subsequently, we conducted a hypothesis test of construct validity and responsiveness using linear regression, incorporating adjustments for the complex sampling design. We carried out calibration between the EAMHS and the Patient Health Questionnaire—4 (PHQ-4) through a single-group design kernel equipercentile equating method, and obtained suggested cut-off scores at each site based on the first follow-up (T2) data. The discriminative ability of the scale with suggested cut-offs was assessed against the adolescents’ PHQ-4 scores of 6 or higher at the second follow-up (T3) using receiver operating characteristic (ROC) curve analyses. Results: The initial 6-item EAMHS was reduced to a 4-item version of a unidimensional structure. Scalar invariance was achieved across genders, age groups, and cultures in longitudinal datasets of 5 study sites. The 4-item EAMHS demonstrated acceptable internal reliability and structural validity, as well as excellent construct validity relative to that of the PHQ-4. Suggested EAMHS cut-off scores showed fair to good discriminative ability in the subsequent follow-up round, with area under the curve (AUC) values ranging from 0.71 (95% CI = 0.64-0.74) in Kinshasa to 0.82 (95% CI = 0.77-0.87) in Shanghai. Conclusion: The findings verified the EAMHS as a consistent and accurate measure, supporting its use for monitoring and evaluating general emotional disturbance within the study context. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way.
Strengthening pediatric oncology pharmacy in Africa: a continental assessment of workforce capacity, training gaps, and network development
(SAGE Publications Ltd, 2026) Wiafe, Ebenezer; Arao, Shauna; Kikonyogo, Steven
Introduction: In Africa, where pediatric cancer survival rates remain low due to interrelated health system challenges, continent-wide data on the availability, training pathways, and distribution of pediatric oncology pharmacists (POPs) are poorly characterized. This study aimed to assess the presence of pharmacists, the availability of formal POP training across pediatric oncology units (POUs) in Africa, and to map existing continent-based training initiatives. Methods: This study profiled POP workforce capacity and training across Africa using data from 109 POUs in 41 countries listed in the SIOP Global Mapping Programme (GMP). POP training programmes were identified through online searches, professional networks, and direct outreach, with data collected on duration, content, accreditation, and trainee capacity. Data collection occurred from February to March 2025, supported by the formation of the African Pediatric Oncology Pharmacy Group (APOP). Results: APOP was established in January 2025, enrolling 97 pharmacists from 28 countries to strengthen networking, mentorship, research collaboration, and standardized training. Among 109 POUs, 83.5% reported a dedicated pharmacist, though coverage varied regionally: Northern Africa (95%), Southern Africa (88%), West Africa (78%), and East/Central Africa (62%). Only three formal POP training programmes were identified, in Egypt, Morocco, and Ghana, varying in duration, certification status, and annual trainee capacity. Collectively, these programmes train approximately 32 pharmacists per year against a backdrop of growing continental need. Conclusion: Although the majority of POUs have a dedicated pharmacist, formal POP training remains scarce. The substantial gap between the availability of training-qualified personnel and access to structured, accredited programmes underscores the need for investment in POP training infrastructure. Enhancing pharmacy training and fostering professional networks are critical to strengthening paediatric oncology care across Africa.
Global, regional, and national burden of road injuries 1990–2023: a systematic analysis for the global burden of disease study 2023
(Elsevier Ltd, 2026) Adebiyi, Babatope Oluwadamilare; van der Lubbe, Stephanie C.C.; Moberg, Madeline E.
Background Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021–30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). Findings In 2023, there were 50·9 million (95% UI 46·1–56·1) road injury incident cases, 1·34 million (1·04–1·58) deaths, and 75·3 million (59·8–89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10–39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9–39·7) and mortality decreased by 32·3% (6·1–49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7–56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1–7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9–947·1] cases per 100 000).
Determinants and strategies for implementation of an adapted data to care vertical HIV prevention intervention in a South African context
(Springer, 2026) Knight, Lucia; Gomba, Yolanda; Myer, Landon
Despite progress in preventing new HIV infections in children, retention in vertical transmission prevention (VTP) remains a challenge in low-resource settings. The REMInD intervention used an adapted Data to Care (D2C) approach with tracing to support mother-infant pairs in completing VTP care. This qualitative study aimed to explore the potential implementation determinants and strategies to enhance the successful implementation of the REMInD intervention in Gugulethu, South Africa. Interviews were conducted with nurses, policy implementers, and mothers who had participated in the REMInD proof-of-concept study. We applied the Consolidated Framework for Implementation Research (CFIR) to identify determinants that could influence future implementation. Data were analysed using inductive thematic analysis. Key potential implementation determinants were identified across multiple CFIR domains. Within the Inner setting domain, limited availability of human resources and infrastructure posed key barriers. Under the Individual domain, the capability to retrieve and use data reports was a central concern. The Innovation domain was reflected in the perceived complexity of data retrieval and tracing procedures, particularly in informal settlements with poor infrastructure. Finally, in the Outer setting domain, HIV-related stigma emerged as a potential barrier. To address these challenges, several strategies were proposed by participants: (i) train and give access to the intervention for all nurses to mitigate staffing shortages, (ii) partnerships with NGOs to enhance patient tracing and support service delivery, (iii) collaboration within the health system to sustain support and resource availability, and (iv) dedicated champions to drive implementation. These findings highlight intersecting systemic, contextual, and individual factors influencing REMInD and similar D2C implementation. Strategies addressing staffing, infrastructure, and tracing gaps could enhance implementation success and HIV retention in low-resource settings.
Evolution of health policy and systems research (HPSR) capacity in West Africa and authorship pattern: a bibliometric analysis from 2015 to 2024
(Elsevier B.V., 2026) Defor, Selina; Gnamon Abe, Juliana F.; Agyepong, Irene A.; Lehmann, Uta
Background The generation of HPSR evidence in West Africa has historically been driven by external institutions, with limited leadership from local researchers. Recent investments, including the establishment of the West African Network of Emerging Leaders in Health Policy and Systems Research (WANEL), aimed to strengthen local research capacity. The objective of this study was to assess how authorship patterns and publication outputs have evolved over the past decade. Methods We conducted a bibliometric analysis using PubMed to identify peer-reviewed publications authored by 103 WANEL members between 2015 and 2024. We analysed the frequency of publication overtime by study type, research domain, authorship order, institutional affiliation, and collaboration patterns. Results Overall, WANEL members produced 1027 publications during the study period, of which 617 (60.1%) were HPSR-related. Of these, 62.9% (388) had West African first authors, mostly from Nigeria (47.0%) and Ghana (17.5%), while contributions from Francophone countries remained limited (6%). First-author institutions were predominantly in West Africa (62.9%), indicating a remarkable shift toward southern-led research. However, intra-network collaboration appeared quite low: only 62 (10%) of HPSR publications were co-authored by multiple WANEL members. Thematic analysis showed service delivery (49.1%) dominated research focus, followed by financing (12.6%) and information systems (11.2%). Conclusion A growing regional research capacity and ownership is observed; this is depicted by the increased West African leadership in HPSR publication. Persistent disparities call for more persistence, increasing targeted investments in underrepresented contexts and stronger cross-country partnerships, for a more equitable and sustainable HPSR ecosystem in West Africa.
Awareness of abortion legality and safe abortion uptake in Ghana: assessing the moderating role of education in a cross‐sectional study
(John Wiley and Sons Inc, 2026) Somefun, Oluwaseyi Dolapo; Banchani, Emmanuel; Gwebu, Hengliwe
Background and Aims: Although awareness of abortion legality has been associated with reproductive health service utilization, little is known about whether legal awareness influences safe abortion uptake in Ghana or whether educational attainment modifies this relationship. This study examined the association between awareness of abortion legality and safe abortion uptake and assessed the moderating role of education among women in Ghana. Methods: Data were drawn from 1282 women aged 15–49 years who reported an induced abortion in the 5 years preceding the 2017 Ghana Maternal Health Survey. Abortions were classified as safe if they involved a recommended abortion method, were performed by a trained provider, and occurred in a recognized health facility. Awareness of abortion legality was assessed by asking respondents whether they knew abortion was legally permitted in Ghana under specific circumstances. Responses were categorized as aware or unaware. Covariates were selected based on existing literature relevant to abortion care-seeking behavior. Multivariable logistic regression models were used to estimate adjusted associations between legal awareness, education, and safe abortion uptake. Results: Overall, 39.39% of abortions were classified as safe, while only 12.09% of women were aware of Ghana's abortion law. Legal awareness was strongly associated with safe abortion uptake (aOR = 2.09; 95% CI: 1.42–3.08; p < 0.001). Educational attainment was also positively associated with safety, with women with secondary (aOR = 1.98; 95% CI: 1.22–3.22; p = 0.006) and higher education (aOR = 3.06; 95% CI: 1.57–5.96; p = 0.001) more likely to obtain safe abortions compared with those with no education. However, education did not significantly moderate the association between legal awareness and abortion safety. Predicted probabilities indicated the highest likelihood of safe abortion among legally aware women with higher education (69%). Conclusion: These findings highlight the importance of improving women's awareness of abortion legality and strengthening women's educational attainment to enhance reproductive health autonomy and reduce unsafe abortion in Ghana.
The applicability of AWaRe-based antibiotic quality indicators to assess the appropriateness of antibiotic prescribing in primary healthcare in South Africa: A multicentre point prevalence study and implications for the future
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Johnson, Yasmina; Chigome, Audrey; Cook, Aislinn
Background/Objectives: Inappropriate antibiotic prescribing in primary healthcare (PHC) contributes to bacterial antimicrobial resistance (AMR). Antibiotic stewardship, including measuring the appropriateness of antibiotic prescribing using quality indicators, is a priority in PHC where most antibiotics are used. Using previously developed WHO AWaRe classification-based quality indicators, we aim to test the clinimetric properties of 13 acute respiratory tract infection (RTI) quality indicators and qualitatively explore factors influencing PHC antibiotic prescribing in South Africa. Methods: We conducted a mixed-methods exploratory feasibility study using point prevalence surveys (PPSs) with clinimetric assessment and prescriber interviews. PPSs were conducted at four PHC facilities in Gauteng province that had taken part in previous PPS studies, alongside face-to-face interviews with PHC personnel. Results: In total, 52/52 (100%) RTI patients received antibiotics. Four (30.8%) indicators achieved scores above 85%, while six (46.2%) scored below 50%. All indicators had applicability scores ≥10%. Twelve (92.3%) indicators had a measurability score of 100%, while one (7.7%) had a measurability score <75%. Twelve (92.3%) indicators met all predefined acceptable scores for applicability and measurability. No participant knew of the WHO’s AWaRe classification and none had specific training on antibiotic prescribing and AMR. They also had no antibiotic stewardship programmes (ASPs) or specific antibiotic-prescribing guidelines at their facilities.
Strengthening pharmacovigilance and regulatory capacity in Southern Africa (SPaRCS): achievements, experiences and lessons learned from a participatory action learning project
(Frontiers Media SA, 2026) Bradley, Hazel; Viljoen, Michelle; Khoza, Star
Effective regulatory systems play a critical role in improving access to safe, efficacious and quality medicines and vaccines. However, most regulatory and pharmacovigilance (PV) systems in sub-Saharan Africa (SSA) are still underresourced and lack recognition of their public health service role, despite encouraging developments in several countries, and positive experiences of harmonization across the continent. The aim of Strengthening pharmacovigilance and regulatory capacities in four Southern African countries (SPaRCS), was to improve pharmacovigilance and clinical trials oversight in Namibia, Eswatini, Zimbabwe and South Africa. The project used a participatory action learning and co-creation approach and built on existing relationships with national regulatory authorities and PV centres in the four countries. Key activities included a mapping of PV and clinical trials oversight in the four partner countries; participatory workshops and learning exchanges in two thematic areas; Strengthening PV systems and Clinical trials oversight, and collaborative development of a training package for community health workers on adverse drug reaction reporting. Intentionally SPaRCS provided opportunities for partners in the four countries to develop relationships amongst those involved in PV and clinical trials oversight in the region. This included sharing of challenges, field experiences and best practices in a sub-national, national and regional setting. Strong commitment of country partners and the flexible learning and co-creation approach facilitated positive achievements. Strengthening PV and clinical trial oversight requires a multi-faceted approach involving the establishment of robust systems, addressing infrastructure and training gaps, integrating PV into public health programs and building formal collaborative platforms at regional level. The regional platform created by SPaRCS provided a starting point, for the establishment of the Centre of Excellence for Pharmacovigilance in Southern Africa (CEPSA) launched at the end of 2024.
Barriers and determinants of low lifestyle and dietary adherence among adults with hypertension in resource-limited settings: A cross-sectional survey from Mokhotlong and Butha-Buthe districts, Lesotho
(SAGE Publications Ltd, 2026) Sello, Mamakase G.; Hlephole, Lieketseng V.; Monyane, Boitumelo
Background: Adherence to lifestyle and dietary modifications is crucial for effective hypertension management, yet non-adherence remains a significant challenge. Aim: This study aimed to identify determinants and perceived barriers of low lifestyle and dietary adherence among adults with hypertension attending chronic care units in Butha-Buthe and Mokhotlong districts, Lesotho. Methods: A quantitative cross-sectional survey of 200 adults with hypertension attending chronic care units in the Butha-Buthe and Mokhotlong districts of Lesotho was conducted. Logistic and linear regression were used to identify determinants of dietary and lifestyle adherence, respectively, with statistical significance set at p < 0.05. Summary: The mean age of participants was (48 ± 11.87 years). Only 8.0% of participants adhered to WHO dietary recommendations, while 36.5% adhered to lifestyle recommendations. Patients with low education were substantially less likely to adhere to dietary guidelines (OR = 0.18, 95% CI: 0.03–0.82, p < 0.05), and those reporting specific food preferences were likewise less likely to adhere (OR = 0.18, 95% CI: 0.03–0.88, p < 0.05). Low educational level was also a significant predictor of lifestyle adherence (β = −0.275, p < 0.05), as were food preferences (β = −0.205, p < 0.05). These findings highlight the need for patient education, nutritionist support, and context-appropriate dietary counseling to improve hypertension management in resource-limited settings.
Mental wellness and adherence self-efficacy among adolescents living with HIV in the Cape Town metropole: a cross-sectional survey
(Multidisciplinary Digital Publishing Institute (MDPI), 2026) Mayman, Yolanda; Petinger, Charné; van Wyk, Brian
Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. Methods: A cross-sectional survey was conducted among ALHIV (N = 251) aged 10–19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. Results: Most participants were aged 15–19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14–3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. Conclusions: Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents’ confidence in managing treatment
The impact of a household intervention on art adherence and household HIV competency for people living with HIV: results from a cluster-randomised controlled trial in cape town, South Africa
(Springer, 2026) Knight, Lucia; de Man, Jeroen; Sematlane, Neo; Dube, Lorraine Tanyaradzwa; Delport, Anton
Abstract: In 2023, an estimated 39.9 million people globally were living with HIV, including 7.7 million in South Africa. Adherence to antiretroviral therapy (ART) is crucial for health outcomes, yet remains challenging. Households may shape health behaviours, including ART adherence. This study evaluated a household-level intervention to improve ART adherence in Cape Town, South Africa, which aimed to promote HIV competency for participants and their households. Baseline data were collected from 316 participants in 12 clinics (May 2021 - May 2022), with endline data from 198 participants (December 2021 - July 2022). Cluster-level analysis and mixed-effects models, with multiple imputation and complete case approaches, were utilised. At endline, there was evidence of a difference between control and intervention arms for following the ART schedule (aOR: 3.88, t = 2.62, p = 0.009), and taking ART on time (aOR: 2.28, t = 2.54, p = 0.01). Household-based interventions may have an impact on ART adherence, and should be considered in future adherence research, programming, and interventions.
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.

Browse

Recent Submissions